HIMSS Clinical & Business Intelligence Community of Practice. June 26, 2014

Transcription

1 HIMSS Clinical & Business Intelligence Community of Practice June 26, 2014

2 Welcome Michael Brooks, BS, MBA, CPHIMS C&BI Community Co-Chair Specialist Leader, Healthcare Information Management Deloitte Consulting LLP J.D. Whitlock, MPH, MBA, CPHIMS C&BI Community Co-Chair Vice President, Clinical & Business Intelligence Catholic Health Partners Shelley Price, MS, FHIMSS C&BI Community Organizer Director, Payer & Life Sciences, HIMSS Nancy Devlin C&BI Community Organizer Senior Associate, Payer & Life Sciences, HIMSS

3 Welcome Agenda HIMSS C&BI Community Updates / Announcements Tools and Resources Presentation & Discussion: Accountable Care Obstacles: The Holy Grail of Value Based Analytics and Why We Aren t Close Yet o J.D. Whitlock, Vice President, Clinical & Business Intelligence, Catholic Health Partners Wrap-Up / Next Steps

4 C&BI Community Updates / Announcements

5 C&BI Tools and Resources

6 C&BI Community Guest Speaker

7 Accountable Care Obstacles: The Holy Grail of Value Based Analytics and Why We Aren t Close Yet

8 Holy Grail of Value Based Analytics

9 Holy Grail of Value Based Analytics 1) Centralized EHR with PHM capabilities baked in 2) Well integrated clinical + claims + patient reported data to deliver holistic view of patient with advanced risk modeling, registries, care gaps, advanced clinical decision support (leveraging patient-specific clinical data) 3) Analytics from #2 delivered to care team within clinical workflow Ideally, supporting data is crunched outside EHR and imported back into EHR At worst, analytics are one click away with patient context sensitive single sign on 4) Patient Portal with appointment scheduling including virtual/video visits; integration of clinical & health plan experience; gamified wellness platform integrated with social media; easy integration with home monitoring & fitness devices 5) Mature EDW, mature BI capabilities, and a robust analyst team with both clinical & claims data skillsets 6) Industry-wide concurrence on <50 measures to monitor Triple Aim Quality + Pt Experience for all ACO patients Similar in concept to the CMS ACO-33 but modified for all patient populations Automated extraction of CQM data must be reasonably easy for CCHIT certified EHRs <50 is NOT counting specialty-specific / acute care / bundled payment (etc.) CQMs 7) Open source library of core clinical decision support algorithms

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11 2014 Reality of Value Based Analytics 1) Most ACOs are BYO-EHR and most EHR vendors are just starting their PHM journey 2) ACOs have to actually GET claims data first, then hire a team with new skill sets to manage it even WITH a good PHM platform, and THEN the hard part starts with normalization and advanced analytics 3) Single Sign On is doable but patient context sensitive SSO? And integration into clinical workflow? Multiplied by how many EHRs? 4) Advanced Patient Portal tethered to EHR(s) or PHM platform? Major integration challenges and no single vendor does everything 5) Mature EDW + mature BI capability is a JOURNEY and is resource intensive 6) <50 measures for Triple Aim does not HAVE to be hard, but would require some leadership (or maybe some legislation?) 7) We can dream, right?

12 Mid-2014 State of the Union for ACOs Only 25% of 2012-start MSSPs achieved shared savings in their first year First and prerequisite for other kinds of progress, the Nation must accelerate the transition to payment models that pay for value rather than volume BETTER HEALTH CARE AND LOWER COSTS: ACCELERATING IMPROVEMENT THROUGH SYSTEMS ENGINEERING. (PCAST) May 2014

13 VBC Death Valley Between Fee For Service and Value Based Care FFS

14 "To be an ACO, you need three things: 1. A common EHR 2. A robust data warehouse 3. A care coordination platform If you don't have those three elements, you are flying blind. Dan Moriarty CIO Atrius Health

15 60% of Atrius Health s revenue is from at risk contracts

16 New ACOs need to be very efficient copycats of accountable care success at organizations like: The success or failure of a nationwide transition to value based care hinges on the ability of hundreds of ACOs to learn very quickly from others At the end of the day, if the only successful ACOs are those from Geisinger, Mayo Clinic and Kaiser Permanente, what has society gained? --Mark Bard, MD, Tufts Health Care Institute, From "ACOs: The Least Agreed-Upon Concept in Healthcare?" via Becker's Hospital Review (May 2013)

17 #1) Centralized EHR Strategy Advantages Built-in clinical integration: vs. Reduced effort to bring PHM analytics to point of care Reduced effort to build & deploy new workflows Reduced effort to build a compelling patient portal Reduced effort to collect data for analytics E.g. annual MSSP GPRO reporting to CMS Operational process improvement reporting

18 #1) Centralized EHR Strategy Disadvantages Success is possible only by subsidizing EHR costs for affiliates obviously this gets expensive Inevitably, some candidate PCP ACO affiliates will desire to remain on their existing EHR If you just say no you may limit the viability of the ACO If you say yes then you inherit the same integration challenges you were trying to avoid with centralized EHR Many specialists, by the nature of their practice, cannot commit to a single ACO Great color commentary on Chilmark blog:

19 #2) The Interoperability Boogieman 51% of ACOs believed the biggest problem in their first year related to data or IT operations Interoperability is the leading IT concern for ACOs

20 #2) Good Luck With That

21 #2) Feb 2014 KLAS Report on HIE Vendors: Satisfaction with HIE solutions drops Overall provider satisfaction with HIE solutions has dropped an average of 8 percent since last year "Payment reform and the future of accountable care continue to keep many HIE vendors struggling to keep up with provider demands."

22 #2) Clinician Network Management (CNM) New report from Chilmark Research titled: The Migration to Clinician Network Management Our goal is to encourage ACOs of all sizes to reconsider their HIEs as something more than information exchange, namely a platform to support a variety of clinician information needs at the point of care CNM should enable: patient-centric longitudinal data viewing patient risk scoring care-gap analysis clinical care guidance care team coordination and interaction physician performance score-carding and attribution total cost of care determination for the population being served

23 #2) Data Normalization Diagnoses Labs & results Drugs Encounters Flow-sheets Procedures Devices Providers Locations Claims ICD, SNOMED LOINC SNOMED / RxNorm E&M Parsed and NLP CPT, SNOMED Standardized NPI Standardized 837/835

24 #2) Advanced Risk Modeling Bring risk scores into EHR Risk scores imported into EHR transactional database? Or PHM platform patient summary view exposed within EHR workflow 3 main uses cases for risk modeling: Identify higher risk patients for Care Coordination Pre-Contract Assessment of VBC or At-Risk Arrangements Risk adjusting quality measures, costs, panel sizes Use risk models to predict: Readmissions Admissions CHF CAD COPD ED visits Broken appts 24

25 #2) Registry-Palooza Large number of registries required To what extent is this doable in EHR(s)? This is where big data technologies begin to shine CHP uses a Hadoop-based PHM platform

26 #3) How Will You Deliver This Type of Patient-Level Information to Providers at the Point of Care? Source of graphic: Aetna / Banner Health HIMSS presentation

27 #3) Single Sign On vs. Bring External Data into EHR Maximize use of Infobutton HL7 standard (or EHR API) to link out to (or ingest) PHM analytics Optimize the steadily increasing PHM capabilities within EHR platform, e.g.: Bring claims generated risk profiling directly into the EHR Populate ACO registries directly in EHR

28 #4) Patient Portal & Activated Patients! (?)

29 #4) Sara Jane s 80/20 Rule on Patient Activation

30 #4) Possible Exception to Sara Jane 80/20 Rule: Personalized Risk Charts Showing Results of Behavior Modification

31 #4) Consumerization of Healthcare = Convenience is King = You Better Have a Good Patient Portal

32 #4) Patient CHP Centralized Epic EHR drives existing MyChart strategy Virtual visits First Epic client to use MyChart Bedside (Inpatient MyChart) Starting in 2015: Latest Epic version supports integration with Fitbit and Withings devices Healthplan module of Epic will enable integration of clinical + health plan experience for patients Adding best of breed wellness platform Comprehensive patient portal strategy

33 #5) ACO Analytics Architecture Pop Health Mgmt Platform Analytics Team Physicians Claims EHR EHR EHR (s) Other Data EDW / Total Cost of Care Care Coordinators

34 #5) Increasing Population-Specific Reporting Requirements All Shared Savings or At Risk Patients Employee Health Plan MSSP Medicare Advantage Commercial ACO Narrow Network Traditional Plan A Plan B Plan A Plan B

35 #5) ACO Patient Reporting Examples Practice Risk Report Identify higher risk ACO patients with risk profiling tools so they can be added to Care Coordination rosters Daily Census Daily report to Care Coordinators, lists all ACO patients (by PCP practice) who have been admitted, are in observation, or who visited the ED within the previous 24 hours Contract-Specific Measures Different cost and quality measures percontract drive need to tag multiple tiers of ACO patient populations and produce separate ACO dashboards for each contract

36 #5) Robust Analyst Team There seems to be a growing trend that analytics is a 'thing' or a tool (bright shiny object) that someone can purchase. I personally believe that analytics is about 80% smart people, 15 % good organization and operation and only 5% or less about the tools. Too many people are chasing a magic solution, but have not focused enough on developing a culture of analytics and the 'smart people' who can make them work. -- Mark Probst, CIO, Intermountain Healthcare Posted on

37 #5) Value Analytics CHP Challenge: Lack of organic ACO analytics capability CHP approach: Built a 9 person analytics team with dedicated support to ACO, PCMH, & Health Plan operations Half were core of existing Health Plan analyst team Focus on IHI Improvement Science methodology Expertise with combination of claims and clinical data Mix of experienced and junior analysts

38 #5) Value Analytics CHP: Mix of Clinical & Claims Expertise Legend: Manager, Value Analytics Strength in Claims Data Strength in Clinical Data Manager, Business Intelligence Analytics Manager, Claims and Clinical Analytics Analyst Analyst Analyst Analyst Analyst Analyst

39 #6) <50 Triple Aim Measures

40 #7) Open Source CDS CDS algorithms as extension of medical science Good use case for open source project Clinical Quality Framework Develop ecqms and associated CDS in lockstep and make it easy to implement

41 Please submit questions in Q&A box J.D. Whitlock, MPH, MBA VP, Clinical & Business Intelligence Catholic Health Partners

42 Wrap-Up Want to get involved? Speaker or topic ideas Key note presenter Blogger, twitter Contact Nancy Devlin Community Website

43 Wrap-Up We would like to extend our appreciation to the supporters of the C&BI Community

44 HIMSS C&BI Committee Leadership: Thank you! o THANK YOU! Extending a deep appreciation to our All-Star Committee for all the hard work, thought leadership, and spirit given FY14 All-Star Team C&BI Committee Members Diane M. Carr Chair J.D. Whitlock Vice-Chair/Com Co-Chair Thompson Boyd Michael Brooks Com Co-Chair Julie Burgoon Linda Campbell Terri Gocsik Ray Hess Michael Kurliand Arthur Panov Maxine Rand Wolf Stapelfeldt Board Liaisons Brian Jacobs Kathleen C. Kimmel

45 Next Steps JOIN US! Next meeting: Thursday, July 24, 2014 Next meeting: Thursday, September 25, 2014

46 FY15 Leadership and Contact Information Chair: Michael Brooks, BS, MBA, CPHIMS Specialist Leader Deloitte Consulting LLP HIMSS Community Organizers: Shelley Price, MS, FHIMSS Director, Payer and Life Sciences HIMSS Nancy Devlin Sr Assoc., Payer and Life Sciences HIMSS 46

47 Thank You and Have a Happy 4 th of July!

48 Appendix

49 COMMITTEE MEMBERS Diane M. Carr, FHIMSS Chair Deputy Executive Director North Bronx Healthcare Network J.D. Whitlock, MPH, MBA, CPHIMS Vice-Chair Director, Clinical & Business Intelligence Catholic Health Partners Thompson Boyd, MD, CPHIMS Physician Liaison Hahnemann University Hospital Michael Brooks, BS, MBA, CPHIMS Specialist Leader Deloitte Consulting LLP Julie Burgoon, MBA, CPHIMS, PMP Manager, Health IT BlueCross BlueShield of Tennessee Linda Campbell, FHIMSS, CPHIMS, PMP, MT, ASCP & SH Principal Consultant Sonoran Consulting Solutions C&BI Committee Terri Gocsik, CRNA, MS, CPHIMS Senior Manager Aspen Advisors Ray Hess, MS, FHIMSS VP, Information Management The Chester County Hospital Michael Kurliand, MS, RN IS Strategy Consultant Children s Hospital of Philadelphia Arthur Panov, MPH, CPHIMS HIT Architect, Biostatistics IBM Maxine Rand, DNP(c), MPA, RN-BC, CPHIMS Director, Clinical Ed, Practice & Informatics Kaiser Permanente Wolf Stapelfeldt, MD Chairman, Department of General Anesthesiology Cleveland Clinic BOARD LIAISON: Brian Jacobs, MD, FHIMSS VP & CMIO, Executive Director, Center for Pediatric Informatics Children s National Medical Center Kathleen C. Kimmel, MHA, RN, CHE, CPHIMS, FHIMSS Chief Clinical Officer Health Care DataWorks

50 C&BI Community of Practice The goal of the C&BI Community is to bring together thought leadership and share knowledge that will support the future success of our members by improving their ability to understand and form partnerships to manage C&BI as a part of doing business and providing accountable and quality care to their members. The Community will support activities that promote peer-to-peer networking, problem solving, solution sharing, and education. Topics of focus may include: Storage and Management of Data and Supporting Technologies Knowledge Management to Support Accountable and Quality Care Case, Risk & Cost Management Best Practices Clinical & Business Analytics Clinical Decision Support Research Data Warehousing/EDW Data Lifecycle Management

51 C&BI Community of Practice Open to all HIMSS members (current membership: approx 7,650 people) Will meet virtually 6-9 times/year Agenda for the meetings may include: Commencing with a short series of 2-Minute Drills presented various Community members Topical discussion with key note presenter The 2-Minute Drill is based loosely on the sports analogy, and in this case is a fast-paced (short in length) presentation on a hot, emerging, or timely topic, news event (e.g. research paper, game-changing market or technology news), or recent and relevant event (e.g., federal public meeting, legislative/federal/judicial news, critical conference or educational event). 2-Minute Drills foster greater peer-to-peer networking, member engagement, problem solving, solution sharing, and education. If you are interested in presenting any drills, please contact Nancy or Shelley.

52 FY14 C&BI Task Forces Data and Analytics Task Force CO-CHAIR: David Dobbs, PMP Health Analytics National Service Line Director Leidos Health CO-CHAIR: Carol Muirhead, MBA Sr. Informatics Project Specialist PinnacleHealth This group create resources and tools to help providers and provider organizations manage, integrate and aggregate the necessary information to support robust data and analysis, facilitate effective reporting by translating data into meaningful knowledge, resulting in improved quality, clinical and financial outcomes. Meeting times: 3 rd Tuesday of the month, 1:00-2:00pm ET NEW! Population Health Task Force CHAIR: William Beach, PhD. Program Chair, Health Services Administration Hodges University This group creates resources and tools to help healthcare organizations use C&BI to execute population health management initiatives to include creating tactical C&BI strategies around data and analytics as well as strategies for organizational planning and patient engagement. Meeting times: 3rd Tuesday of the month, 2:00-3:00pm ET Value of Operationalizing the Data Task Force CHAIR: Amy Rosa, RN Director, Clinical Informatics Baptist Health This group creates resources and tools focused on industry use cases. The use cases highlight best practices and lessons learned by providers and provider organizations using information to drive improved business and clinical decision-making. Meeting times: 1 st Thursday of the month, 1:00-2:00pm ET