Accountable Care Transformation Framework

© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics


Accountable Care Transformation Framework

1

Webinar – June 4, 2014


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


PHM and Accountable Care (AC)

Accountable Care Financing and Administra7on

Popula7on Health Management developing

the asset

packaging and

marke7ng the asset


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


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



Access, Satisfaction

6



Provider network analysis (geoanalytics)

7


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)


Service Area Explorer

Dartmouth Atlas of Health Care (Healthcare Regions)


Network Composition Analyzer

10

Medicare FFS payments by venue – 2008-2012

Outpatient Clinic 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 Outpa7ent Inpa7ent SNF LTCH/IRF Home Health Hospice


Network Composition Analyzer Current network


?

?

Network access Current state (integrated layers)


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%



Patient Registries, Key Process Analyses

14



Patient Registries

15


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


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


Mapping ICD9 Dx to clinical hierarchy PrimaryICDDiagnosi 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$

© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 19

Clinical Programs Relative size (455 care processes)

Hem-Onc GI CV Gen

Med W&N Musc Resp Neuro Surg Comm Peds Spec

Beh

Inpatient Outpatient Series


ICD Patient Registries Foundational and discovery apps CLINICAL INTEGRATION HIERARCHY


Care Processes Total Variable Cost

CARDIOVASCULARIschemic heart disease 1Coronary 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 1Aortic 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 1Congestive 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 1Atrial fibrillation and flutter 1 7,943,076.82$ Cardiac rhythm device insertion, revision, replacement or removal 1 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 1Complication 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 1Heart 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 assessment1Pre-‐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$


Operational Content Population Management Content Patient Injury Prevention Content

Sha

red

Fram

ewor

ks

Available Newly Released or Enhanced

2014

Roadmap

Pla

tform

C

ompo

nent

s

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 Satisfaction Hosting 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 Modeler Clinical Hierarchies

Visualization & Architectural Frameworks

Essentials Layer Definitions Statistical Framework-Metric Correlation Framework

Workflow Content Framework Patient Injury Prevention Content Framework

Fina

ncia

l A

ccou

ntab

le

Car

e

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 Registries Readmission Predictor

Mental Health Deployment Templates

Pediatrics Specialty Respiratory

Oncology GI

Surgery Women & Children

Musculoskeletal Cardiovascular

Neuroscience Primary Care

Application Suite Patient Flow Explorer Patient Satisfaction

Labor Management Exp Supply Chain Explorer

A3/Value Stream Maps Ohio C

External & Regulatory

PM: Appointments Invasive

PM: Prof Billing Acute Medical

PM: Patient Access Ambulatory

PM: Orders and Referrals Therapeutic (Rx, Resp)

Practice Management Diagnostic (Lab, Path)

Patient Safety Explorer

Pressure Injury Falls (S, A, C)

Patient/Procedure Control Glucose Management

Venous Thromboembolism Transfusion

CLABSI Parenteral Nutrition TPN)

Surgical Site Infections RX: Electrolytes

CAUTI RX: Fluids

VAP RX: Medications

Infections Substances

Patient Flight Plan Predictor

A3/Value Stream Maps

Specialty Clinics

US N&W



Key Process (Pareto) Analyses

22


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-A

xis

= Pe

rcen

t of t

otal

reso

urce

s co

nsum

ed

Key Process Analysis (IP+OP)


Key Process Analysis (Pareto sort) CLINICAL INTEGRATION HIERARCHY










1 2 2,071,125.22$ GRAND TOTALS 5 19 143,717,960.78$

Pareto Care Processes

Pareto ICD Registries

All ICD Registries


Cardiovascular Clinical Program Pareto Care Processes


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%



Pricing based on disease density and severity of illness

27



Disease Density and Severity Level Explorer

28


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


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



Financial risk allocation

31


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”

32

Focus on “inlier” management


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



Network Access Contracting

34


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)


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?)


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%



Quality, Safety

38

© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 39

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


Health Maintenance and Preventive Guidelines

Substance Selection

Substance Selection

Clinical Supply Chain Management

Admission Order Sets Admission 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



Quality: Population Health Advanced Applications

40


Focus on the “Golden Few” CLINICAL INTEGRATION HIERARCHY










1 2 2,071,125.22$ GRAND TOTALS 5 19 143,717,960.78$

Pareto Care Processes

All ICD Registries

Pareto ICD Registries


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


AIM statement starter sets

Improvement initiative

knowledge assets

Process and outcome metrics & visualizations


Heart Failure Care Process Model


Heart Rhythm

Disorders

Vascular Disorders

Ischemic Heart

Disease

Heart Failure

CARDIOVASCULAR


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


Heart Failure Advanced Application



Safety: Patient Injury Prevention Applications

46


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


Patient injury – CMS HAC registries

•  Ventilator-associated pneumonia (VAP)

•  Adverse drug events (ADEs)


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


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


CLABSI prevention


CLABSI prevention “A-3” for process redesign


CLABSI prevention – tracking


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%



Cost (waste reduction)

55


56

PHM waste reduction construct

Population Health Management


Waste Per 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



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


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



Population ordering waste reduction

58





Clinic Care Chronic



Invasive Medical

Invasive Surgical

Diagnostic Work-up

Bedside care




Chronic Disease

Subspecialist


Sources of population ordering waste




Triage Criteria



Knowledge Assets

Substance Selection

Substance Selection


Procedure Treatment and

Monitoring Algorithms





Discharge







Per Case Knowledge

Assets


Post-procedure Care


Population ordering waste reduction Community Care dashboard

Popula7on ordering waste reduc7on NTSV C-‐Sec7on rate with no induc7on aGempt





Clinic Care Chronic



Invasive Medical

Invasive Surgical

Diagnostic Work-up

Bedside care




Chronic Disease

Subspecialist


Sources of per case ordering waste




Triage Criteria



Knowledge Assets

Substance Selection

Substance Selection








Discharge







Per Case Knowledge

Assets


Post-procedure Care


Per case ordering waste Appendectomy



Per case workflow waste reduction

65





Clinic Care Chronic



Invasive Medical

Invasive Surgical

Diagnostic Work-up

Bedside care




Chronic Disease

Subspecialist


Sources of per case workflow waste




Triage Criteria



Knowledge Assets

Substance Selection

Substance Selection








Discharge







Per Case Knowledge

Assets


Post-procedure Care


Workflow waste - surgical services


Workflow waste – surgical services

reduce room turnover time


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



Defect waste reduction

70


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


Focus on workflow/defect waste



Summary

73


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


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: [email protected]

© 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.


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Chronic condition management

Primary Care Physician

Chr

onic

Dis

ease

Su

b-sp

ecia

list

Medical Assistant

Gen

eral

ist

Car

e M

anag

ers

(RN

, Beh

)

Spec

ialis

t C

are

Man

ager

s (R

N, B

eh)

MD and/or APC

Clin Ops Behavioral


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PHM waste reduction construct

Population Health Management


Waste Per 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



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


Per Case Knowledge

Assets

Accountable Care Transformation Framework

Health & Medicine

Transcript of Accountable Care Transformation Framework