Sphere of Influence: Achieving the Healthcare Triple Aim ...
A foundation for achieving value based healthcare
description
Transcript of A foundation for achieving value based healthcare
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Let’s Talk Healthcare with Informatica and Edgewater: A Foundation for Achieving
Value-Based Healthcare
Maury DePaloDirector, Healthcare Practice
Edgewater
Michelle BlackmerDirector, Healthcare Product Marketing
Informatica
Richard CramerChief Healthcare Strategist
Informatica
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Transitioning from Current Operating Models -- An Iterative Approach for Incremental Implementation
Data Needs
Analytic Capabilities
Process Needs
Assess the Current State
Envision theFuture State
Increasing Capabilities on Each Cycle through the Process
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Use Case 1 - Reporting & AnalyticsIntegrating Clinical & Financial Performance & Risk Management
By Time Frame
By
Ser
vice
Typ
es
Inpatient
Outpatient
Professional Fees
Radiology
Laboratory
By Practice Area, By Physician
Primary Care: Dr. Jamieson
Specialty Care: Dr. Rubenstein
Year over Year, Quarterly Performance & Tracking
PMPM / Utilization / Adherence to Std / Clinical Risk / Financial Risk DOS Procedure Submit Amt Paid Amt
3/30/2006 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 3/30/2006 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$
Claim Total 150.00$ 150.00$
5/19/2007 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 5/19/2007 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$
Claim Total 150.00$ 150.00$
7/30/2009 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 7/30/2009 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$
Claim Total 150.00$ 140.00$
12/10/2010 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$ 12/19/2010 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ Claim Total 150.00$ 140.00$
Claim Nbr: 2006-1001-00101
Claim Nbr: 2007-1310-00322
Claim Nbr: 2009-1561-00451
Claim Nbr: 2010-1833-00729
ProviderSpecification
PatientSpecification
ProviderPeer Group
ServiceSpecification
LocationSpecification
OtherSpecification
Normative Data
Provider A
Provider B
Provider C
Provider D
Result A
Result B
Result C
Result D
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Use Case 2 – Patient & Physician AttributionCollaborative, Patient-Centered Care
HospitalPrimary
Care Groups
Physical Therapy
Rehab
SNF, LTCSpecialty Groups
Payers
Shared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform
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Use Case 2 – Patient & Physician Attribution
• Establishing a Performance Track Record• Baseline of Effective, Efficient Patient Care & Favorable Outcomes
• Which Patients, Which Services, What Outcomes, What Costs?
• Quality Efficiency Value• Evidence-based Rationale for Components of Shared Value Proposition
• Value Added at Each Step in Coordinated Process of Encounters to Outcomes
• Primary Building Blocks• Models: Data, Process, Business, Populations & Practices• Technology: Data Capture, Quality Control, Integration, Transformation,
Aggregation, Analytics
• Defining Accountability• Who is accountable, and for what?• Shared accountability – measure team and individual performance against industry
or institutional standard (structures, processes, metrics)
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Learn More…….• Register for the second webinar in the series:
A Foundation for Achieving Value-Based Healthcare
Wednesday, November 14, 2012
11:00am PT / 2:00pm ET
http://vip.informatica.com/?elqPURLPage=10576
• Click here to view our first webinar, Journey to the Future of Healthcare Delivery
• To join future webinars in the series,click here