Patient-Centered Insights Complete the Picture

© 2016 Health Catalyst
Proprietary and Confidential
Patient-Centered Care Requires
Patient-Centered Insight:
What We Can Do To Complete The Picture
Carolyn Wong Simpkins, MD, PhD
May 10, 2017

Putting the patient back at the center of the measurement matrix can
bring coherence and completeness to the picture of care delivery
performance across the patient journey, and therefore the
performance of the healthcare ecosystem.
Measure What Matters
2

Where are you on the journey to patient-centered outcomes
measurement? 86 respondents
a) Pre-contemplative – 8%
b) Contemplative – 17%
c) Preparing/Researching – 29%
d) Action/Beginning – 28%
e) Maintenance/Expanding – 17%
Poll Question
3

Developing a Patient Centered Health Ecosystem
4
Patient engagement: 1
Advanced outcomes data
capture & analytics: 5
Value-based
payment
alignment: 4
Continuous
Improvement
efforts: 5
Outcomes
implementation: 4
Integration across all
settings: 2
Alignment between
clinical measures &
patient outcomes: 4
Population level outcome
metrics: 3

What and Why Do We Measure Now?
JCAHO MACRA
Proxy measures
process
structural
Clinical
indicators
Surrogate measures for clinical
endpoints
Clinical
endpoints
HEDIS
We are measuring how Healthcare is doing

What about measuring how the patient is doing?
7

How Are Our Patients Doing…
8
Mortality
Clinical
endpoints
What, then, are patient centered outcomes?

Proprietary and Confidential9
Patient REPORTED Outcomes
Patient Centered
Outcomes
Structure, process, clinical
indicators, surrogate
measures
Patent Satisfaction

Patient Centered Outcomes (ice cream): the health outcomes that
matter from the perspective of the patient, eg avoiding dialysis vs
preserved creatinine clearance
Patient Reported Outcomes (chocolate chips): health outcomes
reported by the patient, eg level of pain
Patient Satisfaction (cherry on top): holistically how satisfied the
patient is with the experience of healthcare, enhances the patient’s
journey but not a health outcome per se
All other measures (the cone): a means to an end – delivering to the
patient the health outcomes they care about
Definitions
10

Knowledge
Experience and evidence base of validated patient centered outcomes
is still left of early adopter end of adoption curve
Comfort level with subjective vs objective measures
Culture
Measuring patient centered outcomes captures results from (a) factors
outside healthcare (socioeconomic, geographic, lifestyle, personal
choice); and (b) factors from other provider entities
Tools, or lack thereof
Challenges to Patient Centered Outcomes
12

• Value based care driving integration of healthcare silos
• Data lakes / EDWs now exist that can ingest an increasing variety
of data types from numerous sources and source types
• Emerging tools to capture PCOMs/PROMs systematically and
electronically, ideally feeding into aforementioned data pools/EDWs
and ultimately into analytics insights engines
• NLP, text analytics hitting maturity level to unearth data from text
• Increasing range of PROMs and PCOMs being validated globally
• Quality and Safety movements establishing culture of transparency
Why Are We Poised to Break Through?
13

Outcomes in the
Value Context
14

Value in Healthcare
15

Marc Berg, Principal, KPMG:
“The value of care delivered cannot be measured silo by silo”
We are drowning in measures because all professions and provider types
are eager to demonstrate their own quality...
... yet the overall quality and cost of care is the outcome of the interactions
of all these activities and interventions
From a patient & payer perspective, what matters is what the overall
outcomes and the overall costs are of this care
LaboratoryServices
ImagingServices
Homecarenurses
Specialtydocscare
Nursinghome
Psychiatrichospitals
Hospital/Clinic
outpatientservices
Inpatientservices
Prenatalcare
Drugsandmedical
devices
PrimaryCareDocs
Pharmacist
BehavioralHealth
Professionals
Homecareaides
Quality ReportQuality Report
Quality Report
Quality Report
Quality Report
Quality Report
Quality Report
Value creation (or lack thereof)
Quality Report

Evolution to Value Based Models in Healthcare
17
Fee for
service:
Volume
rewarded
Pay for
Performance
/shared
savings –
incentives to
providers for
quality and
cost control
Limited
bundling –
condition and
time limited
(Bundled
payments)
Primary care
led – care
coordination
and
commissioning
(Patient
centered
medical homes
in US; Primary
care
commissioning
in NHS)
Community-
wide network
– coalition of
multistage
providers
taking
collective
responsibility
for a
population
(ACO’s in
USA; regional
trusts in UK)
Full
capitation
and risk;
Population
Health

Value Requires Healthcare Become Data-driven
Kernel
Metadata
Data Ingest
Real-time
Streaming
Machine
Learning
NLP
Source
Connectors
Catalyst Analytics Engine Core Services
Data
Processing
Secure
Messaging
Security, Identity
& Compliance
Health Catalyst Fabric
Registries
Terminology
& Groupers
EHR
Integration ISVsPRBLeading Wisely
Catalyst Apps
Care
Management
Apps
Alerting FHIR
Big Data
SAMD & SMD
Measures Patient & Provider
Matching
Atlas
Risk
Classifications
Patient
Attribution
Data Quality
Data
Governance
Data
Pattern
Recognition
Data Export
18

Outcomes
complete the
picture
19

Patient Centered Outcomes: A View on Quality
Across the Care Journey/Continuum
20
Patient at the center
Patient Outcomes
Clinical Outcomes
Environment:
socioeconomic,
cultural, healthcare
CULTURE OF
SAFETY

Hospital System View
Hospital 1
Clinical
measures
Process
measures
Structural
measures
Post-
Acute
Care
?
Outpatient
?

Patient Outcomes
Health Care
Clinical
measures
(HgbA1C,
BP control)
Process
measures
(waiting
times)
Structural
measures
(primary
care
physicians
per capita)
Community
Access to
healthy
foods
Access to
physical
activity
(parks,
gyms)
Patient
Health
literacy
Arenas of
intervention
Actionable
metrics
Overarching
health goals

“The 5% of all patients who are seriously ill and need the
most medical care account for a disproportionate 50-
60% of total healthcare spending.[1] The problem is not
that caring for the sick and the complex costs more than
caring for the well and healthy; of course it does. The
problem is that how we spend that money typically
fails to address the top priorities of such patients
and their families and caregivers.”
Diane Meier
23

How to define the
outcomes that
matter
25

Principles and best practices in defining patient centered outcomes
Sources of patient centered outcome measures and patient reported
outcome measures
Tools for collecting patient centered outcomes
Building patient centered outcomes as capstone of measures matrix
Constructing Patient Centered Outcomes
Matrix
26

Outcomes are results of care for people with similar needs,
across the complete care cycle, often spanning different
providers of care
Outcomes which matter most are best co-defined with citizens
and service users
Defining, measuring and interpreting is easier and more
valuable when we group by needs (patient centered view) than
by intervention or specialty (provider centered view)
Dr Rupert Dunbar-Rees, Outcomes Based Healthcare
27
Principles for Defining Patient Centered Outcomes

Patient Centered Outcome: Avoid Dialysis
Define the denominator: all patients who would prefer to avoid dialysis
but are at risk due to progressive chronic renal insufficiency (or ask)
Define the numerator: all patient who are not on dialysis, weighted for
# person-years in cohort, and also not deceased
28

In how many situations does your hospital / health system
systematically ask the patient’s goals/preferences? 90 respondents
a) 0 – 21%
b) 1 (code status/end of life) – 35%
c) 2 or more – 44%
Poll Question
29

What is an outcome and why are they important?3
Introduction & Context1
David Cryer
Jim Dodsworth
Terms of Art2
Identifying Our Outcomes4
Prioritising Our Outcomes5
Value Agenda Overview6
Exploring the Value Agenda
& Next Steps7

PROMIS
33

ICHOM
http://www.ichom.org/
International Consortium for Health Outcomes
Measurement
Co-founded by Michael Porter
Aims to support value based care
Convenes international experts to define
measure sets for common conditions
34

Example
Care Companion

Leveraging Insight
from Outcomes
51

52
Value-based
payment
alignment: 4
Continuous
Improvement
efforts: 5
Outcomes
implementation: 4
settings: 2
Alignment between
clinical measures &
patient outcomes: 4
metrics: 3

Which aspect of patient centered health are you most challenged by?
99 respondents
a) Engaging patients to identify outcomes and capture PROMs – 43%
b) Integrating the data from numerous sources / silos – 53%
c) Integrating care processes and outcome metrics across silos –
54%
d) Developing analytics insights from this data – 46%
e) Developing actionable decision support from this data – 53%
Poll Question
53

When surveying patients to determine the outcomes of
greatest importance to them, ParkinsonNet staff learned
that the highest priority needs of patients (eg sexual and
sleep complications) were not always the top concerns
of physicians (eg tremors).
“Changing the way healthcare is delivered: Patient centered
Parkinson disease care” BMJ Outcomes 2016
55

Using high-priority
outcomes identified by patients, various process and
outcome measurements were developed, including
several patient-reported outcome measures
57

Parkinsonnet Patient Centered Outcomes
• Independence (use of home care, nursing
home, voluntary care, daycare,
rehabilitation)
• Patients’ quality of life (EG mobility,
activities of daily living, emotional well-
being, stigma, social support, cognition,
communication, and bodily discomfort)
• Perceived quality of care as seen through
the eyes of the patient (emotional support,
cooperation, accessibility, providing
information, participation, and treatment)
• Employment and social participation for
patients
with Parkinson’s disease
• Burden on voluntary carers of patients with
Parkinson’s disease.
These outcome measures go well
beyond medical care and treatment.
Coupled with process and outcome
measures, such as hospitalizations
and hip fractures, these will provide
insights into both clinical and non-
clinical outcomes that are
important to patients.
58

Pay-for-Performance in ParkinsonNet by Using
Outcome Indicators
59
Health Insurer
€€€
Main contractor
€€ €
Value institute
ParkinsonNet
Providers
Process
Outcome
• 3 integrated care products
• fixed price per patiënt
based on phase PD
• 1 contractor
• promote collaboration
• Benchmarking data on
outcome and costs
o Improve overall quality
of care
o Reduce unwanted
variations
Source: ParkinsonNet

Parkinsonnet/CZ Insurance Agreements on
Goals and Triple Aim Indicators
Indicator Quality agreement
CQ Index Parkinson The average score on the CQ index is higher in comparison to
hospitals outside the network (average scores are above 75th
percentile)
Qualtiy of Life (QOL) The average QOL of patients measured 6, 18, 30 etc. months
after the first consult is higher in comparison to hospitals
outside the network (average scores are above 75th percentile)
% nursing home % of admissions in nursing home is lower in comparison to
hospitals outside the network (average scores are below 25th
percentile)
% hospitalization % of hospitalization is lower in comparison to hospitals outside
the network (average scores are below 25th percentile)
% hip fracture % patients with a hip fracture is below the Dutch average
Yearly healthcare cost Healthcare costs are lower than in hospitals outside the network
(averages are below 25th percentile)
Health
Gain
Quality of
Care
Costs
Source: ParkinsonInzicht

Example #2:
Improve Care Now
(C3N)
61

24 Pediatric GI Practice Sites

Eureka N-of-1 Mobile App
•Participant-facing “front end,” an
investigator portal, a secure “back
end” for data storage and analyses
•App allows:
• Collection of outcome data
• Tracking intervention/exposure
status
• Review of collected data in real
time
• Summary of N-of-1 results
•Website allows:
• Review of data
• Tracking of upcoming trial tasks
64

0
1
2
3
4
5
6
7
10/19/11
10/21/11
10/23/11
10/25/11
10/27/11
10/29/11
10/31/11
11/2/11
11/4/11
11/6/11
11/8/11
11/10/11
11/12/11
11/14/11
11/16/11
11/18/11
11/20/11
11/22/11
11/24/11
11/26/11
11/28/11
11/30/11
12/2/11
12/4/11
12/6/11
12/8/11
12/10/11
12/12/11
12/14/11
12/16/11
12/18/11
12/20/11
12/22/11
12/24/11
12/26/11
12/28/12
12/30/12
1/1/13
1/3/13
1/5/12
1/7/12
1/9/12
1/11/12
1/13/12
1/15/12
1/17/12
1/19/12
1/21/12
1/23/12
1/25/12
1/27/12
1/29/12
1/31/12
2/2/12
2/4/12
2/6/12
2/8/12
2/10/12
2/12/12
2/14/12
2/16/12
2/18/12
2/20/12
Nocturnal (I chart)Infliximab
19 yr. old with Crohn’s colitis
Colectomy with ileo-anal anastomosis (10 yrs)
Chronic diarrhea, nocturnal stools, fatigue, poor quality of life
Current medications: Infliximab & PRN imodium
Personalized Care
Heather Kaplan, MD, MPH, Jeremy Adler, MD, MPH, Shehzad Saeed, MD, Ian Eslick, MS,
Lloyd Provost, MS, Tom Nolan, PhD, Peter Margolis, MD, PhD

The ICN SCD N-of-1 Study
Series of individual N-of-1 trials comparing
SCD to a liberalized SCD
Randomized to SCD or liberalized SCD and
alternate between these two conditions for
four 8-week treatment periods
Patients and clinical team will use an app
and web portal to facilitate data collection,
tracking intervention status, and reviewing
individual trial results
Each individual will have personalized
answer about effectiveness of SCD vs.
more liberalized SCD in managing their
symptoms
Results of the individual N-of-1 trials
aggregated to estimate population level
effectiveness

Percent of Patients in Clinical
Remission
Crohn’s Disease and Ulcerative Colitis
67
Centers >75% registered
APR 2007 OCT 2008 AUG 2010 AUG 2012 JUN 2015
80%
95 GI Care Centers
>27,000 patients
> 900 physicians
>50% of all patients with
IBD

Ready for patient-
centered
outcomes?
68

69
Value-based
payment
alignment: 4
Continuous
Improvement
efforts: 5
Outcomes
implementation: 4
settings: 2
Alignment between
clinical measures &
patient outcomes: 4
metrics: 3

“Perhaps what you measure is
what you get.
More likely, what you measure
is all you get. What you don’t (or
can’t) measure is lost.”
- H. Thomas Johnson*
* “Lean Dilemna: Choose System Principles or Management Accounting Controls, Not Both”
Lean Accounting: a living systems approach to lean management and learning, 2007

Thank you!
Carolyn Wong Simpkins, MD, PhD
Chief Medical Informatics Officer, Health Catalyst
Carolyn.simpkins@healthcatalyst.com
72

Healthcare Analytics Summit 17
ERIC J. TOPOL
Author, The Patient Will
See You Now and The
Creative Destruction of
Medicine. Director,
Scripps Translational
Science Institute
DAVID B. NASH,
MD. MBA
Dean, Jefferson
School of
Population
Health
JOHN MOORE
Founder and Managing
Partner, Chilmark Research
ROBERT A. DEMICHIEI
Executive Vice President and
Chief Financial Officer, University
of Pittsburgh Medical Center
THOMAS D.
BURTON
Co-Founder, Chief
Improvement Officer,
and Chief Fun Officer,
Health Catalyst
DALE SANDERS
Executive Vice
President, Product
Development,
Health Catalyst
THOMAS DAVENPORT
Author , Consultant
Competing on Analytics*, ,
Analyitcs at Work, Big Data at
Work, Only Humans Need
Apply:Winners and Losers in the
Age of Smart Machines.
*Recognized by Harvard
Business Review editors as one
the most important management
ideas of the past decade, one of
HBR’s ten must-read articles in
that magazine’s 90-year history.
Summit highlights
Industry Leading Keynote Speakers
We’ll hear from well-known healthcare visionaries. We’ll also
hear from two C-level executives leading large healthcare
organizations.
CME Accreditation For Clinicians
HAS 17 will again qualify as a continuing medical education
(CME) activity.
30 Educational, Case Study, and Technical
Sessions
We have the most comprehensive set of breakout sessions of
any analytics summit. Our primary breakout session focus is
giving you detailed, practical “how to” learning examples
combined with question and opportunities.
The Analytics Walkabout
Back by popular demand, the Analytics Walkabout will feature
24 new projects highlighting a variety of additional clinical,
financial, operational, and workflow analytics and outcomes
improvement successes.
Analytics-driven, Hands-on Engagement for
Teams and Individuals
Analytics will continue to flow through the three-day summit
touching every aspect of the agenda.
Networking and Fun
We’ll provide some new innovative analytics-driven
opportunities to network while keeping our popular fun run and
walk opportunities and dinner on the down.
Early Bird
PricingSINGLE ENTRY
1 Pass -
$595
Save $300
BEST VALUE
3 PACK
3 Passes -
$545/each
Save
$1,000+5 PACK
5 Passes -
$495/each
Save
$2,000+
Sept. 12-14, 2017
Grand America Hotel
Salt Lake City, UT

Patient-Centered Insights Complete the Picture

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Patient-Centered Insights Complete the Picture

Similar to Patient-Centered Insights Complete the Picture (20)

More from Health Catalyst

More from Health Catalyst (20)

Recently uploaded

Recently uploaded (20)

Patient-Centered Insights Complete the Picture

Editor's Notes