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© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
ACO Success Requires Precise Patient
Population Definitions
By Luke Skelley
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
ACO Success Depends on Accurate
Patient Population Definitions
2
Accountable Care Organizations
(ACOs) must precisely pinpoint
patient populations to understand
the risk to customize solutions.
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
How ACOs Use Population
Definitions
3
ACOs define populations for four main reasons
To identify their members and attribute those patients
to the correct physician(s)
To attribute the right patient to the right physician for
pay-for-performance incentives
To accurately report CMS and other quality measures
To perform population health analytics that enable
providers to effectively manage each patient’s health
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Challenges to Defining an ACO
Populations
4
ACOs identify high-risk members and manage their
health more carefully by:
• Performing analytics to predict likelihood of specific events
• Tracking utilization trends across the full care continuum
• Monitoring quality of care by facility and by provider.
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Defining High Risk Populations
5
Key challenges in defining ACO
populations.
• Multiple providers per patient
• Multiple data sources
• Reconciling multiple identifiers for
each member
HOSPITALS REHABS
PHARMACIES LABORATORIES
SURGERY CENTERS DIALYSIS FACILITIES
PRIVATE PRACTICE CLAIMS & BILLING
NURSING HOMES HOME HEALTH
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Clinical Integration Hierarchy
6
Health Catalyst recommends using a clinical hierarchy system for
grouping these common clinical characteristics and identifying
individuals who share these characteristics.
Starting at the most-general and moving to the most-granular level,
this hierarchy is as follows:
1: Clinical program:
Twelve clinical programs make up a comprehensive healthcare
delivery system.
Primary
Care
Care
Process
Families
e.g.,
Diabetes
CV
Care
Process
Families
e.g.,
Heart
Failure
W&C
Care
Process
Families
e.g.,
Pregnancy
G.I.
Care
Process
Families
e.g.,
LowerGI
Disorders
Resp-
iratory
Care
Process
Families
e.g.,
Obstructive
Lung
Disorders
Neuro
Sciences
Care
Process
Families
e.g.,
Spine
Disorders
Musculo-
skeletal
Care
Process
Families
e.g.,
Joint
Replace-
ment
Surgery
Care
Process
Families
e.g.,
Urologic
Disorders
General
Med
Care
Process
Families
e.g.,
Infectious
Diseases
Oncology
Care
Process
Families
e.g.,
Breast
Cancer
Peds
Spec
Care
Process
Families
e.g.,
Peds
CV Surg
Mental
Health
Care
Process
Families
e.g.,
Depression
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Clinical Integration Hierarchy
7
2. Care process family:
Each clinical program consists of multiple care process families.
For Example:
3. Care process:
Represents the most granular level of the hierarchy and may
exist anywhere along the continuum of care.
Cardiovascular clinical program
Ischemic Heart Disease Vascular Disorders
Heart Failure Heart Rhythm Disorders
Ischemic Heart Disease care process family
Hyperlipidemia Coronary Atherosclerosis
Acute Myocardial Infarction Percutaneous Intervention (PCI)
Coronary Artery Bypass Graft (CABG) Cardiac Rehab
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Using Technology to Build and
Refine Registries
Health Catalyst has developed two main tools to easily, efficiently, and
accurately define patient populations. These analytics applications run
on top of our enterprise data warehouse platform.
8
Population Explorer
Delivers a “starter set” of more
than 1,000 different registries.
It begins with standardized
rules for creating the registry
Then adds care mappings to
bring additional data elements
(like laboratory results) into
the registry to create a more
comprehensive rule for
defining the population.
Cohort Builder
This analytics application
enables more sophisticated
definitions of a population.
Teams of clinicians, analysts,
and others work together using
this tool to adjust and refine
the population definition to suit
the ACO’s specific needs.
The level of refinement brought by these tools defines the ACO’s
effectiveness and goes beyond the diagnosis codes to pick up those
patients who might otherwise be missed.
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Summary
9
Using EDW analysis tools mapped to a deep clinical integration
hierarchy allows ACOs to develop the precise, detailed population
definitions, and vastly improve quality and accuracy.
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Luke Skelley joined Health Catalyst in May 2013. Luke’s clinical
nursing background was in critical care and he managed organ and
tissue donation programs for 13 years. His background includes
orthopedic products, severity adjusted outcomes software for
Medstat Group, clinical pathway development software for
CareScience and prospective payment methodologies for Optum
Insight. Luke was recruited by Navinet for a new line of clinical products for
physician offices before they were acquired by Lumeris. Luke has a BSN and
MSN in critical care nursing from the University of Tennessee and an MBA from
Belmont University.
How Would An Accountable Care Approach Change How A
Patient is Treated? Also by Luke Skelley

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ACO Success Requires Precise Patient Population Definitions

  • 1. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. ACO Success Requires Precise Patient Population Definitions By Luke Skelley
  • 2. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. ACO Success Depends on Accurate Patient Population Definitions 2 Accountable Care Organizations (ACOs) must precisely pinpoint patient populations to understand the risk to customize solutions.
  • 3. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. How ACOs Use Population Definitions 3 ACOs define populations for four main reasons To identify their members and attribute those patients to the correct physician(s) To attribute the right patient to the right physician for pay-for-performance incentives To accurately report CMS and other quality measures To perform population health analytics that enable providers to effectively manage each patient’s health
  • 4. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenges to Defining an ACO Populations 4 ACOs identify high-risk members and manage their health more carefully by: • Performing analytics to predict likelihood of specific events • Tracking utilization trends across the full care continuum • Monitoring quality of care by facility and by provider.
  • 5. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Defining High Risk Populations 5 Key challenges in defining ACO populations. • Multiple providers per patient • Multiple data sources • Reconciling multiple identifiers for each member HOSPITALS REHABS PHARMACIES LABORATORIES SURGERY CENTERS DIALYSIS FACILITIES PRIVATE PRACTICE CLAIMS & BILLING NURSING HOMES HOME HEALTH
  • 6. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Clinical Integration Hierarchy 6 Health Catalyst recommends using a clinical hierarchy system for grouping these common clinical characteristics and identifying individuals who share these characteristics. Starting at the most-general and moving to the most-granular level, this hierarchy is as follows: 1: Clinical program: Twelve clinical programs make up a comprehensive healthcare delivery system. Primary Care Care Process Families e.g., Diabetes CV Care Process Families e.g., Heart Failure W&C Care Process Families e.g., Pregnancy G.I. Care Process Families e.g., LowerGI Disorders Resp- iratory Care Process Families e.g., Obstructive Lung Disorders Neuro Sciences Care Process Families e.g., Spine Disorders Musculo- skeletal Care Process Families e.g., Joint Replace- ment Surgery Care Process Families e.g., Urologic Disorders General Med Care Process Families e.g., Infectious Diseases Oncology Care Process Families e.g., Breast Cancer Peds Spec Care Process Families e.g., Peds CV Surg Mental Health Care Process Families e.g., Depression
  • 7. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Clinical Integration Hierarchy 7 2. Care process family: Each clinical program consists of multiple care process families. For Example: 3. Care process: Represents the most granular level of the hierarchy and may exist anywhere along the continuum of care. Cardiovascular clinical program Ischemic Heart Disease Vascular Disorders Heart Failure Heart Rhythm Disorders Ischemic Heart Disease care process family Hyperlipidemia Coronary Atherosclerosis Acute Myocardial Infarction Percutaneous Intervention (PCI) Coronary Artery Bypass Graft (CABG) Cardiac Rehab
  • 8. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Using Technology to Build and Refine Registries Health Catalyst has developed two main tools to easily, efficiently, and accurately define patient populations. These analytics applications run on top of our enterprise data warehouse platform. 8 Population Explorer Delivers a “starter set” of more than 1,000 different registries. It begins with standardized rules for creating the registry Then adds care mappings to bring additional data elements (like laboratory results) into the registry to create a more comprehensive rule for defining the population. Cohort Builder This analytics application enables more sophisticated definitions of a population. Teams of clinicians, analysts, and others work together using this tool to adjust and refine the population definition to suit the ACO’s specific needs. The level of refinement brought by these tools defines the ACO’s effectiveness and goes beyond the diagnosis codes to pick up those patients who might otherwise be missed.
  • 9. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Summary 9 Using EDW analysis tools mapped to a deep clinical integration hierarchy allows ACOs to develop the precise, detailed population definitions, and vastly improve quality and accuracy.
  • 10. © 2014 Health Catalyst www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Luke Skelley joined Health Catalyst in May 2013. Luke’s clinical nursing background was in critical care and he managed organ and tissue donation programs for 13 years. His background includes orthopedic products, severity adjusted outcomes software for Medstat Group, clinical pathway development software for CareScience and prospective payment methodologies for Optum Insight. Luke was recruited by Navinet for a new line of clinical products for physician offices before they were acquired by Lumeris. Luke has a BSN and MSN in critical care nursing from the University of Tennessee and an MBA from Belmont University. How Would An Accountable Care Approach Change How A Patient is Treated? Also by Luke Skelley