A Health Catalyst Overview: Learn How A Data First Strategy Can Drive Increased Outcomes Improvements

1. A Health Catalyst Overview: Learn How A Data First Strategy Can Drive Increased Outcomes Improvements Greg Sill - Director of Solutions Consulting, Health Catalyst Jared Crapo - SVP of Corporate Integration, Health Catalyst

2. © 2018 Health Catalyst A Population Health Story…. “Our health system has seen an increase in the number of cancer related surgeries and inpatient admissions over the last year. Traditionally, we have used our EMR and claim data to analyze the care for the patient, however, it is often incomplete and not timely. How can we collaborate and share information to identify the at-risk patients and increase the number and types of pre-cancer screenings?” 2

5. © 2018 Health Catalyst Poll Question 5 What is the biggest barrier for your organization to provide more data driven insights to clinicians? 1. Data sharing agreements — 25% 2. Technical hurdles — 32% 3. Too many competing priorities — 34% 4. We do this well — 9%

6. © 2018 Health Catalyst We believe when you elevate data as a strategic asset it enables significantly better decision-making and promotes massive improvement in health, cost, and experience outcomes. 6

7. © 2018 Health Catalyst Definition of Data Governance 7 Data governance refers to the plans, processes, and principles that are proactively applied to ensure that a community’s data is managed in such a way to maximize the value of that data to that community.

9. © 2018 Health Catalyst Act Capture Integrate Grant Access Deliver Insight Data Utilization Data Utilization • Lack of contextual training causes incorrect interpretation / conclusions • Fear of loss of privacy prevents appropriate utilization for improvement • Culture of data fiefdoms – that’s “our” data Data Quality • Data capture is incomplete, delayed or inaccurate • Consolidating to a single EMR is slow, expensive, and may not be feasible • Integrating data into fixed models from different sources is error prone Data Quality Data Literacy Data Literacy • Lack of data skills, knowledge and attitudes • Wrong mix of resources (e.g. too many report writers not enough analytic engineers) • Lack of interoperability Challenges 9

11. © 2018 Health Catalyst Data Governance Framework: The Four E’s 11 Act Capture Integrate Grant Access Deliver Insight 1. Elevate Elevate the status of data as a strategic asset of your organization What would make your data a distinguishing asset of your clinical and business objectives? 2. Establish Build your data governance org structure Who are the best individuals and how should you organize to realize the vision? 3. Execute Identify, prioritize and execute on data governance improvements in the data lifecycle How do you ensure all are equipped with data for better decision-making – from the bedside to the boardroom? 4. Extend How do you ensure your data investments are built to last? Expand and extend to create a data centric culture

13. © 2018 Health Catalyst • Pick a “pool table” that is already a “trouble” for the organization – Significant financial pressure or budget cuts – Desire to increase standing in national rankings – Poor Benchmark Score • Show how more effectively managing the data lifecycle through better data governance can benefit that “pool table” trouble • Eventually show a better way to achieve the strategic mission of the organization through data AND improvement governance Elevate: Engagement 13

14. © 2018 Health Catalyst • After your people, your data is your organization’s most strategic asset • How can you help your organization realize this truth? 1. Up to 1/3 of all costs in your organization are wasteful 2. Key Process Analysis – identify opportunities hidden within your data 3. Pilot projects in key areas can help support adoption of a more data driven strategy Elevate Data as a Strategic Asset 14

15. © 2018 Health Catalyst Establish • Data stewards are the owners of clinical and operational processes which produce data (or lack thereof, or bad data) as a result of the current process. • Have you identified your key processes? • Which cost the most? How much less could they cost? • Which processes currently produce the right data at the right time to effectively manage them? • How well is the clinical, financial, and experience data integrated about a process? “Organize everything around front-line value-added work processes.” W. Edwards Deming 15

16. © 2018 Health Catalyst Value Producing Healthcare Delivery Processes 16 Comm Care Care Process Families e.g., Endo- crine Disorders CV Care Process Families e.g., Heart Failure W&C Care Process Families e.g., Pregnancy GI Care Process Families e.g., Liver Diseases Resp- iratory Care Process Families e.g., Chronic Lwr Resp Disorders Neuro Sciences Care Process Families e.g., Dorsop- athies Musculo- skeletal Care Process Families e.g., Arthrop- athies Surgery Care Process Families e.g., Trauma General Med Care Process Families e.g., Infectious Disease Oncology Care Process Families e.g., Neo- plasms Mental Health Care Process Families e.g., Mood Disorders Care Unit Support Services Laboratory Services (anatomic path, clinical path, blood bank) Clinic Services (primary care, med sub-specialty, chronic disease care mgmt, practice mgmt) Acute Medical Services (ECU, ICU, CCU, NICU, PICU, med-surg) Invasive Services (IP/OP surg, cath lab, IR, GI, L&D, rad onc, cysto, ECMO, CS) Pharmacy Services (Rx pharmaceuticals, TPN, infusion therapy, drugs sold to patients) Imaging Services (Dx radiology, US, nuclear, CT, MRI, Dx mammo, waveform imaging) Financial Services (capital/leasing, rev cycle, med records, general accounting) Rehabilitation Services (PT, occupational Tx, Speech Tx, cardiac rehab) Clinical Supply Chain Services (equipment, supplies sold to pts, DME) Hotel Services (plant, scheduling, registration, security, laundry, non-pt food, parking, grounds) Overhead Services (hosp admin, clinical admin, IT/phones, HR, edu, risk mgmt, PR, research) Ancillary Support Services Non- Clinical Support Services Respiratory Services (vent mgmt, O2 Tx, chest PT, inhaled meds, inc spiro, hyperbaric O2 ) Patient Experience Services (nurses, doctors, environment, experiences, discharge) Sub-acute/Post-acute Services (sub-acute, ∂ hosp, SNF, IRF, home health, hospice, LTC) Research Services (design, cohort, IRB, grant app, grant mgmt, analysis, publication )

20. © 2018 Health Catalyst Execute: Capture 20 8% Only 8% of data required for the population health and precision medicine strategy resides in today’s EMR/EHR. Source: Alberta Innovates Health Solutions, Secondary Data Use Project, March 2016 http://www.aihealthsolutions.ca/initiatives-partnerships/secondary- use-data-project/presentations/ A C IG D

21. © 2018 Health Catalyst Just Beginning: Digitization of Health 21 The Growing Ecosystem of Human Health Data Healthcare Encounter Data 7x24 Biometric Data Consumer Data Genomic & Familial Data Social Data Outcomes Data A C IG D

22. © 2018 Health Catalyst Imagine the Richness of the Picture 22 22 Healthcare Encounter Data 7x24 Biometric Data Consumer Data Genomic & Familial Data Social Data Outcomes Data What is your 1, 3, and 5 year strategic data acquisition plan? The Growing Ecosystem of Human Health Data A C IG D

23. © 2018 Health Catalyst Execute: Integrate “Definition: The health data convergence hub is the orchestration platform that brings together data from across the consumer/citizen/patient health and wellness continuum and prepares the data for delivery to downstream consumption platforms, applications, analytics and "things." It automates the ingestion of data — both structured and unstructured — from all identified and permissioned sources; provides tracking and traceability; and manages identity, compliance and security. It may process algorithms and deliver the output to the correct modality.” Laura Craft, Vi Shaffer, “Gartner: Hype Cycle for Healthcare Providers, 2017” Gartner: Health Data Convergence Hub 23 A C IG D

24. © 2018 Health Catalyst Expanding the Patient View 24 Historical and Analytical Insights Data in the Moment • Chief Complaint • Observations • Labs • Diagnosis • Procedures • Medications • Clinical History • “Patients like me” • Risk Prediction Models • Cost Estimates • Gaps in Care • Patient Registries A C IG D

25. © 2018 Health Catalyst Data Operating System (DOS™) 25 Right Time From event to insight quickly Operational analytics Real-time data pipeline, FHIR Right Insights Predictive Prescriptive Quality & performance metrics SQL Algorithms, machine learning models Right Place At point of care In the workflow Unsupervised outcomes EMR closed loop, Excel, Analytics portal Right Delivery Analytic accelerators Software modules Mobile Create-your-own apps Open APIs, app platform, fabric services Right Data Multiple integrated data sources External data sources Socioeconomic, personal device data, Big Data A C IG D

26. © 2018 Health Catalyst Data Access Polarity Data Protection Data Sharing 26 Symptoms of Extreme • Legitimate data request denied • IT approves data access requests • 2 month process to get access Symptoms of Extreme • Data breach • Inappropriate data useEvidence of Balance Streamlined approvals Consistent auditing Appropriate use of data A C IG D

27. © 2018 Health Catalyst Execute: Deliver Insight and Act We believe if you get the Right Information, to the Right Audience, at the Right Granularity, at the Right Time, in the Right Visualization/Modality you produce the Right Action, to improve outcomes. 27 A C IG D

30. © 2018 Health Catalyst Poll Question 30 How would you rate the maturity of your organization’s data centric culture? 1. Limited – Data is a luxury and only the biggest decisions are data driven. — 26% 2. Developing – We have a strategy in place and early adopters have demonstrated success. — 44% 3. Established – Broad, but uneven, adoption. Some pockets of excellence, some areas of concern. — 28% 4. Pervasive – Almost everyone has timely access to the data related to their work, and the skills to apply that data to improve the work they do. — 2%

31. © 2018 Health Catalyst Evaluate data skills, knowledge and attitudes Evaluate mix of resources • Data Scientist • Outcomes Analysts • Analytics Engineers • Data Stewards • Report Writers • Super Users / Data Evangelists Leadership Literacy Evaluation • Understand Signal vs Noise • Control Charts, Variation Data Literacy Assessment 31

32. © 2018 Health Catalyst Analytic Literacy Progression 32 Answering anticipated questions. Single vended system. Tells what happened. Measures outcomes through custom data models populated from multiple sources. Highlights gaps between current state and best practices. Coupling of technical expertise and domain knowledge. Illuminates the ‘why’ behind results. Discovers new paths for future improvements. Reactive Descriptive PrescriptiveAnalyticComplexity Technical Skill + Contextual Understanding

33. © 2018 Health Catalyst Don’t try to fix it all at once • Focus data quality efforts on the areas you have improvement initiatives • Ignore the rest Don’t wait to start improvement until the data is perfect • Fix operational/clinical process variation AND data system variation at the same time Don’t be afraid to stop before you are done • Directionally correct vs perfect • Aim defines the system Data Centric Culture: Quality 33

34. © 2018 Health Catalyst Data Centric Culture: Utilization Recruit Change Agents 34 "In times of change, learners inherit the future, while the learned find themselves beautifully equipped to deal with a world that no longer exists." Eric Hoffer

35. © 2018 Health Catalyst Data Centric Culture: Utilization Change Agents are usually early adopters 35 Innovators Early adopters Early majority Laggards (never adopters) * Adapted from Rogers, E. Diffusion of Innovations. New York, NY: 1995. Late majority Innovators - Recruit innovators to re-design care delivery processes TheChasm Early adopters - Recruit early adopters to chair improvement and to lead implementation at each site (key individuals who can rally support)

36. © 2018 Health Catalyst Data Centric Culture: Utilization • You need both willing and able leaders • Identify those wanting to lead permanent improvement efforts • Allow those not wishing to lead to participate in the selection process • Executive leadership can select from top recommendations the most open minded leaders and give them decision rights • Involvement in the selection process leads to better adoption later Select early adopter leaders 36

38. © 2018 Health Catalyst We believe when you elevate data as a strategic asset it enables significantly better decision-making and promotes massive improvement in health, cost, and experience outcomes. 38

39. © 2018 Health Catalyst 39 Analytic Platform Acquire Organize Standardize Analyze Deliver Extend Claims Biometric Socioeconomic Care Management Other Sources External Data Reports Dashboards Mobile, Web, Apps EHR Patient Experience Departmental Financial Others Internal Data Interoperability Interchange Results Our Network Community Providers Standardize Organize

40. © 2018 Health Catalyst Data, People and Process 40 At-Risk Cohort Gaps in Screening Last Encounter Predictive Probability Quality Metrics Preventative Screening Patient Education Community Outreach Physician Training Best Practices

41. © 2018 Health Catalyst Community Care Demo Community Care The application is aimed at Primary Care Clinical Program leaders, primary care providers and care coordinators working in ambulatory settings, quality improvement teams, and staff responsible for reports related to the organization’s status as an Accountable Care Organization (ACO). The application focuses on providing data to help organizations review population health; compare their performance to national benchmarking standards for specific measures; identify opportunities for costs savings, and help practices track, monitor, and meet the needs of high- risk patients. • 8 percent relative improvement in diabetes HgbA1c poor control (reverse measure = lower is better). • 25 percent relative improvement in the number of patients with diabetes receiving eye exams. • 1.4 percent relative improvement in the documentation of current medications in the medical record. • Community Care Success Story

42. © 2018 Health Catalyst Community Success 42 90th Percentile performance for tobacco and clinical depression screening and planning 80th Percentile performance for flu immunization, blood pressure and future fall risk screenings Made significant contributions to Medicare savings and has been recognized as the fourth best ACO in the nation, saving over $21 million in 2016

43. © 2018 Health Catalyst … Back to Our Story Through linking the data in the moment with the analytic insights, providers can better serve their patients. Data sharing requires collaboration and governance.

44. © 2018 Health Catalyst Healthcare Analytics Summit 18 Sept. 11-13, Salt Lake, Grand America Hotel TOBY COSGROVE, MD former CEO and President of Cleveland Clinic (2004-2017), who as a cardiac surgeon performed more than 22,000 operations and holds 30 patents for medical innovations KIM GOODSELL the actualized ‘genomified,’ quantified, digitalized “patient of the future," her debut at the 2014 Future of Genomic Medicine conference made headline news announcing— “The patient from the future, here today” DANIEL KRAFT, MD a Stanford and Harvard trained physician- scientist, inventor, entrepreneur, and innovator, Kraft is the Founder and Chair of Exponential Medicine, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare BRENT JAMES, MD former Chief Quality Officer at Intermountain Healthcare - known internationally for his work in clinical quality improvement, patient safety, and the infrastructure that underlies successful improvement efforts PENNY WHEELER, MD President and Chief Executive Officer of Allina Health, returns a second time as one of the most popular HAS speakers ever MARC RANDOLF Co-founder of Netflix, Marc will share the Netflixed story: how a scrappy Silicon Valley startup brought down Blockbuster and the lessons that could be applicable to healthcare JILL HOGGARD GREEN PhD, RN, Chief Operating Officer – Mission Health and President – Mission Hospital, and recently named to the 2017 Becker’s Healthcare list of the country’s top Women Hospital and Health System Leaders to Know ROBERT WACHTER, MD global leader in healthcare safety, quality, policy, IT; Chair of the Department of Medicine, University of California, San Francisco; best-selling author, “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age” More highlights 4 Digital Innovators (Keynotes) AI Showcase (10 walkabout case studies) Digitizing the Patient Showcase (10-12 stations) 28 Educational, Case Study, and Technical Breakouts 24 Analytics Walkabout Projects More Networking (Introducing “Brain Date”) CME Accreditation For Clinicians 5-Star Grand America Hotel Experience 96 Total Presentations National keynotes Employer Innovation Scott Schreeve MD, CEO, Crossover Health Payer Innovation Kevin Sears Executive Director of Marketing and Network Services, Cleveland Clinic Biosensor Innovation John Rogers PhD, Founding Director, Center Bio-Integrated Electronics, Northwestern University Pricing Innovation Gene Thompson Project Director, Health City Cayman Islands

45. © 2018 Health Catalyst Have you ever asked yourself, “Why can’t I convince my patient to take her prescriptions?” New York Times bestselling author, Gretchen Rubin, developed The Four Tendencies to help answer this question and more. Join Gretchen and Health Catalyst co-founder, Tom Burton, to explore how these tendencies apply to healthcare, and learn how understanding them can help you to be more productive in your work and easily navigate confrontations. Wednesday, September 19 1:00-2:00 PM EST By attending this webinar you will gain: • Knowledge of the four tendencies: the upholder, the questioner, the obliger, and the rebel • An understanding of how these tendencies can affect behavior in a healthcare setting • Practical tips for working with superiors, colleagues, and patients that fall into different tendencies • Insight into why people choose to act and why they don’t act • The ability to make better decisions, be less stressed and generally be more effective in your work once you understand your own tendency The Four Tendencies for Healthcare Professionals 45 GRETCHEN RUBIN Author, The Four Tendencies TOM BURTON Co-founder, Health Catalyst Gretchen Rubin photo credit: Sam Interrante

46. Thank You!