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Create a Data Driven Processto Manage the Quadruple AimSession 301, March 9, 2018Angie Massey, Director, Strategic AnalyticsMemorial HermannPaul J. Lampi, Director, Enterprise AnalyticsMemorial Hermann1
Conflict of InterestAngie Massey and Paul J. LampiHas no real or apparent conflicts of interest to report.2
Agenda Overview of the Quadruple Aim Memorial Hermann overview Focus on Analytics Building a population health strategy3
Learning Objectives Describe Memorial Hermann’s process for data mining and datamanagement to meet the Quadruple Aim for healthcare improvement Explain the benefits of creating a cross functional team to drive theanalytics process to meet the healthcare operational needs of today’sleaders Illustrate how to create a longitudinal view of a person’s medical record toa enable quality, cost effective care4
Improved consumer experience Improved cost per capitaImprovedconsumerexperience Improved population outcomes Improved provider werhealth carecosts5Betterhealthoutcomes
Improving population health and the patients’experience of care while reducing costs –How do we get there?U.S. health care accounts for 17% of the GDPwith estimates that percentage will grow to nearly 20% by 20201.Measurement principles2:– Need for a defined population– Need for data over time– Need to distinguish between outcome & process measures,HCAand between population and project measuresCHISt. Luke’sHouston– Value of benchmark or comparison dataMethodist1NationalHealthcare Expenditure Projections, 2010-2020. Centers for Medicare and Medicaid Services, Office of theActuary.2StiefelM, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per CapitaCost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.6(Available on www.IHI.org)
Company Snapshot - 2017The Market Leader 6.0B Total Assets1 5.3B Net Operating Revenue124,000 Employees; 5,000 Physicians267 locationsMarket share ranking Inpatient market share1st: Aggregate Market Share1st: Burns1st: Cardiology1st: ENT1st: General Medicine1st: General Surgery1st: Neurology1st: Neurosurgery1st: Ophthalmology1st: Orthopedics1st: Rehab1st: Spine1st: Thoracic Surgery1st: Urology1st: Vascular2nd: Gynecology2nd: Neonatology2nd: Obstetrics2nd: Oncology 35% sharebased on %7%HCACHISt. Luke’s7%20%HoustonMethodist15%MHHS totalrevenuemore thandouble HCAHoustonGreater Houston MSA 6.6 million population,projected to 7.1 million (2020)77
Our PromiseMemorial Hermannemployees andphysicians will provideexceptional end-to-endpatient careexperiences anchoredby superior quality,clinical excellence andaffordable care with acommitment to advancethe health of ourpatients and members.8
Integration of PluralisticPhysician Model 4,000 MHMD Physicians, 3500 ‘CIN’Clinically Integrated NetworkPrivate, Employed &Faculty IntegrationIntegration of pluralistic physician model3 DISTINCT PRACTICE MODELSEmployment PrivateFacultyPopulation health infrastructure9
TIER I501,447membersMH Health PlanCommercialMHHS 39,136 Other28,881MH Health PlanMedicare Advantage 6,790Aetna Whole Health26,200101,007livesGain sharingTIER IIValue drivenCMS MSSP47,400Aetna Commercial85,000Humana Commercial18,700TIER IIIModerateDegree of risk shifting to providersHighPartial -full fiskAssuming Varying Degreesof RiskCommunity Health Choice54,740Aetna Medicare Advantage5,800Humana Medicare Advantage5,000United Healthcare MedicareAdvantage 8,800345,700livesBCBS Commercial75,000United ing10Delivery system readiness for riskIntegratedIncreasing degree of integration
Population Health PlatformApplicationsAlgorithms AnalyticsConsumerSepsisTOCReadmissionsHCC Suspected3MTruvenSmartDataPrimary EMRForeign EMR 1EMRsPaid claimsOn-sitebiometricsForeign EMR 3Foreign EMR 41111
Payer Data–––––MH Health Plan enrollment and claimsAetna enrollment and claimsMedicare ACO enrollment and claimsHumana enrollment and claimsBCBS enrollment and claims EMR Data– Primary EMR – 36 Primary Care and all Specialty Practices, InpatientData– Foreign EMR 1 – 101 Primary Care Practices– Foreign EMR 2 - UT Provider data– Foreign EMR 3 – Primary Care Practice Biometric Screening Data HIE (CCD) – RediClinic, USPI – Surgery Centers,Point Click Care, Homecare/Homebase12
Population Health TimelineHeI/Registry Contract LivePoint of CareReportAnalyticsLaunchEverydayWellAlignment Deal:PI EDW & MHiE HeISmartCareHealtheLife commendations
Consumer erexperienceQuadrupleAimLowerhealth carecostsBetterhealthoutcomes
Digital Experience inOur Daily LivesSusan has a busyday ahead of her.She wakes up to heriPhone alarm uses Slack tocollaborate with herproject team takes a quick callfrom her boss whileshe’s stuck intraffic using and is facedBluetooth with half a checks her Yahoo!Weather app todecide what towear At the office, Susantexts a coworkerthat she’s runninglate for their nextmeeting dozen paper forms on aclipboard that take her 15minutes to fill out – eventhough she has come to thisoffice for 5 years! checks Yelp for agood lunch spot witha colleague whorecently retired uses Waze fordrivingdirections so after surgery she isgiven 15 pages ofdischarge instructions listens toSpotify inher car who a busy receptionistasks to see her paper IDcard so that she can make aphotocopy browses CNN onher iPad while eatingbreakfast uses the Starbucksapp on her phone topick up coffee forher and a coworkeron the way to theoffice and as she arrives ather physician’s office,she finds a “TURNOFF YOUR CELLPHONE” sign on thefront door Before leaving the office forher doctor’s appointment, shechecks the MyCigna app to seeher HRA balance15and confirmher copay amount and bills from 6 differentproviders and an EOB from herinsurance company and enters herlunchtime caloriesinto MyFitnessPalbefore returning towork opens her WellsFargo app to checkher account balanceas she arrives at therestaurant pays for lunchusing Apple Pay
Past StateClasses and eventsPayMyBillMH releaseScheduleNow16Virtual CareCheckMyMemorialHermannShop/Buy/Enroll
Fixing the Strip Mall of AppsBeforeAfterThrough Digital Engagement we will provide: One login, one customer identity A single, consistent user experience Mobile-first design that is device agnostic Customer-managed preferences No more than 3 steps to access a featureWith no single user experience or identity, weoffer: Too many logins Desktop-only Up to 7 steps to access some features17
EveryDay Well AppMemorial HermannFormsMobile ID CardPhysician FinderIntegratedSchedulingHealth PlanSummaryEOBsPrimary EMRLabsDashboardMessagingHealth Plan ClaimsSymptom CheckerTreatment PlansPreferencesPhysician Messaging(TBD)Health RecordEveryday WellArrivalBundleShop, Buy, Enroll(Connecture)Find My Way(Connexient)Pediatric House Calls(PediaQ)Patient Reviews(TBD)MUPay My Bill(Simplee)AllergiesProxyGaps ofCareHold My Place in Line(ClockwiseMD)Physician Ratings & Reviews(Reputation.com)Third Parties18ProfileMedicationsAppointmentsHealth AssessmentCoachingAdvanced Care Planning(TBD)
Current DashboardSusanFamily19
Q3 Dashboard20
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Additional detail for facility and provider list as well as detail patient view23
HCC Tools CMS Payment ModelProspective workflow tool for providers to help identifydocumentation requirements– Persistent diagnoses Previously documented diagnoses which have not been documented yetin the calendar year on the patient.– Suspected conditions Diagnoses that are supported by data within SmartData (HealtheIntent),but have not ever been documented before, especially during thiscurrent year.Management dashboardRetrospective supplemental data chart chase24list
HCC:Prospective IntegratedWorkflow/POC PowerChart/PowerChart Ambulatory usershave integrated and streamlined access tothe HCC data. 25Available on Point of Care Report as well.
HCC Chart Chase26
Categories for Tracking Need Chart Review– Patients with a kept appointment greater than 90 days thathave HCCs which need to be on a claim. Schedule Appointment– Patients with suspected and/or persistent HCC gaps andneed to be scheduled for an appointment. Conduct Visit Doc/Code– Patients with a scheduled appointment who need to haveany HCCs documented and coded. Outreach for Future– Patients not seen this year who have no suspected orpersistent conditions and need to be seen.27
Categories for Tracking Pending Claim Validation– Patients seen in last 90 days with potential HCCs waitingto be on a claim. Healthy (No Opportunity)– Patients with a kept appointment in current year with noidentified HCCs. Entirely Validated– Patients with all suspected and persistent HCCs fullyvalidated.28
HCC Chart ChaseHCC Patient Chase29
experienceQuadrupleAimLowerhealth carecostsBetterhealthoutcomes
List of RegistriesSenior WellnessAdult DiabetesPediatricWellnessAdult WellnessAmbulatoryUrgent CareAsthmaBack PainDepressionHeart FailureIschemicVascular DiseaseCoronary ArteryDiseaseHypertensionRheumatoidArthritis31COPD
Adult Wellness:Pediatric Wellness:Hypertension: Annual Office VisitBlood Pressure MeasurementBlood Pressure Re-ScreenBody Mass IndexBody Mass Index Follow-up PlanBreast Cancer Screening (ages40-64)Cervical Cancer Screening (ages 21-64)Colorectal Cancer Screening (ages 50-64)Depression ScreeningDepression Follow-up PlanInfluenza VaccinationPost-Osteoporotic Fracture Evaluation – WomenPost-Osteoporotic Fracture Evaluation – MenTobacco Use Screening and CessationSenior Wellness: Annual Office VisitBlood Pressure MeasurementBlood Pressure Re-ScreenBody Mass indexBody Mass Index Follow-up PlanBone Density ScreeningBreast Cancer Screening (ages 65-69)Colorectal Cancer ScreeningDepression ScreeningDepression Follow-up PlanFall Risk ScreeningInfluenza VaccinationPost-Osteoporotic Fracture Evaluation – WomenPost-Osteoporotic Fracture Evaluation – MenPneumonia VaccinationAnnual Office VisitAdolescent Depression ScreeningImmunization Status Age 2Tobacco Exposure ScreeningTobacco Use Screening and CessationCOPD Registry: Semi-Annual Office VisitsBlood Pressure 140/90 mm HgIschemic Vascular Disease Coronary ArteryDisease: AMI or CAD: ACEI or ARB if diabetic or EF 40%Antiplatelet TherapyLipid PanelLDL 100 mg/dLLipid-Lowering TherapyAdult Diabetes: Antiplatelets for DM with IVD/CADBlood Pressure 140/90mm HgDiabetes Tx Mgmt ACE Inhibitor or ARBTherapyEye ExamHbA1C MonitoringHbA1C 8%HbA1c Poorly Controlled – HbA1c 9%Lipid PanelLDL 100 mg/dLLDL Poorly Controlled – LDL 130 mg/dLNephropathy ScreeningSemi-Annual Office VisitsTobacco Use Screening and CessationHeart Failure: Beta Blocker for Low EF ( 40%)Beta Blocker Therapy After AMISemi-Annual Office Visits32Asthma: Medication ManagementBack Pain: Imaging Studies for Low Back PainRheumatoid Arthritis Management: Rheumatoid Arthritis ManagementAmbulatory Urgent Care: Avoidance of Antibiotic Treatment inPatients w/ Acute BronchitisAppropriate Treatment for Children w/ URIAppropriate Testing for Children w/ Pharyngitis
SmartRegistry: IntegratedWorkflow/ Web Tool PowerChart/PowerChart Ambulatory usershave integrated and streamlined access tothe SmartRegistry module. 33Web-based access to SmartRegistry portal alsoan option.
SmartRegistry:POC/Right Chart PaneleCW Current Workflow: Providers/Staff can access a daily reportshowing gaps of care for patientseCW Integrated Workflow: A fully integrated panel showing gaps ofcare for patientsTest, Patient01/01/1960MRN 123434
SmartRegistry:MSSP Claims eCW Encounter DataMSSP claims dataXXX EMR encounter with physician35
Quality DashboardFiltersTop areas for improvement36
Quality DashboardQuality – provider/practice37
Tracking Contract MetricsSupporting value-based care & fee-for-service contracts 38
But Wait There’s More!!!39
Provider erexperienceQuadrupleAimLowerhealth carecostsBetterhealthoutcomes
SmartRegistry:Integrated WorkflowPowerChart/PowerChart Ambulatory usershave integrated and streamlined access tothe SmartRegistry module.Web-based access to SmartRegistry portal alsoan option.41
SmartRegistry: MSSP Claims eCW Encounter DataMSSP claims dataXXX EMR encounter with physician42
Direct access to SmartAnalyticswhere reports and dashboardare exposed in project groups tospecified usersAllows us to get claim leveldetail directly out to the reportaudience.43
“Our providers love having dataintegrated into their workflow. Theseamless integration makesproviders’ lives easier and theiruse of the EMR and Registry toolmore satisfying.”Alan Weiss, MDAVP, CMIO - Ambulatory
Received additional dollars from Aetna due to using SmartAnalytics to showadditional care gaps closed meeting a higher threshold. In October, used 3M Episodic grouper to analyze and respond to a bundle RFP Visualization of network utilization by providers is providing insights into how wecan better server the community. Productivity– Previous analysis method consisted of pulling data and reporting eachtime something was needed.– Time spent on requests is converting from creating the analysis toevaluating the analysis. We can tell the story instead of spending all ourtime putting the story together.45
Continued workflow tools and analytics dashboards and reports toimprove quality, optimize network and reduce overall cost– Potentially preventable events– Care redesign/performance improvement– Incentive payment reporting– Employer solutions– HEDIS submission for health plan46
Preparing for BundledContracts Understand physician performance in an episodic context– Especially important for specialists– Provides different lens for cost in care continuum Ability to group across different types– Episodes, Diagnoses, Risk Setting up for employer “Centers of Excellence”47
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Population Health ceexperienceApplicationsAlgorithms QuadrupleAimLowerLowerhealth nsHCC Suspected3MTruvenSmartDataEMRs49 claimsPaidOn-sitebiometrics49
Questions Angie.Massey@memorialhermann.org Paul.Lampi@memorialhermann.org Please complete the online session evaluation50
- Primary EMR -36 Primary Care and all Specialty Practices, Inpatient Data - Foreign EMR 1 -101 Primary Care Practices - Foreign EMR 2 - UT Provider data . PowerChart/PowerChart Ambulatory users have integrated and streamlined access to the HCC data. Available on Point of Care Report as well. 26
