Post on 09-Jun-2020
Monday – November 2, 2015 – 2:00 PM – 3:15 PM
Visualize Your Data with Analytics
Topic
Level
Presenter(s):
Bob Dichter - Senior Director, Product Mgmt, Population Health
Stephen Albuquerque – Director of Data Analytics, R&D Mirth
Visualize Your Data with Analytics
300
CME/CNE
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,
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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
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economic conditions; and the risk factors detailed from time to time in the Company’s periodic reports and registration statements
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Getting to know the audience
• Where do you practice?• < 10 provider group
• 10 – 29 provider group
• 30+ provider group
• Other
• ACO?• Current
• Less than a year
• Over a year
• Not in the plans
• Bundled Payments?
What are your Analytics Needs?
• Clinical Measures
• Cohort Management
• Comparative Physician Performance
• Financial Measures
• Leakage and Referral
• Other
Healthcare Industry is Evolving
Drivers of Health Market 2.0
Rise of Value
Based Care
Acceleration of
Consumer
Powered Health
Delivery System
Restructuring
New Economic
and Clinical Models
New Customer and
Competitive
Landscape
Fundamental Shifts Resulting Market Dynamics
1
3
© Oliver Wyman Group
2
3
A
B
Value-based healthcare
Healthcare tomorrow
“Patient-centered, high value population management”
Redefine care delivery and patient
experience around clinical and financial
outcomes
1
Physicians drive shift from one-size-fits-all to
population-health approach, aligning
resources to meet patient needs
3
Care becomes adaptive process driven by
analytics that power robust decision tools to
support care team and patients
4
2 Focus on patient-focused care that is
collaborative, evidence-based and
coordinated across continuum of care
Redistributes revenues and profits amongst
incumbent and new players resulting in new
profit levers and leadership needs
5
Coaching
Medication
Management
E-health/
Web-
Based
Services
Convenience
Clinics
Weight
Management
Home
Services
Monitoring
Lifestyle/
Wellness
Social/Mobile
Physician
CaseManager
Extenders
Behavioral Health
Navigators
Social worker
Nutritionist
Pharmacist
Shifts focus from volume of services to patient outcomes achieved
Quality/Cost for Populations and Individuals
Public PolicyAway from FFS to Population Health
So…what is Population Health?
A report in 2012 by the Institute for Health Technology Transformation (iHT2)
provides a relatively good framework for the components that should be
included in a complete solution (http://ihealthtran.com/pdf/PHMReport.pdf).
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.”
Data & Analytics
Referrals and network management
Patient relationship Care Delivery & Coordination
Revenue and practice management
A successful independent ambulatory group of the
future will have a whole new set of capabilities
I know my patient
and own the patient
relationship
Wellness andPrevention
I provide convenient and
accessible care
I monitor my
patients
remotely and
can predict
health events
before they
happen
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 manage my revenue
across a wide variety of
contract types
I manage my
clinical and
administrative
workflows on my
iPad as I work
I run Smart
Care teams
with adaptive
workflow
systems
I treat hospitals as
commodities and try
to limit use of these
contracted services
I facilitate direct
patient payment and
management of
patient financial risk
I have
integrated cost,
quality and
experience
measurement
Care teams will be deployed to proactively and holistically
manage patient health based on individualized care plans
Complex Adaptive Workflow
Personalized Health Itinerary
Intuitive engagement model
Real time biometric
and daily living
information
Value based acute and
complex care services
Personalized connected
relationship
Smart care
teams partner
with consumers
to navigate and
coordinate
acute and
complex care
Smart Care
Team
A Personalized
Ecosystem
Communication
platform
Biosensors and
monitoring
Predictive
insights engine
Weight
management
Stress
management
Nutrition
management
Genomics and
advanced diagnostics
Smart
clinics
Retail
pharmacy
clinics
Coaching
Telehealth
Physical in
the community
resources
Virtual health
resource
access
Better living
programming
IT
enablement
engines
Shared longitudinal
and collaborative
health record
Care teams needed for population health
7
How Fast?
2014 2015 2016 2017 2018 2019 2020
$0.6 TNMedicare
$0.4 TN
$0.2 TN
Managed Medicaid$0
$0.8 TN
$1.2 TN
$1.0 TN
$1.4 TN
$1.6 TN
$1.8 TN
$2.0 TN
2013
U.S. Value Market Opportunity by Funding Source2013-2020, based on OW projections of choice, incentives, and access to value-based providers
$1.9 TN in 2020
(46% of total spend)
Tipping point
Innovative employers
Individuals & exchange
Duals
Value market tops
30% of the total
6
© Oliver Wyman Group
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
ACO Landscape Today
Medicare FFS beneficiaries attributed to an ACO
Population Health
Management
Improvement Chronic Disease Mgmt
Reduction Healthcare
Waste
High Risk Patient
Mgmt
Care Standards
Compliance
Changing Reimbursement
Longitudinal Med Record
Mgmt
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
4.Improvement in Compliance with
Standards of Care
5.Changing Reimbursement
• Shift from Fee-For-Service to Value-
based Reimbursement
• Managing Risk with Payers (including
ACO)
6.Improvement in Managing Patient’s
Longitudinal Medical Record (including
home monitoring)
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
© eHealth Initiatives Population Health Survey – Oct 2015
Support for PHM
© eHealth Initiatives Population Health Survey – Oct 2015
PHM Approach
© eHealth Initiatives Population Health Survey – Oct 2015
Supporting Data % Analytics
© eHealth Initiatives Population Health Survey – Oct 2015
Uses of Analytics
© eHealth Initiatives Population Health Survey – Oct 2015
Analytics are …
© eHealth Initiatives Population Health Survey – Oct 2015
Key Takeaways
Who are your patients and how to manage?
Range of Function for PHM
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
Patient Engagement
Rule-based
Workflows
Patient Outreach
Care Management
Point-of-Care (EHR)
Referral Management
Data Aggregation
Analytics
Clinical
Financial
Operational
Data Normalization
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
Introducing Mirth Analytics
Part of Enterprise-wide
Collaborative Care Solution from NextGen
Architecture Overview
Sources
NextGen Ambulatory
OthersHL7, XDS, CCLF etc
CDR(Results)
Mirth ConnectClinical/Claims
Periodic Data Load
Analytics(Staging)
Analytics(Reporting)
Build Your Own BI
Computations Aggregations
Technology StackDatabase : PostgresData Integration : PentahoScheduler : RundeckUI : Angular & Node Js
Risk and Performance Management, Population Analysis,
Provider Management, Ad hoc Reporting
NG ShareClinical/Claims
AdhocReporting
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).
Provider Comparative Analysis
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
Risk and Provider Performance Analysis (In/Out Network, Inpatient, ED, Procedure & Drugs Utilizations)
Population Analysis (Patient Categorization by Major Disease Conditions )
KPI & Trend Analysis
Ad hoc Reporting
Clinical Performance Analysis – CMO View
Mirth Group Mirth Practice
CMO
Practice Level
Compare Peers
Peer Comparison
Compare Peers for selected measure
Clinical Performance Analysis – Provider View
Physician
Select Measures
Drill-down to
Missed Patients
Sortby
% Towards Goal
Legend
Missed Patient List
ViewPatient Face-sheet
Drill-down To
Measure Met Patient List
Patient Face-sheet - 1
Continued Next Slide
Scroll down
Clinical Data
Patient Face-sheet - 2
Continued Next Slide
Scroll down
Patient Activity Financial Data
Patient Face-sheet - 3
Pharma Charges Data
Chargesby
Care Settings
Population Analysis – Provider’s Panel
Single-click filtering
by Major Condition Category
Normalized Patient Count
In/Out NetworkSpend
View Patient Face-sheet
Claims Reveal Breath of Information
Understanding Leakage with Claims Data
Out/In Network Charges & Patient Count
Default Sortby
Out of Network $
Top 20 PCP by
Out of Network $
View Provider Synopsis
CMO
Percentage Out of Network
Default Sortby
Total Patients
Top 20 PCP by
% Out of Network
View Provider Synopsis
Provider Synopsis - 1
Continued Next Slide
Scroll down
Normalized Financial
Data
Provider Synopsis - 2
Continued Next Slide
Scroll down
Charges by
OON Service Org
Charges by
Procedure
Provider Synopsis - 3
Charges by
Patient Demographic
Charges by
Major Condition Category
Leakage by Organizations
Default Sortby
Charges
Top 20 OON Organizations
by Charges
Leakage by Providers
Default Sortby
Charges
Top 20 OON Providers
by Charges
Admissions Normalized Stats
Default Sortby
Admits Charge PMPM
Top 20 PCP by
Admits Charge PMPM
View Provider Synopsis
Predictive Analysis by Leveraging Milliman
Industry Leading Brand
• Known for technical acuity
• Offers intelligent, independent analysis to help clients cost-effectively 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
Access to Predictive Data
through Incremental Product Releases
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)
Peer comparison using Blinded Benchmarking
Alerts and Role-based Home Page
Risk & Pre-visit Assessment
Network Referral Optimization Analysis
Measures Submission using Certified Submission Agent
Analytics Incremental Releases
Home-Monitoring Data Analysis
Patient Outreach Analysis
Predictive Modeling
Road Ahead: Analytics Enabled Workflows
Patient Outreach
- Letter Printing
- Voice Reminders
- Texting
- Emailing
- Patient Portal
Care Management
- Basic Workflows (CRM)
- Dashboards
- Work-lists
- Advanced Workflows
- Care Plan Documentation
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
Questions?
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Thank You!