Accountable Care Transformation Framework

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Unlike few can do, Dr. David Burton has simplified these complex topics into a simple construct of four population health management building blocks. By acquiring proficiency in each of these four dimensions, healthcare delivery systems can create an asset which can be marketed to various types of governmental and commercial payers, which sponsor health benefit plans and offer shared accountability contracts (i.e. accountable care) into which these population health management sponsors can enter.

The key learning points of the webinar include:

The four building blocks of population health management (provider network, population(s), quality/safety outcomes, and cost outcomes)
The central role patient registries play in success in population health management
Pragmatic tools and methodologies to help healthcare delivery systems become proficient in each of the four dimensions of the framework
A discussion of the categories of governmental and commercial sponsors of shared accountability solutions, including the potential impact of the shift from defined benefit to defined contribution health benefit programs

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  • Accountable Care Transformation Framework

    1. 1. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Accountable Care Transformation Framework 1 Webinar – June 4, 2014
    2. 2. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Population Health Management Developing the asset Provider Network 1 Population 2 Cost Outcomes 4 Quality Outcomes 3 Four Building Blocks of Population Health Management developing the asset
    3. 3. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics PHM and Accountable Care (AC) Accountable Care Financing and Administration Population Health Management developing the asset packaging and marketing the asset
    4. 4. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Accountable Care Transformation Retail Marketing Access, Satisfaction: Optimize: 1) coverage of the service area by the AC network; and 2) member/patient satisfaction Quality, Safety: Improve clinical and patient safety outcomes Cost: Provide care at the lowest necessary cost Pricing: Negotiate “price” based on clinical registry assessment of disease density and severity
    5. 5. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Accountable Care Transformation • Population Health Advanced Applications • Permanent Clinical Team Structures • Repeatable Deployment Methodology • Ordering Waste Reduction Explorer • Workflow Waste Reduction Explorer • Defect Waste Reduction Explorer • Disease Density Explorer • Risk (Severity Level) Explorer • Cohort Driven “Underwriting” • Network Composition Analyzer • Service Area Explorer • Wholesale Contracting • Network Access Agreement* Health Catalyst Products/Services • Deployable • Under development • On Road Map • Client, Third-party Payer and/or Health Catalyst • Patient Injury Prevention Applications • Patient Registries • Activity-based Costing • Predictive models for clinical staffing • Financial Risk Allocation - Reinsurance • Patient-Provider Attribution Modeler • Retail Marketing Vehicle(s) • Care Management Resources • Care Management Resources • Patient Analytics and Communication • Patient Analytics and Communication • Payer Market Analyzer • Key Process Analyses • Participating Provider Service Agreements* * Outline of concepts to be included in agreements • Accountable Care Organizational Plan* • Risk/Reward Allocation Plan* • Member/Patient Satisfaction Explorer • Patient Leakage • AC Executive Dashboard
    6. 6. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Access, Satisfaction 6
    7. 7. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Provider network analysis (geoanalytics) 7
    8. 8. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Service Area Explorer Potential “layer” inputs under evaluation Hospital Service Areas from the Dartmouth Atlas of Health Care Medical care regions, medical trade areas and hospital service areas defined using central place theory (Margot W. Smith) Census data from the U.S. Census Bureau of the U.S. Department of Commerce Health Benefit Program filings with state health insurance departments, including definition of geographic coverage areas Patient origin analyses based on client data CMS service area definition (Hospital Compare)
    9. 9. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Service Area Explorer Dartmouth Atlas of Health Care (Healthcare Regions)
    10. 10. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Network Composition Analyzer 10 Medicare FFS payments by venue – 2008-2012 OutpatientClinic Care Inpatient SNF Home Hlth Hospice $ 152 Billion 11.8% 372 Billion 28.7% 447 Billion 34.5% $ 133 Billion 10.3% $ 90 Billion 6.9% $ 48 Billion 3.7% LTCH/IRF $ 53 Billion 4.1% Clinic Care Outpatient Inpatient SNF LTCH/IRF Home Health Hospice
    11. 11. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Network Composition Analyzer Current network
    12. 12. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics ? ? Network access Current state (integrated layers)
    13. 13. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Poll question • How well do you feel your current network of physicians and facilities covers the geographic service area of the third-party payers with whom you want to establish a shared-accountability contract? (five-point scale) • 5 - Full coverage – 10% • 4 – 33% • 3 – 37% • 2 – 16% • 1 - Little or no coverage – 4%
    14. 14. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Patient Registries, Key Process Analyses 14
    15. 15. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Patient Registries 15
    16. 16. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Registries – “the Intel chip” Patient registries are the “Intel” chip inside PHM/AC; they form the basis of: • Essentials layer applications. • Population evaluation. • Quality outcomes. Advanced applications and Patient Injury Prevention Processes • Cost outcomes. Ordering waste, workflow waste and defect waste
    17. 17. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Heart Rhythm Disorders Vascular Disorders Ischemic Heart Disease Heart Failure CARDIOVASCULAR Care Process Families Clinical Program ICD9 Volumes I-II 17,674 Diagnosis Codes ICD-9 Volume III 3,903 Procedure Codes 2013 CPT® Code Set 9706 Codes CPT-4 Code Groupings ICD9 Procedure Code Groupings ICD9 Diagnosis Code Groupings Care Processes Valve Disorders CHF Cardio- myopathy Pulmonary Heart Disease
    18. 18. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Mapping ICD9 Dx to clinical hierarchyPrimaryIC DDiagnosi ICDDiagnosisDSC ClinicalProgram CareProcessFamily CareProcess TotVarCostAMT 648.91 OTH CURR COND-DELIVERED Women and Newborns Pregnancy Management of high-risk pregnancy 1,380,256.84$ 644.21 EARLY ONSET DELIVERY-DEL Women and Newborns Pregnancy Management of high-risk pregnancy 1,177,045.05$ 659.61 ELDERLY MULTIGRAVIDA-DEL Women and Newborns Pregnancy Management of high-risk pregnancy 1,168,355.92$ 642.32 TRANS HYPERTEN-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 1,020,221.38$ 642.41 MILD/NOS PREECLAMP-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 908,276.75$ 642.51 SEVERE PREECLAMP-DELIVER Women and Newborns Pregnancy Management of high-risk pregnancy 906,969.56$ 648.81 ABN GLUCOSE TOLER-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 837,075.90$ 658.11 PREM RUPT MEMBRAN-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 808,349.85$ 658.23 PROLONG RUP MEMB-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 596,809.84$ 648.93 OTH CURR COND-ANTEPARTUM Women and Newborns Pregnancy Management of high-risk pregnancy 590,661.91$ 656.53 POOR FETAL GRTH-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 544,525.63$ 649.03 TOBACCO USE DIS-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 510,959.65$ 648.21 ANEMIA-DELIVERED Women and Newborns Pregnancy Management of high-risk pregnancy 395,594.30$ 646.83 PREG COMPL NEC-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 363,172.67$ 642.71 TOX W OLD HYPERTEN-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 352,317.40$ 642.02 ESSEN HYPERTEN-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 345,091.13$ V23.89 SUPRV HIGH-RISK PREG NEC Women and Newborns Pregnancy Management of high-risk pregnancy 332,141.48$ 658.03 OLIGOHYDRAMNIOS-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 307,153.00$ 646.83 PREG COMPL NEC-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 304,254.45$ 656.61 EXCESS FETAL GRTH-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 303,155.43$ 648.02 DIABETES-DELIVERED W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 259,335.69$ 648.93 OTH CURR COND-ANTEPARTUM Women and Newborns Pregnancy Management of high-risk pregnancy 256,935.47$ 655.83 FETAL ABNORM NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 246,455.47$ 659.53 ELDER PRIMIGRAVID-ANTEPA Women and Newborns Pregnancy Management of high-risk pregnancy 244,258.48$ 644.03 THRT PREM LABOR-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 241,969.46$ 646.83 PREG COMPL NEC-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 212,033.71$ 648.93 OTH CURR COND-ANTEPARTUM Women and Newborns Pregnancy Management of high-risk pregnancy 208,806.46$ 648.42 MENTAL DIS-DELIV W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 198,240.68$ 644.13 THREAT LABOR NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 180,973.69$ 678.03 FETAL HEMATOLOGIC-ANTE Women and Newborns Pregnancy Management of high-risk pregnancy 179,887.38$ 652.63 MULT GES MALPRES-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 172,157.76$ 644.03 THRT PREM LABOR-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 168,240.11$ 764.96 FET GRWTH RET 1500-1749G Women and Newborns Pregnancy Management of high-risk pregnancy 167,934.27$ 655.83 FETAL ABNORM NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 167,045.46$ 649.32 COAGULATN DEF-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 164,740.85$
    19. 19. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 19 Clinical Programs Relative size (455 care processes) Hem- Onc GI CV Gen Med W&NMusc RespNeuroSurg Comm Peds Spec Beh Inpatient Outpatient Series
    20. 20. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics ICD Patient Registries Foundational and discovery apps CLINICAL INTEGRATION HIERARCHY Care Process Families Care Processes Total Variable Cost CARDIOVASCULAR Ischemic heart disease 1 Coronary artery disease 1 20,354,043.06$ Acute myocardial infarction 1 16,271,150.87$ Chronic ischemic heart disease 1 2,603,804.78$ Totals 1 3 39,228,998.71$ Vascular disorders 1 Aortic aneurysm and dissection 1 9,975,878.61$ Vascular insufficiency - extremities 1 9,680,024.62$ Venous phlebitis, thrombosis, embolism 1 6,861,044.17$ Complication of vascular device, implant or graft 1 3,922,582.89$ Other vascular or lymphatic disorders 1 3,392,116.22$ Vascular insufficiency - intestines 1 2,748,775.13$ Arterial embolism and thrombosis 1 1,425,285.88$ Aneurysm and dissection except aorta 1 941,468.22$ Totals 1 8 38,947,175.74$ Heart failure 1 Congestive heart failure 1 18,591,198.70$ Cardiac valve disorders 1 9,232,012.97$ Cardiomyopathy and myocarditis 1 2,512,491.38$ Pulmonary heart disease 1 1,393,951.25$ Totals 1 4 31,729,654.30$ Heart rhythm disorders 1 Atrial fibrillation and flutter 1 7,943,076.82$ Cardiac rhythm device insertion, revision, replacement or removal1 2,872,634.31$ Conduction disorders 1 2,764,910.95$ Other dysrhythmias 1 4,340,898.91$ Ventricular tachyarrhythmias 1 2,866,885.63$ Totals 1 5 20,788,406.62$ Other cardiovascular diorders 1 Complication of cardiovascular device, implant or graft 1 3,809,826.99$ Disorders of the endocardium 1 1,036,527.10$ Disorders of the pericardium 1 1,260,923.96$ Hypotension 1 1,623,867.20$ Other cardiovascular findings and anomalies 1 457,535.73$ Totals 1 5 8,188,680.98$ Heart and lung transplants 1 Heart transplant 1 1,345,601.35$ Lung transplant 1 1,418,317.86$ Totals 1 2 2,763,919.21$ Cardiovascular diagnostic testing and pre-operative assessment1 Pre-procedural CV exam 1 1,691,636.46$ Abnormal CV diagnostic study 1 379,488.76$ 1 2 2,071,125.22$ GRAND TOTALS 5 19 143,717,960.78$
    21. 21. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Operational ContentPopulation Management Content Patient Injury Prevention Content Shared FrameworksAvailable Newly Released or Enhanced 2014 Roadmap Platform Components Comorbidity Analyzer & Content Readmission Explorer Source Mart Mapping Content Ambulatory EMR, Professional Billing, Time Card, Human Resources, Accounts Receivable, Supply Chain, Claims Atlas IDEA Security and Auditing Metadata Core Additional Source Marts as necessary Source Mart Designer & Patterns SAM Designer & Patterns Product Components EMR, Patient Billing, Costing, General Ledger, Patient SatisfactionHosting Infrastructure & Services CAFÉ De-identification Infrastructure EDW Console Common Linkable Identifiers EDIT—Executive Dashboard Integration Tool Clinical Content Framework Severity Risk Models *CAFE—Comparative Analytics Framework and Exchange Essentials Layer Mapping Content Patient-Provider Attribution ModelerClinical Hierarchies Visualization & Architectural Frameworks Essentials Layer Definitions Statistical Framework-Metric Correlation Framework Workflow Content Framework Patient Injury Prevention Content Framework FinancialAccountable Care GL Explorer Financial Management Explorer Key Process Analysis CORUS: Real Time Location Services Integration CORUS: Predictive Staffing Models CORUS: Activity Based Terminology Mapping CORUS: Clinically Driven Activity Based Costing Revenue Cycle Explorer CORUS: Clinically Driven Revenue Cycle Cohort Builder Accountable Care Organizational Plan Participating Provider Srv Agr Templates Payer Market Analyzer Patient Analytics & Communication Network Composition Analyzer Wholesale Contract Network Access Agreement Disease Density Explorer Risk Allocation (Reinsurance) Modeler Service Area Explorer ACED Accountable Care Executive Dashboard Risk (Severity Level) Explorer Cohort Driven “Underwriting” Modeler Member Satisfaction Explorer Risk/Reward Allocation Modeler Patient Leakage Care Management Planner Essentials Application Population Explorer Admin Patient Registries Precise Patient RegistriesReadmission Predictor Mental HealthDeployment Templates Pediatrics SpecialtyRespiratory OncologyGI SurgeryWomen & Children MusculoskeletalCardiovascular NeurosciencePrimary Care Application Suite Patient Flow Explorer Patient Satisfaction Labor Management Exp Supply Chain Explorer A3/Value Stream MapsOhio C External & Regulatory PM: AppointmentsInvasive PM: Prof BillingAcute Medical PM: Patient AccessAmbulatory PM: Orders and ReferralsTherapeutic (Rx, Resp) Practice ManagementDiagnostic (Lab, Path) Patient Safety Explorer Pressure Injury Falls (S, A, C) Patient/Procedure ControlGlucose Management Venous ThromboembolismTransfusion CLABSI Parenteral Nutrition TPN) Surgical Site InfectionsRX: Electrolytes CAUTIRX: Fluids VAPRX: Medications InfectionsSubstances Patient Flight Plan Predictor A3/Value Stream Maps Specialty Clinics US N&W
    22. 22. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Key Process (Pareto) Analyses 22
    23. 23. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 23 Top 10 Care Process Families account for 34% of the opportunity Top 40 Care Process Families account for over 80% of the opportunity X-Axis = Care Process Families by resources consumed (High to Low) Y-Axis=Percentoftotalresourcesconsumed Key Process Analysis (IP+OP)
    24. 24. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Key Process Analysis (Pareto sort) CLINICAL INTEGRATION HIERARCHY Care Process Families Care Processes Total Variable Cost CARDIOVASCULAR Ischemic heart disease 1 Coronary artery disease 1 20,354,043.06$ Acute myocardial infarction 1 16,271,150.87$ Chronic ischemic heart disease 1 2,603,804.78$ Totals 1 3 39,228,998.71$ Vascular disorders 1 Aortic aneurysm and dissection 1 9,975,878.61$ Vascular insufficiency - extremities 1 9,680,024.62$ Venous phlebitis, thrombosis, embolism 1 6,861,044.17$ Complication of vascular device, implant or graft 1 3,922,582.89$ Other vascular or lymphatic disorders 1 3,392,116.22$ Vascular insufficiency - intestines 1 2,748,775.13$ Arterial embolism and thrombosis 1 1,425,285.88$ Aneurysm and dissection except aorta 1 941,468.22$ Totals 1 8 38,947,175.74$ Heart failure 1 Congestive heart failure 1 18,591,198.70$ Cardiac valve disorders 1 9,232,012.97$ Cardiomyopathy and myocarditis 1 2,512,491.38$ Pulmonary heart disease 1 1,393,951.25$ Totals 1 4 31,729,654.30$ Heart rhythm disorders 1 Atrial fibrillation and flutter 1 7,943,076.82$ Cardiac rhythm device insertion, revision, replacement or removal1 2,872,634.31$ Conduction disorders 1 2,764,910.95$ Other dysrhythmias 1 4,340,898.91$ Ventricular tachyarrhythmias 1 2,866,885.63$ Totals 1 5 20,788,406.62$ Other cardiovascular diorders 1 Complication of cardiovascular device, implant or graft 1 3,809,826.99$ Disorders of the endocardium 1 1,036,527.10$ Disorders of the pericardium 1 1,260,923.96$ Hypotension 1 1,623,867.20$ Other cardiovascular findings and anomalies 1 457,535.73$ Totals 1 5 8,188,680.98$ Heart and lung transplants 1 Heart transplant 1 1,345,601.35$ Lung transplant 1 1,418,317.86$ Totals 1 2 2,763,919.21$ Cardiovascular diagnostic testing and pre-operative assessment1 Pre-procedural CV exam 1 1,691,636.46$ Abnormal CV diagnostic study 1 379,488.76$ 1 2 2,071,125.22$ GRAND TOTALS 5 19 143,717,960.78$ Pareto Care Processes Pareto ICD Registries All ICD Registries
    25. 25. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Cardiovascular Clinical Program Pareto Care Processes
    26. 26. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Poll questions How well prepared do you feel your organization is to: • Use patient registries and key process analysis as important elements in prioritization of improvement initiatives? (five-point scale) • 5 – Very Prepared – 7% • 4 – 18% • 3 – 28% • 2 – 33% • 1 – Not Prepared – 13%
    27. 27. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Pricing based on disease density and severity of illness 27
    28. 28. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Disease Density and Severity Level Explorer 28
    29. 29. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Disease density analysis • Use ICD patient registry groupings to analyze third- party payer populations to determine the “density” of disease by Clinical Program, Care Process Family and Care Process • Determine organizational readiness to address care improvement opportunities highlighted by the patient registry groupings analysis • Use output from the disease density analysis of claims data as the starting point for risk (severity level) stratification
    30. 30. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Risk (severity level) analysis • Apply a risk stratification framework (e.g., Charlson- Deyo comorbidity analysis, CMS-HCC) to the disease registry populations highlighted in the claims-based disease density analysis • Compare a statistical sample of historical data from delivery system data sets (inpatient facility, outpatient facility, clinic care) to the claims-based disease registry data (drill down) to project cost of care • Determine whether to include or exclude statistical outlier cases for each disease registry sub-population
    31. 31. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Financial risk allocation 31
    32. 32. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Excellent Outcomes Poor Outcomes # of Cases Mean Excellent Outcomes # of Cases Poor Outcomes Bring cases above the mean down to the mean • Strategy. Use content and analytics to develop value-based guidelines and protocols to reduce inlier variation • Implementation. Work with clinicians to use these value-based guidelines and protocols to bring the cases above the mean down to the mean Approach: “Tighten the Curve and Shift it to the Left” Focus on “inlier” management
    33. 33. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Financial risk allocation Contract for coverage of outlier risk. Health systems should consider contracting for some type of reinsurance to cover stochastic events (outlier risk management) • Alternative #1: Contract with each third-party payer to assume risk for outliers as a part of the Network Access Agreement; or • Alternative #2: Contract with one reinsurer across all Network Access Agreements to cover outlier risk • As a new line of business within their captive medical malpractice reinsurer (GPO?) • With a third-party payer such as Aetna • With a traditional reinsurer such as Employers Re
    34. 34. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Network Access Contracting 34
    35. 35. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Network access agreements Wholesale contracting. A Network Access Agreement specifies the terms and conditions between a health care financing sponsor and the AC provider network • Leases the AC provider network to the payer • Defines the nature of the payment relationship; e.g.,: • Bundled per case • Population-specific capitation (capitation by disease registry) • Global capitation • Specifies the nature of financial risk allocation (e.g., outlier trim points) and the reinsurance treaty (if any)
    36. 36. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Network access agreements Contracting strategy. Contracting negotiations could be informed by data-driven criteria, such as: • Volume. How much volume does the payer have to drive to the AC provider network? • Directability. How strong is the payer’s health benefit program gradient (delta between plan payment for in- network vs. out-of-network services) • Alignment. What proportion of the network offered to members of the payer’s plan does the AC provider network represent? (i.e., How exclusive is the contract with the AC provider network?)
    37. 37. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Poll question • How well prepared do you feel your organization is to evaluate the risk of sharing financial responsibility for managing defined populations of members/patients? (five-point scale) • 5 – Very prepared – 2% • 4 – 15% • 3 – 37% • 2 – 33% • 1 – Not prepared – 12%
    38. 38. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Quality, Safety 38
    39. 39. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential39 Home (Patient Portal) * To Invasive Care Processes Clinic Care Non-recurrent Clinic Care Chronic Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Triage to Treatment Venue Substance Preparation Invasive* Subspecialist Chronic Disease Subspecialist Screening & Preventive Symptoms The Anatomy of Healthcare Delivery Procedure Indications for Intervention Diagnostic algorithms Indications for Referral Triage Criteria Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Treatment and Monitoring Algorithms Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Substance Selection Substance Selection Clinical Supply Chain Management Admission Order SetsAdmission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post- procedure Order Sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Management of Acute Medical, Invasive & Post- Acute Care Modules Per Case Knowledge Assets Clinical ops procedure guidelines and patient injury prevention Post-procedure Care
    40. 40. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Quality: Population Health Advanced Applications 40
    41. 41. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Focus on the “Golden Few” CLINICAL INTEGRATION HIERARCHY Care Process Families Care Processes Total Variable Cost CARDIOVASCULAR Ischemic heart disease 1 Coronary artery disease 1 20,354,043.06$ Acute myocardial infarction 1 16,271,150.87$ Chronic ischemic heart disease 1 2,603,804.78$ Totals 1 3 39,228,998.71$ Vascular disorders 1 Aortic aneurysm and dissection 1 9,975,878.61$ Vascular insufficiency - extremities 1 9,680,024.62$ Venous phlebitis, thrombosis, embolism 1 6,861,044.17$ Complication of vascular device, implant or graft 1 3,922,582.89$ Other vascular or lymphatic disorders 1 3,392,116.22$ Vascular insufficiency - intestines 1 2,748,775.13$ Arterial embolism and thrombosis 1 1,425,285.88$ Aneurysm and dissection except aorta 1 941,468.22$ Totals 1 8 38,947,175.74$ Heart failure 1 Congestive heart failure 1 18,591,198.70$ Cardiac valve disorders 1 9,232,012.97$ Cardiomyopathy and myocarditis 1 2,512,491.38$ Pulmonary heart disease 1 1,393,951.25$ Totals 1 4 31,729,654.30$ Heart rhythm disorders 1 Atrial fibrillation and flutter 1 7,943,076.82$ Cardiac rhythm device insertion, revision, replacement or removal1 2,872,634.31$ Conduction disorders 1 2,764,910.95$ Other dysrhythmias 1 4,340,898.91$ Ventricular tachyarrhythmias 1 2,866,885.63$ Totals 1 5 20,788,406.62$ Other cardiovascular diorders 1 Complication of cardiovascular device, implant or graft 1 3,809,826.99$ Disorders of the endocardium 1 1,036,527.10$ Disorders of the pericardium 1 1,260,923.96$ Hypotension 1 1,623,867.20$ Other cardiovascular findings and anomalies 1 457,535.73$ Totals 1 5 8,188,680.98$ Heart and lung transplants 1 Heart transplant 1 1,345,601.35$ Lung transplant 1 1,418,317.86$ Totals 1 2 2,763,919.21$ Cardiovascular diagnostic testing and pre-operative assessment1 Pre-procedural CV exam 1 1,691,636.46$ Abnormal CV diagnostic study 1 379,488.76$ 1 2 2,071,125.22$ GRAND TOTALS 5 19 143,717,960.78$ Pareto Care Processes All ICD Registries Pareto ICD Registries
    42. 42. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics42 Population Health Advanced Applications Mapping admin codes to clinical hierarchy ICD patient registries Key Process Analysis Precise patient registries (add clinical rules) Care Process Models for Pareto Care Process Families AIM statement starter sets Improvement initiative knowledge assets Process and outcome metrics & visualizations
    43. 43. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Heart Failure Care Process Model
    44. 44. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Heart Rhythm Disorders Vascular Disorders Ischemic Heart Disease Heart Failure CARDIOVASCULAR Care Process Families Clinical Program Valve Disorders CHF Cardio- myopathy Pulmonary Heart Disease Care Processes Systolic Dysfunction Diastolic Dysfunction Improvement Initiatives Anatomy of Healthcare Delivery Goals (e.g., Beta blocker Rx) Regulatory and Accreditation Goals (e.g., HF readmits) Aim Statement Packets
    45. 45. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Heart Failure Advanced Application
    46. 46. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Safety: Patient Injury Prevention Applications 46
    47. 47. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics47 Hospital-Acquired Condition (HAC) cohorts Analysis of frequency, costs, potential savings Patient injury Improvement initiative process Criteria for PIPP intervention identified Care units identified to which PIPPs apply PIPP surveillance process, outcome metrics & visualizations AIM statement starter sets PIPP intervention protocol starter sets Patient Injury Prevention Process (PIPP) starter set maps
    48. 48. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics48 Patient injury – CMS HAC registries • Ventilator-associated pneumonia (VAP) • Adverse drug events (ADEs)
    49. 49. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Condition Estimated cost % of Total Cum % Cases Cost/Case Vascular Cath-Assoc Infection 405,299,703$ 51.9% 51.9% 2318 174,849$ Pressure Ulcers Stages III and IV 96,917,626$ 12.4% 64.3% 402 241,089$ Iatrogenic Pneumothorax 89,402,081$ 11.4% 75.8% 747 119,682$ Falls and Trauma 67,772,069$ 8.7% 84.4% 1134 59,764$ Cath-Assoc Urinary Tract Infection 59,991,394$ 7.7% 92.1% 720 83,321$ Surgical Site Infection 37,792,448$ 4.8% 97.0% 233 162,199$ Venous thromboembolism (VTE) 8,544,237$ 1.1% 98.1% 204 41,884$ Manifestions of Poor Glycemic Control 6,561,973$ 0.8% 98.9% 119 55,143$ Foreign Object Retained After Surgery 6,347,387$ 0.8% 99.7% 110 57,704$ Air Embolism 1,395,845$ 0.2% 99.9% 13 107,373$ Blood Incompatability 849,397$ 0.1% 100.0% 6 141,566$ 780,874,160$ 6,006 130,016$ Cost estimated from gross charges based on cost to charge ratio = 0.254); Savings calculated from cost of DRG with HAC subtracted from average cost of DRG (for MS-DRGs and HAC with at least 5 cases). Estimated cost per case for all cases in California = $12,700 (3.7 million cases). Michael Dietzel analysis. Estimated cost of defects 2011 OSHPD data
    50. 50. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Approach to patient injury prevention Approach and tools to reduce patient injury Define for each type of defect a Patient Injury Prevention Process (PIPP). ● Cohort of patients to be screened because they may be at risk ● Screening criteria/tool (e.g., Braden Scale) to define patients who are at risk ● Clinical operations protocol to be implemented with at-risk patients to prevent injury ● Tracking system to detect injuries and near misses Regard patient injury as a “process failure” to be subjected to root-cause analysis rather than an “incident” to be reported
    51. 51. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics51 CLABSI prevention
    52. 52. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics52 CLABSI prevention “A-3” for process redesign
    53. 53. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics53 CLABSI prevention – tracking
    54. 54. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Poll question • How well prepared do you feel your organization is to demonstrate with dashboards and outcomes reports your proficiency in quality and safety to third-party payers? (five-point scale) • 5 – Very prepared – 9% • 4 – 23% • 3 – 19% • 2 – 36% • 1 – Not prepared – 13%
    55. 55. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Cost (waste reduction) 55
    56. 56. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 56 PHM waste reduction construct Population Health Management Population Utilization WastePer capita management (population focus) Sample Metrics Admits/1000 members IP days/1000 members OP visits/1000 members Procedures/1000 members ED visits/1000 members Readmissions/1000 members Per Capita Waste Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Per case management (individual patient focus) Per Case Utilization Waste Sample Metrics Cost/visit Cost/case OR minutes L&D hours LOS # of comorbidities Per Case Waste Acute Medical, Invasive & Post-Acute Care Modules Per Case Knowledge Assets
    57. 57. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Ordering Waste Workflow Waste Defect Waste Ordering tests, care, substances and supplies that do not add value Variation in efficiency of delivering tests, care and procedures ordered Patient injuries incurred in delivering tests, care and procedures ordered 57 Three forms of waste
    58. 58. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Population ordering waste reduction 58
    59. 59. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential59 Home (Patient Portal) * To Invasive Care Processes Clinic Care Non-recurrent Clinic Care Chronic Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Triage to Treatment Venue Substance Preparation Invasive* Subspecialist Chronic Disease Subspecialist Screening & Preventive Symptoms Sources of population ordering waste Diagnostic algorithms Indications for Referral Indications for Intervention Triage Criteria Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Substance Selection Substance Selection Clinical Supply Chain Management Procedure Treatment and Monitoring Algorithms Admission Order SetsAdmission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post- procedure Order Sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Acute Medical, Invasive & Post-Acute Care Modules Per Case Knowledge Assets Clinical ops procedure guidelines and patient injury prevention Post-procedure Care
    60. 60. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Population ordering waste reduction Community Care dashboard
    61. 61. Population ordering waste reduction NTSV C-Section rate with no induction attempt
    62. 62. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.comProprietary and Confidential Per case ordering waste reduction 62
    63. 63. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential63 Home (Patient Portal) * To Invasive Care Processes Clinic Care Non-recurrent Clinic Care Chronic Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Triage to Treatment Venue Substance Preparation Invasive* Subspecialist Chronic Disease Subspecialist Screening & Preventive Symptoms Sources of per case ordering waste Diagnostic algorithms Indications for Referral Indications for Intervention Triage Criteria Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Substance Selection Substance Selection Clinical Supply Chain Management Procedure Treatment and Monitoring Algorithms Admission Order SetsAdmission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post- procedure Order Sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Acute Medical, Invasive & Post-Acute Care Modules Per Case Knowledge Assets Clinical ops procedure guidelines and patient injury prevention Post-procedure Care
    64. 64. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Per case ordering waste Appendectomy
    65. 65. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.comProprietary and Confidential Per case workflow waste reduction 65
    66. 66. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential66 Home (Patient Portal) * To Invasive Care Processes Clinic Care Non-recurrent Clinic Care Chronic Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Triage to Treatment Venue Substance Preparation Invasive* Subspecialist Chronic Disease Subspecialist Screening & Preventive Symptoms Sources of per case workflow waste Diagnostic algorithms Indications for Referral Indications for Intervention Triage Criteria Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Substance Selection Substance Selection Clinical Supply Chain Management Procedure Treatment and Monitoring Algorithms Admission Order SetsAdmission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post- procedure Order Sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Acute Medical, Invasive & Post-Acute Care Modules Per Case Knowledge Assets Clinical ops procedure guidelines and patient injury prevention Post-procedure Care
    67. 67. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential67 Workflow waste - surgical services
    68. 68. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential68 Workflow waste – surgical services reduce room turnover time
    69. 69. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential IP per case waste reduction opportunity Facility perspective Per case ordering waste Per case workflow waste Per case defect waste 69 $144 MM ~ 23% Total IP per case waste $57 MM* ~ 9 % $87 MM* ~ 14 % In Progress < 1** %* Preliminary Findings (work in progress) ** Extrapolated from OSHPD and CMS data DRAFT
    70. 70. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.comProprietary and Confidential Defect waste reduction 70
    71. 71. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Defect waste reduction CMS’s establishment of penalties weighted by measurement domain creates an incentive to choose CLABSI and CAUTI improvement initiatives (65% of total) 71
    72. 72. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Focus on workflow/defect waste
    73. 73. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.comProprietary and Confidential Summary 73
    74. 74. © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Accountable Care Transformation Retail Marketing Access, Satisfaction: Optimize: 1) coverage of the service area by the AC network; and 2) member/patient satisfaction Quality, Safety: Improve clinical and patient safety outcomes Cost: Provide care at the lowest necessary cost Pricing: Negotiate “price” based on clinical registry assessment of disease density and severity
    75. 75. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Questions and Answers Building a Data Warehouse and Analytics Strategy from the Ground Up Date: June 11th 1-3 pm ET Presenter: Eric Just and Mike Doyle, Health Catalyst Register at http://healthcatalyst.com/ Healthcare Analytics Summit Join top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs. Date: September 24th-25th Location: Salt Lake City, Utah Save the Date: http://www.healthcatalyst.com/news/healthcare- analytics-summit-2014 For Information Contact: david.burton@healthcatalyst.com
    76. 76. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics 76 Obtain unbiased, practical, educational advice on proven analytics solutions that really work in healthcare. The future of healthcare requires transformative thinking by committed leadership willing to forge and adopt new data-driven processes. If you count yourself among this group, then HAS ’14 is for you. OBJECTIVE MOBILE APP Access to a mobile app that can be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics.
    77. 77. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics Chronic condition management Primary Care Physician ChronicDisease Sub-specialist Medical Assistant Generalist CareManagers (RN,Beh) Specialist CareManagers (RN,Beh) MD and/or APC Clin Ops Behavioral
    78. 78. © 2013 Health Catalyst www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 78 PHM waste reduction construct Population Health Management Population Utilization WastePer capita management (population focus) Sample Metrics Admits/1000 members IP days/1000 members OP visits/1000 members Procedures/1000 members ED visits/1000 members Readmissions/1000 members Per Capita Waste Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications Population Utilization Knowledge Assets Per case management (individual patient focus) Per Case Utilization Waste Sample Metrics Cost/visit Cost/case OR minutes L&D hours LOS # of comorbidities Per Case Waste Acute Medical, Invasive & Post-Acute Care Modules Per Case Knowledge Assets

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