Healthcare Data Warehousing for Business Coalitions

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Healthcare Data Warehousingfor Business
Coalitions

• James W. Lederer, MD, Chief Medical Officer
• Geoff T. Wood, President CEO
• Salem Health Solutions

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Learning Objectives

• Data Sources
• Public vs. Private
• Utility/Applications
• Technology
• Phased Approach to Implementation by Coalitions
• Build vs. Buy

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(No Transcript)
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The Urgent Need to Improve Health Care Quality
Institute of Medicine National Roundtable on
Health Care Quality JAMA 1998 2801000-1005
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After the IOM Report

• IOM - 98,000 deaths a year, cost 37B/year
• AHRQ - 770K injuries and deaths a year due to
  adverse drug events
• RWJF - very high percent of all doctors, nurses
  have witnessed a serious medical error
• RAND - patients receive appropriate care only 50
  of the time (NEJM June , 2003)

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After the IOM Report
PRESS RELEASES Released 1.26.00 BRT-Sponsored
Initiative Focuses on Patient Safety Testimony
Highlights Employers' Efforts to Reduce Medical
Errors Washington, DC - Speaking before the
Senate Health, Education, Labor and Pensions
(HELP) committee today, Dr. Arnie Milstein
discussed an innovative initiative sponsored by
The Business Roundtable (BRT) to address patient
safety and quality issues in America's health
care system. The program, entitled the "Leapfrog
Initiative, encourages large employers to
recognize and reward health plans and hospitals
that make breakthrough improvements in patient
safety and quality with preferential use and
other market reinforcements.
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Hospital Quality Data

• Historically, all hospitals were perfect because
  the physicians who worked within the hospitals
  were perfect and told us so.
• It is a capital mistake to theorize before one
  has data. Insensibly, one begins to twist facts
  to suit theories, instead of theories to suit
  facts. Sir Arthur Conan Doyle (1859 - 1930)
• Quality is never an accident it is always the
  result of intelligent effort. John Ruskin (1819 -
  1900)

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Hospital Quality

• JCAHO
• Mission To continuously improve the safety and
  quality of care provided to the public through
  the provision of health care accreditation and
  related services that support performance
  improvement in health care organizations

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Get the Gold!!!

• Quality is the pot of gold at the end of the
  rainbow, information is the path to the gold, and
  hospitals are the Leprechauns who control the
  path and the pot of gold.
• Youve got to get the gold from the Leprechauns!
• Be sure you got All the gold!
• Be sure what you got IS gold!
• Remember sometimes the path to the gold is not
  clear or understandable!

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The Right Path to the Gold??

• Early Databases and Quality Reports
• Medpar, Healthgrades, US News and World Report
  Best Hospitals, JCAHO
• Healthcare systems historically used these as
  primary gauges of quality
• Easy Access
• Nationally recognized
• Publicly recognized
• CMS Mandated

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The Right Path to the Gold??

• Medpar, Healthgrades, US News and World Report
  Best Hospitals, JCAHO
• Limited clinical data, limited outcomes data
• The quality connection is thin
• Not always apples-to-apples comparison
• The data is 2 years old - medical technology is
  changing much faster than that!
• To most physicians, the data is not meaningful
• Useless data for performance improvement
  activities within a hospital

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A New Path is Found to the Quality Pot of Gold

• JCAHO Core Measures
• CMS Public Reporting Initiative
• Leapfrog
• National Quality Forum
• National Committee for Quality Assurance
• Agency for Healthcare Research and Quality

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A New Path is Found to the Quality Pot of Gold

• Evidence-based literature underpinnings
• More clinical, outcome-based data though still
  many process measures reported
• Represent major service lines, patient safety
  issues, and include outpatient data
• National targets agreed upon - provides for
  comparative databases to be developed
• More meaningful data to physicians
• Also easily accessed

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Other Paths Can Also Lead to Rich Rewards

• Provider-driven clinical improvement initiatives
• Use of severity-adjusted data to analyze
  performance across the continuum of care
• Alter physician behavior and service line
  processes to improve outcomes
• Preparation for Pay for Performance by CMS,
  commercial and employer groups

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Provider-Driven Improvements
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Whats an employer to do??
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The Missing 70

• Medical claims
• Office visits
• Ambulatory Surgical
• ER
• Hospital outpatient
• Pharmacy
• Disability
• Workers Comp
• Productivity

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What You Really Need Actionable Information Not
Data

• Local market analyses
• Real time information vs. aged, static reports
• Information that engages all stakeholders
• Consumer
• Employer
• Payer/TPA
• PBM
• Physicians
• Hospitals

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Leveraging Technology to Get What You Need

• Technology now exists
• Driving the evolution of healthcare Data to
  Information, to Intelligence
• Foundation for meaningful financial and clinical
  decision-making
• Real-time information to decision makers where
  and how they need it
• HIPAA/ ERISA Security compliance

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Phased Approachto Implementation
byCoalitions
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Phase One Data Integration Validation

• Integrate disparate sources of data
• Medical claims
• Pharmaceutical claims
• Clinical observation data
• Disability and Workers Compensation claims
• Worker productivity data (i.e., absenteeism)
• Other health data (HRAs, DM data, etc.)
• Establish data credibility

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Phase 2 Data Hosting

• Systems built specifically to accommodate
  healthcare clinical and administrative data
• Customized for each Coalitions unique
  initiatives
• Current, plus 2-3 years historical data

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Phase 3 Data Transformation

• Provider data
• Provider Profiling
• Based on claims data
• Quick identification of outliers
• Severity adjustment
• Based on claims and ancillary hospital data
• Refined performance stratification
• Medical and pharmaceutical data
• Predictive modeling
• Population and Member Profiling

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Predictive Modeling

• Improvement in the accuracy of forecasting and
  budgeting for employee health related costs.
• R2 values of 0.27
• Traditional actuarial values lt 0.19
• Health risk profile of all members of the
  population.
• Identification of the highest risk members most
  likely to benefit from disease management
  interventions.

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Provider Profiling
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Provider Profiling
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Severity Adjustment Overview

• Multiple tools in the marketplace
• Industry recognized models, no industry standards
• Adjust severity in highly accurate and
  statistically valid manners
• Define disease states/conditions to analyze
  majority of patient encounters
• Report key Clinical, Financial and Quality
  indicators by disease/condition
• Benchmarks facility and physician performance
  internally and against external databases

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Benefits of Severity-Adjustment Tools

• Physician acceptance and trust of data
• Apple-to-apple comparisons
• Utility of data
• Ability to view stratified risk factors and
  outcomes
• Side-by-side comparison of cohorts

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Phase 4 Data Analyses

• Mine, analyze, organize, and share your data to
  discover opportunities for improvement.
• Define standard clinical and financial analyses
  that
• Establish benchmarks
• Prompt ad hoc queries

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INSIGHT
ACTION
Cost Driver Analysis
Taking Control
Continuous Improvement
Center of Excellence Contracting Network
Tiering Utilization Controls
HIGH Unit Price - LOW Frequency
Periodic Review Risk Prediction Outcomes
Analyses ROI Evaluation Evidence-Based Medicine
Benchmarking
Transplants Specialty Pharma
Disease Disability Management
Carve-Outs Total Population Management
HIGH Total Case Cost
Chronic Illness Shock Claims
LOW Unit Price - HIGH Frequency
Employee Education Consumer Benefit Designs
Antibiotics Labs Office Visits
Analytic Approach Driven by Technology
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Phase 5 Project Definition/Implementation

• Example Community Diabetes Treatment Project
• Member selection
• Initial provider tiering
• Patient volume
• Bell-curve or four-quadrant assignment based on
  historic data
• Evidence-based medicine guidelines
• Evaluation metrics
• Provider incentives

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Phase 5 Project Definition/Implementation

• Deployment of information pertinent to all
  stakeholders
• Education, education, education
• HIPAA-compliant, 24/7/365 web-enabled access

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Phase 6 Project Management

• Trend your data to track the progress of your
  actions
• Use stoplights
• Issue Report Cards
• Generate targeted satisfaction and outcome
  surveys
• Pay for Performance based on severity-adjusted
  data
• If you cant measure it, you cant manage it.

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Using Technology for.
Work/life support
Provider performance
Health risk assessments
Tiered network
Disease management
Gap analysis
Direct provider contracting
Wellness programs
Data Warehouse Analytic tools
Forecasting
Consumer-centric initiatives
Monitoring vendor performance
Plan design
Product Development
Measuring ROI
Information Transparency
Re-insurance Stop-loss needs
Cost Quality Improvement
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Key Warehouse and Analytic Benefits

• Access longitudinal data despite vendor/plan
  changes
• Improve outcomes
• Reduce lost time
• Impact costs
• Gaining Control
• Being Proactive versus Reactive

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Bottom Line ROI

• Beyond hospital data
• Technology available today
• Less expensive and more practical than ever
• More efficient to buy than build
• Faster implementation
• Minimal upfront investment
• Leverage the experience of others
• Yields a minimum ROI of 21, plus the greater ROI
  of better healthcare for employees more
  productive workforce