Using Medicare and Cerner Electronic Health Facts data

1. CHSI Final Report
November 29, 2016 Presenter: Team7
Prashanthraj Goud
Vaibhav Vanamala

2. Objectives
Use Medicare and Cerner Electronic Health Facts data to:
• Perform descriptive analytics to characterize the data and identify patterns
and trends of disease
• Make recommendations to CMS (Center for Medicare and Medical Services)
• Compare the analysis of Medicare and Health Facts dataset and to
identify whether both datasets support each other or diverge from each
other

4. Heart Disease

5. Why are we interested in heart disease?
• It is the leading cause of hospitalization in people older than age 65;
• 1 in every 4 death occurs due to heart disease in the U.S;
• Early actions is important for treating heart attack.
About 47% of sudden cardiac deaths occur outside a hospital.
(http://ww.cdc.gov/heartdisease/facts.html)

6. Data preparation
Electronic Health Facts
1 2 3 4
1 2
2008---2010 2008---2010
• Diagnose
• Encounter
• Procedure
• Categorical
• Diagnose
• Encounter
• Procedure
• Categorical
Medical Claim
RAW DeSYNPUF DATA
BENIFICIARY DATA 2008, 2009 & 2010
OUTPATIENT CLAIMS DATA 2008-2010
MODIFIED DeSYNPUF DATA
BENIFICIARY ALIVE DATA 2008-2010
BENIFICIARY DEAD DATA 2008-2010
BENIFICIARY _OUTPATIENT _ALIVE DATA
2008-2010
BENIFICIARY_OUTPATIENT_DEAD DATA
2008-2010

7. Basic Demographic Findings—
Medicare data
• About 1/3 of the patients suffer from CHF
• Occurrence of CHF is mostly found in:
-Females
-Caucasians
-Age group of 65 to 80+
-Texas and Kentucky states
-Patients with Ischemic heart disease and/or diabetes
• Medicare trust fund pays: $306/claim record;$985/patients.
• Annual Medicare reimbursement amount: $370/patients, it depends on:
1.beneficiary responsibility amount
2.other disease
3.age group (patients of age>60)
• Medicare reimbursement amount increases by $200-250 when CHF is associated with
diseases like cancer and depression. It is 47% more for heart disease than all other diseases.
• Beneficiary responsibility amount for CHF is 200% more for heart disease than all other
diseases
Medicare
Reimbursement
+ Beneficiary
responsibility
Total Amount:

8. Basic Demographic Findings—
Cerner Health Facts Data
Occurrence of Chronic Heart Failure is more in
• People from Northeast region
• Caucasians followed by African American
• Age group 85 -90
• Patients with symptoms of disease and disorder of circulation system
Diseases that occur along with CHF are-
• Therapeutic drug monitoring
• Diseases having diagnosis description of anticoagulants usage
• Anemia
• Atrial fibrillation
• Long term use of medication and other persistent mental disorder

9. Discussions
Comparing the analysis of Medicare and Cerner Health Facts datasets, the differences in
some findings are summarized as in Table.1:
Table.1 Comparison of difference findings between Medicare and Cerner Health Facts data

10. Discussions
(https://www.optum.com/content/dam/optum/resources/whitePapers/Benefits-of-using-both-
claims-and-EMR-data-in-HC-analysis-WhitePaper-ACS.pdf)

11. Recommendations
1. Advocate awareness campaign for people at higher risk of CHF:
• Female
• Caucasian and African America
• Age group of 60 years old above
3. Ensure adequate hospital services for areas have higher CHF distributions:
• States/regions that have the higher percentage of CHF patients: Texas, Kentucky;
4. Improve CMS Medicare scheme to help patients reducing beneficiary amount:
• The responsibility amount of CHF patients is twice as compared to all other diseases
2. Ensure easy diagnosis and preventions for:
• Patients suffering from Ischemic heart disease and/or Diabetes (prone to associate with CHF)
• Patients suffering from top 5 CHF associated diseases
• Patients with symptoms that occur the most along with CHF

12. Thank You