Integrating Quality Data to Improve Care
Dan Housman
Managing Director and Co-Founder
October 20, 2010
Copyright © 2010 Recombinant Data Corp. All rights reserved.
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Outline/Agenda
• About Recombinant
• What is driving Clinical Intelligence in healthcare?
• Why Recombinant and IBI are partnering
• Case study – Piedmont Healthcare
• Demonstration
• Discussion
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About Recombinant
Best of breed software/analytics company focused 100%
on secondary uses of clinical data
Core Competencies
• Life science data warehousing & integration services
• Translational research & quality reporting solutions
• Data strategy, governance & compliance consulting
• Open Source implementations & extensions
Core Values
• Pragmatism
• Effective Communication
• Trust
3
Ecosystem
4
AMC - Personalized Medicine Vision
5
Perfect Storm Opportunity
Meaningful
Use
HITECH/HIPAA
Restructuring
EHR
Adoption
(e.g EPIC)
Personalized
Medicine
Accountable
Care
Organization
Why
Adopt
Now?
DW Solution
Maturity
10 Years
6
Data Access Needed for Quality Measurement Frameworks
PQRI
Provider
Bonus
Program
HEDIS/P4P
Operations
Physician
Incentives
Balanced
Scorecard
System
Incentives
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
Meaningful
Use
In Patient/Hospital
Ad-hoc queries
Report Library
Board
Reporting
Quality
Management
Core
Measures
Compliance
Six Sigma
7
Data management solution map
8
Why IBI and Recombinant are partnering
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Why IBI and Recombinant together?
Recombinant
IBI
Capabilities
Needs
Expertise in healthcare data sets
Packaged healthcare modules
Packaged data models, reference data
(measures), report library
Packaged reporting on IBI platform (future)
Implementation partners
(healthcare focus)
Consulting services (governance/strategy)
Custom healthcare BI development services
Needs
Capabilities
Packaged development tools
Packaged BI software
Advanced analytics/ad-hoc data mining
Advanced BI (ad-hoc mining) tools
Adapters to key source systems
Broad usage outside “clinical”
Broader capability reach
Solution partner/application
community
Adapter library
10
IBI Recombinant Partnership
Information
Builders
as
BI framework
Information
Builders
Recombinant
ETL Integration
Information
Builders /
Open Source
Integration
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ACOs/Analytics
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Bending the curve? ACO models…
“In God we trust; all others must bring data.”
W. Edwards Deming
2010
2013?
Payment
Reform
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Reducing “gaps” from transitions in care
Did heart failure visits have sufficient out patient follow-up?
Average Cost/Utilization Per Patient
Episode
Cost
120000
Outpatient
100000
Inpatient
Outpatient
80000
60000
40000
20000
0
-8
-7
-6
-5
-4
-3
-2
-1
AP/AR
0
1
Diagnosis
3
4
5
6
7
8
Claims
Processing
Episode of care
Health Need
2
Procedure
Results &
Outcomes
Patient
Perception
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Teams need measures & benchmarks
 For now what’s “hot”
 Figure out how to analyze clinancials to reduce costs
 Reduce 30 day readmits with care co-ordination/six sigma
 Reduce chronic disease costs for “high risk” (diabetes,
CAD)
 Use groupers that payers use (ETG, MEGGS, Prometheus)
or prepare for CMS grouper
 Join the ACO collaborative led by The Dartmouth Institute
and Brookings
 Near future
 Sites supporting open benchmarking as it evolves
 Best practice pathways will evolve from collaborations
 An open source CMS grouper and open analytics are
planned
15
Avoid Reinventing the Wheel
16
Recombinant Goal
17
Data Needed for Typical Report
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Operations
• Denominators (panels, locations)
• Practice snapshots
95
400
90
350
85
300
80
Percent
250
200
150
65
60
50
55
0
50
20
03
-1
20 1
04
20 3
04
20 -7
04
-1
20 1
05
20 3
05
20 -7
05
-1
20 1
06
20 3
06
20 -7
06
-1
20 1
07
20 3
07
-7
Avg. Time initialization (hrs)
Avg. Time to finalization (hrs)
45
% initialized 72 hr from visit
% initialized 120 hr from visit
% created total
Operations
• Visits/utilization
100
75
70
20
03
-1
1
20
04
-3
20
04
20 -7
04
-1
1
20
05
-3
20
05
20 -7
05
-1
1
20
06
-3
20
06
20 -7
06
-1
1
20
07
-3
20
07
-7
hours
• EHR adoption
Percentage of notes initialized within N hours
Visit to note cycle tim e
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Ad-hoc queries
Report Library
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Chronic Disease Management
• Diabetes
• Asthma
• CAD
Operations
• CHF
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Ad-hoc queries
Report Library
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Dashboard Measures
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Preventative Medicine
• Adult/Pediatric immunizations
• Cancer screening (Pap, Mammogram, Colonoscopy)
Operations
• Lab order completion
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Ad-hoc queries
Report Library
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Recombinant Data Model Overview
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Data Trust Subject Area Model
Interventions
Observations
Events
High Content
Vocabulary
Equipment
Provider
Organization
Devices
Medications
Procedures
Clinical
Decision
Support
Problems
Diagnosis
Notes
Biomarkers
Narratives
Labs
Orders
Incidents
Registration
Experiments
Images
Biomaterial
Insurance
Membership
Location
Patient
Reported
Outcomes
Appointments
Clinical Trials
Meta Data
Master Data
Patient
Omics
Compiled
Finance
Internal Analysis
Core Measures
External Analysis
Good Citizenship
Claims
Billing
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Data Trust Data Model: Entities
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Case Study – Piedmont Health
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Piedmont Clinic – Current State
• 4 Acute Care Hospitals
• 671 Physicians
• 250 Employed Primary Care
• 90 Employed Cardiology
• Other Employed Specialists
• Hospitalists, Transplant Surgeons, CT Surgery
• Balance of Independent Practices
• No health plan
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Piedmont Clinic (Brief History)
• Traditional PHO formed in 1980s - contracting
• Part of larger Atlanta Holding Company
• (Promina)
• Participated in Full-risk capitation
• Left Promina around 2002
• Clinic restructured around Financial Integration
Model
• Experience with measuring quality essentially mirrored
hospitals
• Added Patient Satisfaction (Office based)
• 20% financial risk
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Evolution to Clinical Integration
• New CEO 2008
• Studied Memorial Hermann
• MDs frustrated with quality data (limited to hospital)
and financial risk
• Required new governance
• Adopted PQRI to improve quality both inpatient and
outpatient
• 3 Quality Specialists “detailed” practices on CPT-II
codes
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Phase I (Jan-June 2010)
• Jan 2010 launched new web portal and CIT
• Combination of Clinical Integration and Financial
Integration
• Collect claims data from each MD in clinic and
associated CPT II (PQRI) codes
• All claims, all patients
• 670 docs represent 150+ DIFFERENT practice
management systems, Billing clearing houses
• 4 technical support + Recombinant to develop “back
end” claims loading process, coding metrics, etc
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Clinical Data Agents
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Clinical Integration Trust (CIT) – Phase 1
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Phase II
• Add Population Management Dashboards
• Integrate data across providers (PQRI, EMR) and
hospitals (EPSI)
• Had to “map” patients to providers
• 2 visits in 2 years
• Building risk adjustment model
• Adding metrics related to Efficiency and Cost /
Utilization
• Based on CMS metrics and methodology
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Clinical Integration Trust (CIT) – Phase 2
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Results
Metric
Community Acquired
Pneumonia (Hospital)
Congestive Heart
Failure (Hospital)
SCIP (Hospital)
Colon Cancer
Screening (Ambulatory)
Pneumovax age > 65
(Ambulatory)
Diabetes BP Control
(Ambulatory)
% Improvement
78% to 92% since 2007
83% to 90% since 2007
80 to 93% since 2007
(100 pts per yr)
+10% since Jan 2010
(958 more pts)
+25% since Jan 2010
(50 more pts)
+12% since Jan 2010
(700 more pts)
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Questions/Feedback discussion
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Thank You
Recombinant Data Corp.
255 Washington Street, Suite 235, Newton, MA 02458
Tel: (617) 243-3700 Fax: (617) 243-3788
www.recomdata.com
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