Analytic-Driven Quality Keys Success in Risk-Based Contracts

March 2nd, 2016

Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst

Brian Rice, Vice President Network/ACO Integration,

Allina Health

Conflict of Interest

• Ross Gustafson, MBA

• Ownership interest: Health Catalyst options

Agenda

• Allina Health Context & Strategy

• Data Analytics Structure & Tools

• Analytics & Outcomes Experience

• Summary

Learning Objectives

• Discuss the direct effect quality improvement has on cost containment and why it

is key to moving to a value-based model of payment

• Demonstrate how Allina Health is using advanced analytics to bridge historical,

current and predictive information to improve quality while lowering the cost of

care

• Describe the effect care coordination driven by predictive analytics has made in

improving the overall quality of health experienced by Allina Health patients and

how it has helped reduce unnecessary hospital admissions and readmissions

• Describe how transparency of data with physician community supported

engagement and improved triple aim outcomes for Allina Health

>60% Care

Management

Engagement

with Patients

vs Health

Plans

Improved

Outcomes to be

Leader in

Diabetes Optimal

Care

Management

STEPS: Patient Engagement & Population Management

Allina Health Context & Strategy

About Allina Health

• Largest Healthcare System in the Twin Cities and Region

– 13 hospitals – 1,812beds

– 59 Allina Clinics, 22 hospital-based clinics

– 15 community pharmacies

– 3 ambulatory care centers

– 8 Clinical Service Lines

– Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice

– Over 26,000 employees

– Allina Integrated Medical Network representing over 3,000 employed & independent physicians

• Key statistics (2014)

– $3.6 billion in revenue

– 108,124 inpatient admissions

– 1.3 million outpatient admissions

– 3.5 million total clinic visits

Minnesota Market

• Leader in quality improvement, reporting & outcomes

– ICSI

– MN Community Measurement

• Competitive provider environment with consolidation occurring

• Fortune 500 companies seeking greater value

Connected Care Strategy

Allina Health pursuing a strategy of

‘Connected Care’

– Better connect and coordinate care (and support the

caregiver’s ability to do just that)

– Advance new payment systems that rewards

outcomes

– Integrate data and knowledge to improve care and

health

All About Creating Value and Advancing Outcomes Based Delivery Strategy…

…the one outcome that unites all

players in health and health care

Value =

Cost

Quality (in its full definition)

Four Measures of Success: 2016 Strategic Priorities

4. Organizational Vitality

Performance

Employee/Physician engagement

Brand and member engagement

1. Optimal Health/Experience for Individuals

Personal Primary Care Teams

Strategic positioning acute care assets

2. Optimal Health for the Community

Allina’s readiness to manage population health

Community health benefit

3. Affordable Care

Payment integration strategy

Better

Care/

Experience

Organizational Vitality

Better

Health

Reduce per

capita costs

Triple Aim Integration Initiatives Quality Roadmap

Goal Initiative(s)

1) Perform under value based

payment risk models

Accountable care pilots

• Pioneer ACO

• Commercial partnerships

• Medicaid

2) Align incentives across

employed and affiliated

providers

Allina Integrated Medical Network (Clinically Integrated Network)

3) Give providers the data and

information needed to improve

outcomes

Advanced analytics infrastructure including

a robust Enterprise Data Warehouse

(EDW)

4) Provide consistently

exceptional care without waste

• Primary care team model redesign

• Care management/patient engagement

• Clinical program optimization

5) Support transformation with

new skills development Allina Advanced Training Program

Strategic Partnership with Health Catalyst

Why did Allina Health Pursue?

– Ability to focus on core competency

– Accelerating analytic adoption

– Cost stabilization

Healthcare Analytic Adoption Model

Allina 2008

Allina 2010

Allina 2014

Allina +

Catalyst

Data Analytics Structure & Tools

Allina Health- Analytic Adoption

• Foundation of data and technology

Level 8 Cost per Unit of Health Reimbursement &

Prescriptive Analytics

Level 7 Cost per Capita Reimbursement &

Predictive Analytics

Level 6 Cost per Case Reimbursement

& Data Driven Culture

Level 5 Clinical Effectiveness & Population

Management

Level 4 Automated External Reporting

Level 3 Automated Internal Reporting

Level 2 Standardized Vocabulary & Patient

Registries

Level 1 Data Integration– Enterprise Data

Warehouse

Level 0 Fragmented Point Solutions

• Relating and organizing the core data

• Efficient, consistent production

• Efficient, consistent production & agility

• Measuring & managing evidence based care

• Taking financial risk and preparing your culture for the next levels of analytics

• Taking more financial risk & managing it proactively

• Contracting for & managing health

• Inefficient, inconsistent versions of the truth

Source: Healthcare Analytic Adoption Model

2013

2010

2009

2011

2012

2008

2014 2015

Enterprise Data Warehouse: Data to Information

Clinical Intelligence Tools

Potentially

Preventable

Events

Census

Dashboard

Enterprise Data

Warehouse

Operational

Reports

Predictive Retrospective Real time

What is

happening?

What happened? What may

happen?

PPR Dashboard

Specific

G

enera

l

Allina Health

Readmissions

Model

Allina Health

Modeling of

Potentially

Preventable

Events

EHR Dashboard

Supporting Cohort Management Driving Improvement through Access to Information

Shows

performance of

composite measure

components

Select by patient,

clinic, provider or

any combination

Filter by

Pioneer ACO

Patients

Getting the Predictive Analytics to the Bedside The Census Dashboard

Identifies Patient

Readmit Risk

Identifies Prior IP Visits

in Last Week & Month

Identifies Transition

Conference Status

Established Data Governance Model - ACO Population Health Analytics

TCOC Opportunities

ACO Analytics Workgroup

Clinical Ops & Physician Perceptions

Payer Reports

MNCM, HP Reports

Claims DataACO Applications

Internal Data

Clinical Variation

Network Quality Committee

INPUTS

ANALYZE, SYNTHESIZE & REPORTING

PRIORITIZATION

RECOMMENDATIONS

Focus on identifying Total Cost Of Care Opportunities in value-

based payment populations

Analytics & Outcomes Experience

Examples of Allina Health’s Efforts & Outcomes

• How have enhanced analytics supported Allina Health in improving its performance?

– Prioritizes areas for care model changes

• Risk stratification

• Patient finding

• Clinical variation

• Enables focus on risk-based contract populations

• Provides insights on efforts, areas for further change, readiness to spread

Population Health Management Risk Stratification Model

High Risk

Rising Risk

Low Risk

Healthy

Complex Care Management 1- 2% Commercial

5% Government

Primary Care:

Registries

Screening

Prevention

Outreach

Health Coaching

Digital Strategy:

Education

24/7 Access to Care

Stratify the

population with data

integration for unique

care models

Claims

•Utilization

•Predictive Models

Clinical

•Assessment

•Diagnostics

•Predictive Models

Consumer

•Activity Trackers

•Biometrics

•Preferences & Goals

Health Plan • Claims

• Utilization

• Pharmacy

• Online Health

Assessments

Health Plan Care provided outside of

Allina Health

Allina Health • Hands on

assessment

• Predictive models

• Screening tools

• Diagnostics

Allina Health

Intake

Members Identified for Complex Care Management

Data Sources

Resources to Support Patients

Care Management: Ambulatory Census Dashboard Case Finding

Locating patient populations

Care Management Interventions for Hospital Transitions

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%A

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Follow-up Appointment within 5 Days at Allina Clinc

0.85

0.90

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1.00

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1.10

1.15

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Readmissions Actual to Expected PPR Trend by Rolling 3 Months

Example: Supporting Cohort Management

Providing Care to Patients with Diabetes

Challenge

– Provide superior care for Allina Health’s diabetic population

Solution

– Identified and stratified diabetes cohorts using registries

– Identified gaps in care for diabetes patients (e.g. A1c, blood pressure management)

– Provided workflow capability for care teams to manage the population through ambulatory quality dashboard

Results

– Highest national score for Diabetes Care Quality Measure in 2012 of all CMS Pioneer ACOs

– U.S. leader in management of diabetes patients and Diabetes Optimal Care results

Supporting Cohort Management Driving Improvement through Access to Information

Shows performance

of composite measure

components

Select by patient,

clinic, provider or

any combination

Filter by

Pioneer ACO

Patients

Example: Supporting Wellness & Prevention Successfully Keeping Patients Well

Challenge

– Avoiding future illness is core to superior population health management

Solution

– Established and reported on optimal care scores for individuals

– Identified gaps in care and accurately connected them to care teams to close gaps in care

Results

– Eliminated significant gaps in wellness screening and preventative care

– Allina Health has achieved some of the best ambulatory optimal care scores in the nation through a focused clinician engagement strategy

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

88.0%

Jan-1

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Mammogram Optimal Care Goal = 85%

56.0%

61.0%

66.0%

71.0%

76.0%

Jan

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Colon Cancer Screening Optimal Care

Goal = 73%

Colon Cancer Screening Optimal Care

Supporting Wellness & Prevention Ambulatory Dashboard

MD Name

Ability to focus on

a specific provider

or patient

population

Shows performance on

optimal care and

component measures

with patient detail,

provider name and clinic

ACO Population Focus Northwest Metro Alliance

• HealthPartners and Allina Health care for nearly 300,000 people in the Northwest Metro together.

• Serves as a learning lab for Accountable Care to move forward the Triple Aim

– Data sharing critical across organizations

– Use of claims and clinical EMR data valuable

– Physician engagement and collaboration has been core to success

Critical shift in mindset from competition to cooperation

2014 Northwest Alliance TCOC Trend HealthPartners Commercial Population

Summary

Summary This is Only the Beginning…

• Have patience & prioritize: Utilize Pareto analysis of population data key for determining opportunity and focus

• Focus on waste: Consistent quality drives lower cost of care

• Use predictive modeling to focus care management resources

• Prepare to invest $$’s for tech & talent

• Engage physicians in data strategy development

• Integrate and analyze claims and clinical data

• Transparency and access are critical

• Use outcome improvement approach

• Keep the patient at the center of all decisions

http://www.himss.org/ValueSuite

Value

Easier to share information

& identify opportunities

Evidenced based protocols

deployed

Data available right time,

right place

Individual and Population

Health planning backbone

Efficiency

Questions?