CISummit: Zach Henderson, Data-tastick: A Deep Dive on Data Driving Networks

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CISummit: Zach Henderson, Data-tastick: A Deep Dive on Data Driving Networks

  1. 1. DATA-TASTICK A Deep Dive on Data Driving Networks Zach Henderson SVP, Healthcare Markets Connected Insight Summit © Health Market Science 2013, All Rights Reserved
  2. 2. It’s time to get excited about data… We all think of Data in different ways © Health Market Science 2013, All Rights Reserved
  3. 3. If you’re like me, as a bunch of 1s and 0s flowing through the pipes of healthcare processing streams… 3 © Health Market Science 2013, All Rights Reserved
  4. 4. To many, it’s simply the content in spreadsheets… 4 © Health Market Science 2013, All Rights Reserved
  5. 5. For some, data is a little more simple than that… 5 © Health Market Science 2013, All Rights Reserved
  6. 6. Data often gets front page billing… 6 © Health Market Science 2013, All Rights Reserved
  7. 7. And some think of “Data” quite differently… 7 © Health Market Science 2013, All Rights Reserved
  8. 8. Data is sometimes frustrating… 8 © Health Market Science 2013, All Rights Reserved
  9. 9. And data became worse when it got “Big” 9 © Health Market Science 2013, All Rights Reserved
  10. 10. But when we finally understand Data, it is great! 10 © Health Market Science 2013, All Rights Reserved
  11. 11. BUT LET’S GET MORE SPECIFIC We are in the Healthcare track at this conference after all
  12. 12. What types of data are available? Type of Data Prescription/Rx Claims Medical Claims 12 Benefits Caveats • Concentrated sources… easier to collect • Excellent for tracking retail pharma products • High coverage with weekly updates available • Known denominator • Only usable for retail tracking • Variable correlation between Rx activity and medical activity • Tailored to diagnosis and procedure codes of interest • Covers both retail and nonretail settings • Best for identifying “splitting” behavior of procedures • Closest correlation to actual referral networks • Severely fragmented • Difficult to source • No standard denominator/total • Latency © Health Market Science 2013, All Rights Reserved
  13. 13. Where do medical claims come from? +50 State Databases & Collaboratives Claims Switches/ Clearinghouses +4,000 +500 837 835 Office Practice Management Software © Health Market Science 2013, All Rights Reserved Payers
  14. 14. Types of Claims Forms (UB-04) • UB-04 • Institutional claims for services provided by hospitals, hospices, and long-term care facilities (e.g. SNFs) are billed on Uniform Bills (UB-04 or CMS-1450, formerly UB-92) • All services are summarized by revenue codes • For inpatient claims, UB-04 describes procedures primarily by ICD-9 procedure codes • For outpatient claims, UB-04 describes the services and supplies provided by using CPT and HCPCS codes • 1500 • Professional claims for services provided by physicians, labs, ambulances, and DME vendors are billed on CMS 1500 forms (HCFA 1500 or 1500 forms) • CMS 1500 always describes the services and supplies provided by using CPT and HCPCS codes 14 © Health Market Science 2013, All Rights Reserved
  15. 15. Medical Claim Form Diagnosis Code: • Glean useful information: ICD-9-CM code for appropriate diagnosis or nature of illness Drug Name & Strength, NDC: 12345-6789-01 › Physician ID, diagnoses and procedure codes, facility ID, etc Office Visit Code: 174 9 CPT code for services provided to an established patient 197 7 Drug Name & Strength, NDC: 12345-6789-01 174 9 197 7 01 06 03 01 06 03 11 1 99211 01 06 03 01 06 03 11 01 06 03 01 06 03 11 06 1 0190782 01 03 06 03 11 01 03 06 03 11 01 06 03 01 06 03 11 06 1 01J9010 123-45-6789 1 1 99211 1 $$ $$ 1 $$ $$ Procedure Code: 90782 1 1 $$ $$ 1 $$ $$ CPT code for an injection J9010 1 $$ $$ 1 $$ $$ 123-45-6789 xxx xx xxx xx John Brown, M.D. 111 Hospital Drive Anytown, USA 12345 Required: Drug Code 123-45-6789 Appropriate HCPCS Drug Code 123-45-6789 for medication administered xxx xx xxx xx John Brown, M.D. 111 Hospital Drive Anytown, USA 12345 15 © Health Market Science 2013, All Rights Reserved
  16. 16. We almost forgot the most important part… Patient Information: The details on the unique patient Drug Name & Strength, NDC: 12345-6789-01 174 9 197 7 01 06 03 01 06 03 11 1 99211 1 01 06 03 01 06 03 11 1 90782 1 $$ $$ $$ $$ 01 06 03 01 06 03 11 1 J9010 1 $$ $$ Drug Name & Strength, NDC: 12345-6789-01 174 9 197 7 123-45-6789 123-45-6789 xxx xx xxx xx 01 06 03 01 06 03 11 99211 1 90782 1 01 06 03 01 06 03 11 16 1 01 06 03 01 06 03 11 John Brown, M.D. $$ $$ 111 Hospital Drive Anytown, USA 12345 $$ $$ 1 J9010 1 $$ $$ 1 © Health Market Science 2013, All Rights Reserved
  17. 17. But that is HIPAA data!!! First Name Last Name Date of Birth Magical Encryption/De-identification Patient 123456 17 © Health Market Science 2013, All Rights Reserved
  18. 18. So what? PCP Patient 123456 Specialist Patient 123456 Cardiac Surgeon Patient 123456 © Health Market Science 2013, All Rights Reserved
  19. 19. 19 WHY DO YOU CARE?
  20. 20. First off, healthcare companies can do a lot with data 10% 20% 30% Understand where there is opportunity to grow referrals Identify areas of patient leakage 70% 20% 10% Know where splitters are “splitting” Grow system/ACO through acquisitions, partnerships and recruitment © Health Market Science 2013, All Rights Reserved
  21. 21. Physician to Physician relationships are important  Medical claims data can be used to derive physician-physician relationships based on shared patients for a disease state of interest.  Analytic methodologies can leverage longitudinal tracking of patients across physician visits by leveraging an anonymized patient ID.  A pair of physicians that share a statistically significant number of patients within a specified time window are assumed to have a professional relationship. Is it a leap? © Health Market Science 2013, All Rights Reserved
  22. 22. Example Network for a Service Line Dr. Ashesh Jani Dr. Monica Rizzo Dr. Ruth O’Regan Georgia network Atlanta network Zoom in to portion of Atlanta network 22 Relationships for Dr. O’Regan © Health Market Science 2013, All Rights Reserved
  23. 23. A Provider Centric View of Competition in Cleveland Dr. Michael Walker Surgery, Orthopedic 9500 Euclid Ave Cleveland, OH Ortho National Rank - 9 Xian Jin Internal Medicine 9500 Euclid Ave Cleveland, OH Strength of Relationship Jin 10 10 Ranjit Tamaskar Internal Medicine 20000 Harvard Ave Beachwood, OH 10 Tamaskar 10 Andrew Brobbey Internal Medicine 25701 N Lakeland Blvd Euclid, OH 8 Barbara Vizy Family Practice 3690 Orange Pl Beachwood, OH Walker 7 8 Brobbey © Health Market Science 2013, All Rights Reserved 7 Vizy
  24. 24. Shows a Referral Source that has relationship with 2 different systems Dr. Ranjit Tamaskar Internal Medicine 2000 Harvard Ave Beachwood, OH Michael Walker Surgery, Orthopedic 9500 Euclid Ave Cleveland, OH Strength of Relationship Walker 10 10 Tamaskar William Petersilge Internal Medicine 20000 Harvard Ave Beachwood, OH 6 6 Petersilge © Health Market Science 2013, All Rights Reserved
  25. 25. Now that you can “see” how the data relates, it’s time to put data into action 25 © Health Market Science 2013, All Rights Reserved
  26. 26. 26 QUESTIONS Zach Henderson SVP, Healthcare Markets

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