COMPANY HISTORY
1989
Staff developed and supported innovative
clinical, financial, and marketing
applications for SysteMetrics/McGraw-Hill
(New York, NY)
1992
HCIA, Inc. (Baltimore, MD): staff responsible
for HCIA’s Provider Profiling Business Unit
which led company’s IPO in February 1995.
1995
The Delta Group founded by former HCIA
staff to specialize in improving the clinical,
financial, and market performance of
healthcare organizations.
Present
The Delta Group offers web-based provider
profiling products to leading healthcare
organizations across the country.
HOSPITAL
ORGANIZATIONS

University HealthSystem Consortium (UHC)

Henry Ford Health System

Baycare Health System

Iowa Health System

Trinity Health System

SunLink Healthcare Corporation

Galaxy Health Alliance

Maine Health Alliance

Sagamore Health Network
TEACHING HOSPITALS &
ACADEMIC INSTITUTIONS

Massachusetts General Hospital (Harvard)

Brigham & Women’s Hospital (Harvard)

Yale-New Haven Hospital

Mary Hitchcock Memorial Hospital (Dartmouth)

Vanderbilt University Hospital

Robert Wood Johnson University Hospital

University of Notre Dame

Medical College of Virginia Hospitals

University of Alabama-Birmingham Hospital

Erlanger Medical Center

Oregon Health Sciences University Hospitals
PHYSICIAN
ORGANIZATIONS

Partners Community Healthcare (Harvard)

HealthCare Savings (North Carolina Medical Society)

Morton Plant Mease PHO (Physicians Health Alliance)

Presbyterian Medical Group

Preferred Health Services

Heritage Health System

Mid-Valley CareNet
OTHER
ORGANIZATIONS

Tennessee Hospital Association

Oregon Association of Hospitals and Health Systems

CSC Healthcare Group

Cambio Health Solutions

Peat Marwick

Ernst & Young

Physcape (MGMA)

Prudential

BC/BS of Alabama

Ford, Chrysler & General Motors (MHA)
PARADOS®
Provider Profiling System

Physician Hospital Practice Analysis

ORYX Clinical Performance Analysis

Hospital Competitive Positioning Analysis

Hospital Quality Outcomes Analysis

Hospital Planning and Marketing Analysis (2004)

Physician Office Practice Analysis

Continuum of Care Analysis
APPLICATIONS
®
OF PARADOS

Clinical Resource Management and Quality
Improvement

Knowledge-Based Managed Care Contracting

Provider Network Evaluation and Monitoring

Strategic Planning, Marketing & Public Relations
$750,000 Increase in Financial Performance
$150,000
$150,000
Supplies
Supplies
$185,000
$185,000
Laboratory
Laboratory
$415,000
$415,000
Operating
Operating Room
Room
“Using The Delta Group’s PARADOS Provider Profiling System, we were able to improve our financial
performance by $750,000 by altering practice patterns and policies in laboratory, operating room, and
medical/surgical supplies. Importantly, The Delta Group’s software and consulting services allowed
us to achieve a favorable managed care position in the marketplace.”
Jeff Judd, CEO
The McDowell Hospital (65-bed general, acute care hospital)
North Carolina
Severity & Risk
Adjustment
Clinically Adjusted Data Accounts
for Differences in Patient:
• Severity (stage of disease)
• Intensity (resource need)
• Complexity (type of CCs)
Adjusted Data Provides an Accurate
Unit of Measure for:
Peer and Benchmark Comparisons
Accurate Outcome Comparisons Require
Indicator-Specific Adjustment Methods
™
• Charge/Cost: APS-DRG Relative Charge/Cost Weights
• Length of Stay: APS-DRG™ Relative LOS Weights
• Mortality Rates: Risk-Adjusted Mortality Index™
• Complication Rates: Risk-Adjusted Complications Index™
• Readmission Rates: Risk-Adjusted Readmissions Index™
Indicator-Specific Severity & Risk-Adjustment Methods
Are Required to Accurately Assess
Variation in Clinical & Financial Outcomes
Risk-Adjusted Readmissions Index
(RARI)
 Standard logistic regression was used to model risk of an
unanticipated readmission to the same hospital within 30
days of discharge for specific diagnoses and procedures
 Predictive variables used for risk of readmission were:
o age
o sex
o presence or absence of comorbidities “and” complications
o presence of cancer (except skin cancer)
o DRG cluster (risk associated with principal
diagnosis/procedure)
o total number of comorbidities
Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality,
Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.
Risk-Adjusted Mortality Index
(RAMI)
 Standard logistic regression was used to model risk of death
during a hospital stay for specific diagnoses and procedures
 Predictive variables used for risk of death were:
o age, sex, race
o presence or absence of comorbidities (not complications)
o presence of cancer (except skin cancer)
o DRG cluster (risk associated with principal
diagnosis/procedure)
o total number of comorbidities
Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality,
Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.
Risk-Adjusted Complications Index
(RACI)
 Standard logistic regression was used to model risk of postsurgical and post-obstetrical complications during a hospital
stay for associated diagnoses and procedures
 Predictive variables used for risk of complications were:
o age
o sex
o presence or absence of comorbidities (not complications)
o presence of cancer (except skin cancer)
o DRG cluster (risk associated with principal diagnosis/procedure)
o total number of comorbidities
Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality,
Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.
The Need to Clinically Adjust Inpatient Information
DRG 127: Heart Failure & Shock
Principle Diagnosis: Congestive Heart Failure
Secondary Diagnoses:
Patient #1
Acute Bronchitis
Clinical Demand Index: .654
Patient #2
Stroke
Clinical Demand Index: 2.154
CDI Norm: 1.000
$14,000
$11,352
$12,000
$10,000
$9,017
$8,000
$5,897 / .654
$6,000
$5,897
Actual Charge
$5,270
$11,352 / 2.154
$4,000
Clinically Adjusted Charge
$2,000
$0
Patient #1
Patient #2
All Payer Severity-adjusted DRGs
™
(APS-DRGs )

Developed by HSS, Inc.
(participated in original Refined-DRG research with CMS—formerly
HCFA)

Incorporates most recent CMS severity research (SDRGs)
 Use principal and secondary diagnosis to indicate the severity
of a patient’s illness to predict inpatient resource need


Use occurrence and degree of surgery as a discriminating
variable; occasionally use patient’s age and discharge status
Applicable for all hospitalized patients, regardless of age, type
of illness, or payer category

Comprised of 1,076 clinically homogeneous statistically stable
groups
 Reviewed by clinicians to ensure clinical integrity
Source: “All Payer Severity-adjusted DRGs (APS-DRGs): A Uniform Method to Severity-adjust Discharge Data.”
Topics in Health Information Management, Winter 1997.
™
APS-DRG
Patient Classification System
Severity
Class
Description
Clinical Examples
0
No CC or Major CC:
Heart failure & shock w/o CC
1
At least 1 CC:
Heart failure & shock w/ hypertension
2
At least 1 Major CC:
Heart failure & shock w/ acute renal
failure
Source: “All Payer Severity-adjusted DRGs (APS-DRGs): A Uniform Method to Severity-adjust Discharge Data.”
Topics in Health Information Management, Winter 1997.
Differences in Patient Risk for Adverse
Events within the Same Severity Class
DRG 107: Coronary Bypass w/Cardiac Catheterization
(Severity Class 2)
34.0%
Mortality Risk
11.0%
Patient A
Patient B
57.0%
Complications Risk
68.0%
0%
10%
20%
30%
40%
50%
Risk of Adverse Outcome
60%
70%
80%
®
PARADOS
Clinical, Financial & Market Indicators:
(Includes Severity & Risk-Adjustment where Appropriate)








Charges
Costs
Gross Margins
Lengths of Stay
Mortality Rates
Complication Rates
Readmission Rates
ORYX Core Measures








Market Share
Patient Origin
Patient Outmigration
Demographics
Lifestyle Characteristics
Acute Morbidity Projections
Acute Use Rates
Planning Indicators by MD,
Employer, and Health Plan
PARADOS
®
ORYX Core Measurement Sets*:

Acute Myocardial Infarction (AMI 1-9)

Heart Failure (HF 1-4)

Community Acquired Pneumonia (CAP 1-5)

Pregnancy & Related Conditions (PR 1-3)
FUNCTIONALITY OF PARADOS


®
Provides online access to evidence-based guidelines
(EBGs) developed by the Institute for Clinical Systems
Improvement (ICSI)
Easily sorts, finds, filters, graphs and trends data

Compares to national benchmarks of top performing
providers

Compares to national, regional, or local peer groups

Customizes service lines and payer groupings

Drills-down to the diagnosis, procedure & patient level

Creates PDF and comma-delimited files for ease of
distribution & customization
Consulting
CONSULTING
SERVICES

Management consulting in executive
summary format

Medical management consulting led by
practicing physicians

Lean Six Sigma training in seminar format
MEDICAL MANAGEMENT
CONSULTING

Dwight Wooster, MD

James Kennedy, MD

Michael Langley, MD

William Hill, PharmD

Judy Homa-Lowry, RN, MS

Linda Easterly, MS, BSN

Cynthia Whitaker, BS, RRA

Henry Dove, PhD
LEAN SIX SIGMA
TRAINING

Conducted by Master Black Belts certified by
The George Group

Integrates Lean techniques for “minimizing
complexity and eliminating waste” with Six Sigma
methods for “improving quality and reducing
variation”