Visualize Your Data with Analytics. Monday November 2, :00 PM 3:15 PM

Transcription

1 Visualize Your Data with Analytics Monday November 2, :00 PM 3:15 PM

2 Presenter(s): Bob Dichter - Senior Director, Product Mgmt, Population Health Stephen Albuquerque Director of Data Analytics, R&D Mirth Topic Visualize Your Data with Analytics Level 300 CME/CNE

3 Safe Harbor Provisions/Legal Disclaimer This presentation may contain forward-looking statements within the meaning of the federal securities laws, including statements concerning future prospects, events, developments, the Company s future performance, management s expectations, intentions, estimates, beliefs, projections and plans, business outlook and product availability. These forward-looking statements do not represent a commitment, promise or legal obligation to deliver any material, code or functionality. The development, release and timing of any features or functionality described for our products remains at our sole discretion. Future products developed beyond what is contemplated by existing maintenance agreements, will be priced separately. This roadmap does not constitute an offer to sell any product or technology. We believe that these forward-looking statements are reasonable and are based on reasonable assumptions and forecasts, however, undue reliance should not be placed on such statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and uncertainties, some of which are outlined below. As a result, actual results may vary materially from those anticipated by the forward-looking statements. Among the important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are: the volume and timing of systems sales and installations; the possibility that products will not achieve or sustain market acceptance; the impact of incentive payments under The American Recovery and Reinvestment Act on sales and the ability of the Company to meet continued certification requirements; the development by competitors of new or superior technologies; the timing, cost and success or failure of new product and service introductions, development and product upgrade releases; undetected errors or bugs in software; changing economic, political or regulatory influences in the health-care industry or applicable to our business; changes in product-pricing policies; availability of third-party products and components; competitive pressures including product offerings, pricing and promotional activities; the Company's ability or inability to attract and retain qualified personnel; uncertainties concerning threatened, pending and new litigation against the Company; general economic conditions; and the risk factors detailed from time to time in the Company s periodic reports and registration statements filed with the Securities and Exchange Commission.

4 Getting to know the audience Where do you practice? < 10 provider group provider group 30+ provider group Other ACO? Current Less than a year Over a year Not in the plans Bundled Payments?

5 What are your Analytics Needs? Clinical Measures Cohort Management Comparative Physician Performance Financial Measures Leakage and Referral Other

6 Healthcare Industry is Evolving

7 Drivers of Health Market 2.0 Fundamental Shifts Resulting Market Dynamics A Rise of Value Based Care 1 Delivery System Restructuring B Acceleration of Consumer Powered Health 2 3 New Economic and Clinical Models New Customer and Competitive Landscape Oliver Wyman Group 3

8 Value-based healthcare Shifts focus from volume of services to patient outcomes achieved Coaching 1 Redefine care delivery and patient experience around clinical and financial outcomes E-health/ Web- Based Services Pharmacist Physician Case Manager Medication Management 2 Focus on patient-focused care that is collaborative, evidence-based and coordinated across continuum of care Weight Management Home Services Nutritionist Social worker Convenience Clinics Navigators Behavioral Health Extenders Social/Mobile Monitoring Lifestyle/ Wellness Healthcare tomorrow Patient-centered, high value population management Physicians drive shift from one-size-fits-all to population-health approach, aligning resources to meet patient needs Care becomes adaptive process driven by analytics that power robust decision tools to support care team and patients Redistributes revenues and profits amongst incumbent and new players resulting in new profit levers and leadership needs

9 Quality/Cost for Populations and Individuals

10 Public Policy Away from FFS to Population Health

11 So what is Population Health? A report in 2012 by the Institute for Health Technology Transformation (iht 2 ) provides a relatively good framework for the components that should be included in a complete solution ( It also provides a pragmatic definition of population health: The federal Agency for Healthcare Research and Quality (AHRQ) has developed a concept called practice-based population health (PBPH). It defines PBPH as an approach to care that uses information on a group of patients within a primary care practice or group of practices to improve the care and clinical outcomes of patients within that practice. Other observers also define the population as a provider s patient panel.

12 A successful independent ambulatory group of the future will have a whole new set of capabilities I enable my patients to engage with their own health I can effectively prioritize and triage care I use evidence-based medicine and guidelines to provide care I treat hospitals as commodities and try to limit use of these contracted services Wellness and Prevention I manage my clinical and administrative workflows on my ipad as I work Data & Analytics I facilitate direct patient payment and management of patient financial risk Referrals and network management Patient relationship Care Delivery & Coordination Revenue and practice management I know my patient and own the patient relationship I provide convenient and accessible care I monitor my patients remotely and can predict health events before they happen I run Smart Care teams with adaptive workflow systems I manage my revenue across a wide variety of contract types I have integrated cost, quality and experience measurement

13 Care teams will be deployed to proactively and holistically manage patient health based on individualized care plans Care teams needed for population health Value based acute and complex care services Communication platform Biosensors and monitoring Predictive insights engine Physical in the community resources Genomics and advanced diagnostics Smart clinics Retail pharmacy clinics Smart care teams partner with consumers to navigate and coordinate acute and complex care IT enablement engines Smart Care Team A Personalized Ecosystem Virtual health resource access Complex Adaptive Workflow Personalized Health Itinerary Intuitive engagement model Personalized connected relationship Weight management Stress management Nutrition management Better living programming Coaching Telehealth Real time biometric and daily living information Shared longitudinal and collaborative health record 7

14 How Fast? The market is projected to hit a tipping point shortly after 2016, with more than 30% of U.S. healthcare spend linked to value-based reimbursement $2.0 TN $1.8 TN $1.9 TN in 2020 (46% of total spend) $1.6 TN $1.4 TN Value market tops 30% of the total Tipping point Individuals & exchange $1.2 TN Innovative employers $1.0 TN $0.8 TN Duals $0.6 TN Medicare $0.4 TN $0.2 TN $ Managed Medicaid U.S. Value Market Opportunity by Funding Source , based on OW projectionsof choice, incentives, and access to value-based providers Oliver Wyman Group 6

15 ACO Landscape Today Medicare FFS beneficiaries attributed to an ACO

16 Top 6 Drivers shaping PHM 1.Improvement in Chronic Disease Management 2.Reduction in Healthcare Waste (Unnecessary Procedures, Duplicate Tests, PAA and Ed visits) 3.Identification and Management of High Risk Patients Longitudinal Med Record Mgmt Improvement Chronic Disease Mgmt Reduction Healthcare Waste 4.Improvement in Compliance with Standards of Care 5.Changing Reimbursement Shift from Fee-For-Service to Valuebased Reimbursement Managing Risk with Payers (including ACO) 6.Improvement in Managing Patient s Longitudinal Medical Record (including home monitoring) Changing Reimbursement Population Health Management Care Standards Compliance High Risk Patient Mgmt

17 PHM to Improve Collaborative Care Comprehensive PHM involves: 1. Identifying patients at risk & with gaps in care 2. Managing risk thru chronic care mgmt. 3. Improving clinical outcomes & patient satisfaction 4. Engage patient for proactive care 5. Reducing cost

18 Support for PHM ehealth Initiatives Population Health Survey Oct 2015

19 PHM Approach ehealth Initiatives Population Health Survey Oct 2015

20 Supporting Data % Analytics ehealth Initiatives Population Health Survey Oct 2015

21 Uses of Analytics ehealth Initiatives Population Health Survey Oct 2015

22 Analytics are ehealth Initiatives Population Health Survey Oct 2015

23 Key Takeaways ehealth Initiatives Population Health Survey Oct 2015

24 Who are your patients and how to manage?

25 Range of Function for PHM

26 Comprehensive PHM Solution Foundation Data Aggregation & Normalization Analytics Clinical Financial Operational Rule-based Workflows Patient Outreach Care Management Point-of-Care (EHR) Referral Management Patient Engagement Rule-based Workflows Patient Outreach Care Management Point-of-Care (EHR) Referral Management Analytics Clinical Financial Operational Patient Engagement Data Aggregation Data Normalization

27 Analytics as the Catalyst Analytics is the Catalyst for effective PHM, turning data into action: Clinical, Financial and Administrative analysis Risk stratification & identification of gaps in care Segmentation into appropriate cohorts understand our panel Comparative analysis and benchmarking Network utilization where is the leakage? Financial analysis where are spending money? Actionable Workflows for Care Management, Outreach & Referral powered by analytics

28 Introducing Mirth Analytics Part of Enterprise-wide Collaborative Care Solution from NextGen

29 Architecture Overview Sources NextGen Ambulatory NG Share Clinical/Claims Risk and Performance Management, Population Analysis, Provider Management, Ad hoc Reporting Adhoc Reporting Others HL7, XDS, CCLF etc Mirth Connect Clinical/Claims CDR (Results) Periodic Data Load Analytics (Staging) Computations Aggregations Analytics (Reporting) Technology Stack Database : Postgres Data Integration : Pentaho Scheduler : Rundeck UI : Angular & Node Js Build Your Own BI

30 Gennius - Analytics Engine a. Powerful measures analysis engine that allows healthcare delivery organizations (HODs) to identify outliers (organizations, physicians and patients) against benchmarks and take actions at the right time to close gaps in care and improve clinical performance. b. Versatile risk analysis engine that can use clinical and financial data to allow HODs analyze key financial indicators to identify and manage network leakage and improve financial performance. c. Flexible population analysis engine that allows healthcare providers (physicians, nurses and care managers) to find high risk patients (frequent flyers) to proactively manage care and improve standards of care and reduce healthcare waste (readmissions and ED visits).

31 Provider Comparative Analysis

32 Initial Release Key Features System Foundation (Data Aggregation, Centralized Data Repository, Security & User Roles, Audit, Measures Engine) Clinical, Financial (CCLF) data processing Clinical Performance Analysis (ACO-26) with Missed Patient List Population Analysis (Patient Categorization by Major Disease Conditions ) Risk and Provider Performance Analysis (In/Out Network, Inpatient, ED, Procedure & Drugs Utilizations) KPI & Trend Analysis Ad hoc Reporting

33 Clinical Performance Analysis CMO View CMO Mirth Group Mirth Practice Practice Level Compare Peers

34 Peer Comparison Compare Peers for selected measure

35 Clinical Performance Analysis Provider View Physician Select Measures Sort by % Towards Goal Legend Drill-down to Missed Patients

36 Missed Patient List View Patient Face-sheet Drill-down To Measure Met Patient List

37 Patient Face-sheet - 1 Clinical Data Scroll down Continued Next Slide

38 Patient Face-sheet - 2 Patient Activity Financial Data Scroll down Continued Next Slide

39 Patient Face-sheet - 3 Pharma Charges Data Charges by Care Settings

40 Population Analysis Provider s Panel Single-click filtering by Major Condition Category Normalized Patient Count In/Out Network Spend View Patient Face-sheet

41 Claims Reveal Breath of Information

42 Understanding Leakage with Claims Data

43 Out/In Network Charges & Patient Count CMO Top 20 PCP by Out of Network $ Default Sort by Out of Network $ View Provider Synopsis

44 Percentage Out of Network Top 20 PCP by % Out of Network Default Sort by Total Patients View Provider Synopsis

45 Provider Synopsis - 1 Normalized Financial Data Scroll down Continued Next Slide

46 Provider Synopsis - 2 Charges by OON Service Org Charges by Procedure Scroll down Continued Next Slide

47 Provider Synopsis - 3 Charges by Patient Demographic Charges by Major Condition Category

48 Leakage by Organizations Top 20 OON Organizations by Charges Default Sort by Charges

49 Leakage by Providers Top 20 OON Providers by Charges Default Sort by Charges

50 Admissions Normalized Stats Top 20 PCP by Admits Charge PMPM Default Sort by Admits Charge PMPM View Provider Synopsis

51 Predictive Analysis by Leveraging Milliman Industry Leading Brand Known for technical acuity Offers intelligent, independent analysis to help clients costeffectively manage their businesses or populations without compromising quality of care Expertise derives from the diverse backgrounds of their consultants, who include actuaries, clinician professionals, and information technology specialists

52 Access to Predictive Data through Incremental Product Releases

53 Analytics Incremental Releases Clinical Performance Analysis (Additional Quality Measures: PQRS, HEDIS, UDS, PCMH) with drill-downs Spend & Utilization Analysis (Detail Spend & Utilization Analysis) with drill-downs Population Analysis (Patient Cohort Builder & Risk Stratification) Alerts and Role-based Home Page Peer comparison using Blinded Benchmarking Risk & Pre-visit Assessment Network Referral Optimization Analysis Measures Submission using Certified Submission Agent

54 Analytics Incremental Releases Home-Monitoring Data Analysis Patient Outreach Analysis Predictive Modeling

55 Road Ahead: Analytics Enabled Workflows Patient Outreach - Letter Printing - Voice Reminders - Texting - ing - Patient Portal Care Management - Basic Workflows (CRM) - Dashboards - Work-lists - Advanced Workflows - Care Plan Documentation

56 Road Ahead: Analytics Enabled Workflows Point-Of-Care Integration - EHR Integration - Gap-in-care Alerts - Daily Huddle & Task Mgmt - Referral Management - Using HISP & EHR workflow Patient Engagement - Basic - Patient Portal - Patient Satisfaction Survey - Advanced - Mobile App & Multiple form factors - Centralized Appointment Scheduling - Patient Education

57 Questions?

58 Session Survey Please take a moment to complete a brief survey regarding this session. 1. Open your ONE UGM Mobile App (please note: you must have already logged in and accepted the Terms of Use to access this feature) 2. Click the Navigation Button at the top left of the screen 3. Select Sessions 4. Search for and select this session 5. From the sessions details screen, select Survey at the bottom right of the screen 6. Remember to hit Save at the bottom of the survey once you have answered the questions

59 Thank You!