Presentation on transparency of doctor performance at Health Datapalooza 2015 by Josh Rosenthal, PhD Applications of Transparency: From Visibility to Action As transparency in health care has emerged as a crucial enabler towards achieving the Triple Aim, myriad sources and types of information have become available in the last few years. Join this session to learn new ways of understanding the behaviors of patients and providers, and novel approaches to payment and delivery already underway. Moderator: Ben Harder, U.S. News & World Report Panelists: Elizabeth Mitchell, NRHI; Jeanne Pinder, ClearHealthCosts; Josh Rosenthal, PhD, RowdMap, Inc.

2. Applications of Transparency:
From Visibility to Action
As transparency in health care has emerged as a crucial enabler towards
achieving the Triple Aim, myriad sources and types of information have
become available in the last few years. Join this session to learn new ways of
understanding the behaviors of patients and providers, and novel approaches
to payment and delivery already underway.
Moderator: Ben Harder, U.S. News & World Report
Panelists: Elizabeth Mitchell, NRHI;
Jeanne Pinder, ClearHealthCosts;
Josh Rosenthal, PhD, RowdMap, Inc.

3. Unexpected
Transparency:
Underserved Populations,
Unwarranted Variation and
Unnecessary Spend
How valuable is a doctor to
a population?
Which doctors start with
higher intensity options?
Which will succeed in Pay
for Value?
Which doctors create the
most no-value care and
unnecessary spend?
This is different than ranking
docs by cost of drugs or
treatment, or the basics of
care and operations.

4. Another way to
think about it
What do my rankings measure?
How much an antibiotic costs?
How nice the doctor’s office is while waiting for
the antibiotic?
Or…
Whether the doctor should have started with
the antibiotic out of the gate in the first place?

5. David Wennberg,
RowdMap Advisory Board
Open Data Is Powerful, Disruptive
Outperforms claims-based models for risk adjustment

6. New Government
Released Referral Data
(Patient flows between
PCPS, specialists, hospitals
and post acute centers)
Dartmouth Atlas for
Unwarranted Variation
(Decades of research and data on
unwarranted variation by condition
and geography to keep things
apples-to-apples for comparisons,
hence “Unwarranted” in the name)
New Government
Released Performance Data
(Individual providers, groups,
hospitals and post acute centers
including the new part B&D)
Provider Pattern Intensity Profiles and
Risk Readiness for every provider,
hospital, post acute center in the US.
All preloaded with no IT.
Incredibly Meaningful Rankings
Particularly powerful when pulled together
Affordable Care Act data to determine
Risk-Readiness of Providers / Networks

7. The business context has changed- health plans,
government payers, providers, and hospital systems need
to develop Risk-Readiness SM strategies to excel as they
transition from fee-for-service to pay-for value.
CMS: 50% of FFS will
be gone by 2018

8. Featured Nationally
US CTO on
RowdMap:
“Visionary
Genius”

9. Chronic prevalence & physician supply
Population Health Report
Population Report Card
Match practice patterns to the right
risk arrangements – Pay for Value Readiness
Group Risk-Readiness SM Report
Physician Risk-Readiness SM Report
Hospital Risk-Readiness SM Report
Post Acute Center Risk-Readiness SM Report
Risk-Readiness SM Arrangement Match-Maker
Manage clinical care and costs –
Remove No Value Care
Group Unnecessary Cost Report
Physician Unnecessary Cost Report
Hospital Unnecessary Cost Report
Post Acute Center Unnecessary Cost Report
Unnecessary Cost Referral and Value Chain Report
Unexpected Transparency:
Underserved Populations, Unwarranted Variation and Unnecessary Spend

10. Chronic Prevalence &
Physician Supply
Match Practice Patterns to the right
Risk Arrangements – Pay for Value Readiness
Manage Clinical Care and Costs –
Remove No Value Care
Unexpected Transparency:
Underserved Populations, Unwarranted Variation and Unnecessary Spend

11. Diabetes Prevalence -
Westchester
Use this data to allocate providers and care management
resources around condition-specific population needs by zip.
Locate clinics, health fairs, etc. based on chronic needs.
Income
Obesity
Depression
Health Opportunity Index
Lots of diabetics
but few PCPs
Lots of diabetics
and lots of PCPs
What type of populations?
Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE
CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT
Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk
PCP Density –
Westchester
Demand and Supply

12. 12
County Profiles
Largest Counties In Ohio
People use this data to calibrate expectations for profitability by
incorporating population health and provider performance into
product strategy. Use excess to subsidize operations in counties with
fewer high-performing resources
Risk Scores
Total
Cost
PMPM
Reimbursement Overall Star
Chronic
Star
Health
Rank
MA Profit
Opportunity -
MA
Profit
Opportunity -
Exchange
MA
Eligibles
MA
Enrolled
Exchange
Subsidized
Exchange
Enrolled
Compare to National
and Regional
Benchmarks
Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE
CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT
Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk
Demand and Supply

13. Chronic Prevalence &
Physician Supply
Match Practice Patterns to the right
Risk Arrangements – Pay for Value Readiness
Manage Clinical Care and Costs –
Remove No Value Care
Unexpected Transparency:
Underserved Populations, Unwarranted Variation and Unnecessary Spend

14. At the core of Risk-Readiness SM is
Unwarranted Variation:
RowdMap applies the Dartmouth Atlas for Unwarranted Variation
methodologies to data on Medicare Parts B & D. This research has
been repeatedly validated over the last 30 years and we now have
a national data set to apply the methodologies at a large scale.
The estimated 30% of medical expense that
goes to unnecessary care. This unnecessary
spend drives billing in a fee-for-serve economic
model, but success in pay-for-value comes
from managing and mitigating these pockets
of variation.
Every provider has a unique practice
pattern that informs Risk-Readiness SM
Pay for Value Readiness

15. Los Angeles, CA
Compare to National or
Regional Benchmarks
Pay for Value Readiness
Provider Profiles
Identify highly efficient, Risk-Ready practices and physicians to
profitably grow into. Improve profitability of lower performing
practices with large panel sizes through modified arrangements
or performance improvement plans.
Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk
Referrals: http://1.usa.gov/1FzoEOV

16. Identify high and low performing hospitals and
post-acute facilities— are there post acute
facilities that hospitals with poor chronic
readmits are routing members to?
Pay for Value Readiness
EOL Hosp Days: Which hospitals fewer end-of-life days
than their peers?
Chronic Admits: Which hospitals see their most chronic
population repeatedly/ with the most frequency?
Cardiac Imaging: Which hospitals are more likely to over-
utilize cardiac imaging compared to their peers?
Dartmouth Atlas: http://bit.ly/1GXvlJp
CMS Hospital Compare: https://goo.gl/p8MtoI
CMS Hospital Readmissions: http://goo.gl/02KnQd
CMS Nursing Home Compare: https://goo.gl/3DpT8m

17. Pay for Value Readiness
Great profile for
aggressive risk
Tread carefully for
some risk
Match appropriate risk arrangements based on
provider practice patterns and
Population characteristics within a geography.

18. Chronic Prevalence &
Physician Supply
Match Practice Patterns to the right
Risk Arrangements – Pay for Value Readiness
Manage Clinical Care and Costs –
Remove No Value Care
Unexpected Transparency:
Underserved Populations, Unwarranted Variation and Unnecessary Spend

19. Remove no-value Care
Manage Unnecessary Spend
Risk-Readiness℠ looks at a different
category of spending
Shift focus from clinical edits, audits, and recovery efforts to
identifying care that is clinically appropriate, but unnecessary.
Historical efforts have shown returns, but they only look at a
fraction of total spending. Unnecessary care can account for up
to 30% of total spending and provides significantly larger
opportunities for cost containment and quality improvement.
Clinically Appropriate,
but Unnecessary Care
(30% of spend)
Claims Spend for a Health Plan
Necessary Utilization
(70%)
“It’s generally agreed that about
30 percent of what we spend on
health care is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”
-Dr. Elliott Fisher,
Dartmouth Institute for Health Policy

20. Remove no-value Care
Manage Unnecessary Spend
RowdMap tackles the 30% of the U.S. health care spend
that goes to clinically appropriate, but unnecessary care
Over $9B in
Orange County, CA
How much unnecessary spend is in your market?
Over $66B in Florida
$850 Billion Unnecessary Spend* in 2014
Least Unnecessary
Spend
Most
Unnecessary Spend
RowdMap tackles the 30% of U.S. health care
spend that goes to clinically appropriate, but
unnecessary care. RowdMap’s models
identify the cost-savings opportunities in a
geography based on the collective intensity
of care delivered by doctors in that area.
* Unnecessary Spend =
(Dartmouth Avg cost) * (Population) *
(RowdMap Network Opportunity Index)

21. Remove no-value Care
Manage Unnecessary Spend
Unnecessary Spend in Florida
In Broward Co. alone,
there is over $7.6B in
unnecessary spend.
Let’s look at which hospitals, groups and physicians
account for this and for what conditions

22. Physician Marketshare
by Major Clinical Categories
Remove no-value Care
Manage Unnecessary Spend
Match appropriate risk arrangements based on provider practice
patterns and Population characteristics within a geography.
Hospital Marketshare
by Major Clinical Categories
Provider Group Marketshare
by Major Clinical Categories
Unnecessary Spend in Broward
By condition across hospitals,
groups and physicians
This Physician.
Let’s start here
This GroupThis Hospital
Circulatory
Muscular-
skeletal
Respiratory

23. Remove no-value Care
Manage Unnecessary Spend
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
Physicians Driving Unnecessary Care in Broward
Musculoskeletal care is major contributor to unnecessary spend in Broward. Let’s take a
physician who is not an outlier but in the middle of the pack such as Dr. Spend*. Let’s walk
through what his clinically acceptable, but medically unnecessary, practice pattern creates
in unnecessary spend.

24. Remove no-value Care
Manage Unnecessary Spend
Least Unnecessary
Spend
Most
Unnecessary Spend
Option 2: Reinforce
highest-performing referral
and care pathways.
Increase the number of patient interactions
with green dot doctors.
Option 1: Change provider behavior.
Requires lots of provider education. Requires
payer to make up a significant portion of a
provider’s revenue. Increase the number of
green dot doctors.
Zoom to zip

25. Remove no-value Care
Manage Unnecessary Spend
Referral Patterns and Physician Value Chains
Identify high performing providers and downstream
referral patterns. Encourage referrals to
high-performing specialists.

26. Remove no-value Care
Manage Unnecessary Spend
If had same ratio as :
• His decompression rate would drop from
6.01 to 0.436 per patient.
• Which translates to 2,608 fewer
decompressions per year.
• At an average cost of $332 per
decompression, this represents potential
savings of over $850K
If decompression to fusion rate were
average for orthopedic surgeons:
• He would have 1629 fewer decompressions
for a potential savings of $540K.
*Actual physician names have been changed.
For every 10 back fusions, does
103 decompressions
For every 10 back fusions,
does 2 decompressions.
Dr. Save*
Dr. Spend’s
Dr. Spend*
Dr. Save*
That’s one physician, with one procedure, in one clinical condition.
This savings would not be picked up in unit cost or utilization analysis,
but cumulatively dwarfs fraud, waste and abuse outliers.
Intense practice patterns like this power FFS arrangements
but success in Pay for Value comes from identifying Risk-Ready providers.
Dr. Spend*

27. Benchmark cost structures, benefit designs, value of providers and networks, even
over/under coding and which types of risk arrangements will succeed
+ + =
Profit Opportunity Network Opportunity Price Sensitivity
Surprise:
Report Cards for Health Plans

28. Start with Data for Business Context then add Tech.
The ACA at your finger tips
For Payers & Providers