Betting on Data? - First Illinois Chapter...
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Betting on Data? Krishna G. Ramachandran Vice President, Health Data Strategy and Enterprise Network Operations BlueCross and BlueShield of Illinois, Montana, New Mexico, Oklahoma & Texas
Transcript of Betting on Data? - First Illinois Chapter...
BettingonData?
KrishnaG.Ramachandran
VicePresident,HealthDataStrategyandEnterpriseNetworkOperationsBlueCrossandBlueShieldofIllinois,Montana,NewMexico,Oklahoma&Texas
Agenda
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•Investments
•Incentives
•Innovation
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Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures.pdf
NationalHealthExpendituresupfrom5%ofGDPin1960to18%in2016;Expectedtobe20%ofGDPby2025
6Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures.pdf
Whatdowegetforthemoney?
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Source:https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf
HealthCareRegulationAcronymSoup
• ARRA• MU• PPACA• ACO• BPCI
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•PQRS•AHCA•MACRA•MIPS•APM
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From2013,butstillholdsrelevancetoday
Source:https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-big-data-revolution-in-us-health-care
“MeaningfulUse”Stages
Stage1ObjectiveMeasures(15Core,5Menu)
HITECHAct,partofARRA
MaxincentiveperProvider(Medicaid$64k)
Dayreportingperiod(year1);thenfullyear
PagesinStage1FinalRule
QualityMeasures(Stage1)
PagesinStage2FinalRule
ITSpend– EHRImplementations(2017)
• VA- $10Billion• Mayo- $1.5Billion• UMassMemorial- $700Million• UofVermontHealthNetwork- $112Million• UofIllinoisHealth- $101Million
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Source:https://www.beckershospitalreview.com/ehrs/10-ehr-implementations-with-the-biggest-price-tags-in-2017.html
Diditwork?
• “…Theadministrationrushedtheprocesswithitspenalties—andatthesametimemadethefederalgovernmentthearbiterofITquality.” –Sen.LamarAlexander(R-Tenn);March2015
• “Halfofphysicianshavenotmettherequirementsoftheprogramandarenowfacingpenalties. ”
• “AMedicalEconomicssurveylastyearfoundnearly70%ofphysicianssaytheirEHRsystemshavenotbeenworthit.”
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Source:http://www.help.senate.gov/chair/newsroom/press/alexander-government-should-enable-and-encourage-adoption-of-electronic-health-records-rather-than-trying-to-force-by-taking-away-medicare-payments
PhysicianAdoption
13Source:http://dashboard.healthit.gov/quickstats/pages/FIG-Health-Care-Professionals-EHR-Incentive-Programs.php
HospitalAdoption
14Source:http://dashboard.healthit.gov/quickstats/pages/FIG-Hospitals-EHR-Incentive-Programs.php
Vendors
15Source:http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php
PhysicianE-Prescribing
16Source:http://dashboard.healthit.gov/quickstats/pages/FIG-Percent-Physicians-eRx-through-EHR.php
HealthInformationExchange– Central
17Source:https://www.healthit.gov/sites/default/files/reports/finalsummativereportmarch_2016.pdf
18Source:https://www.healthit.gov/sites/default/files/reports/finalsummativereportmarch_2016.pdf
HealthInformationExchange– DirectConnections
ExternalPatientHealthInformationQueries
19Source:http://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Electronic-Query-Capability.php
AlternativePaymentModel(APM)Framework2016
20Source:https://hcp-lan.org/workproducts/apm-whitepaper.pdf
MedicareACOProgram(MSSP)Results2015• 392participants• 7.7millionbeneficiaries(of54million;14.25%)• $429millioninsavings($1.29billionsince2012)• Medicarespendsabout$500billion/year• 119ACOs earnedsharedsavings(30%)• 83hadcosts<benchmark,butnosavings• 51%ofACOshadcostsbelowbenchmark• 2017update(Hmm?):
• 12.3millionbeneficiariesserved(of59million;21%)• 562ACOsacrosstheSharedSavingsProgram,NextGenerationACOModelandCECModel• 121ACOsinarisk-bearingtrack,includingintheSharedSavingsProgram,NextGenerationACOModelandCECModel
Sources:https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-25.htmlhttps://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-18.htmlhttps://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html
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Category1 Category2 Category3 Category4
FEE FOR SERVICE – NO LINK TO
QUALITY &VALUEFEE FOR SERVICE –
LINK TO QUALITY &VALUEAPMS BUILD ON
FEE-FOR-SERVICE ARCHITECTUREPOPULATION-BASED
PAYMENT
Comprehensive Population-Based Payment
Condition Specific Population-Based Payment
Upside Gainsharing/ Downside Risk
Upside Gainsharing
Rewards for Performance
Pay for Reporting
Accountable Care Organizations
Performance-Based
Pop. Based
25% COSTSAVINGSrelativetobroadPPO
$12- $13SAVINGSperattributedmonthpermember(comparedtomatchedcontrolpopulation)
$$$ SAVINGSinachievingquality&costmetrics
35% ofBCBSMembersinIL,MT,NM,OK,TXareinvalue-basedprograms
BCBS– APMExperience(2017)
2009 AQC Cohort 2010 AQC Cohort 2011 AQC Cohort 2012 AQC Cohort
Source:Song,Zirui,etal."Changesinhealthcarespendingandquality4yearsintoglobalpayment." NewEnglandJournalofMedicine 371.18(2014).
BCBSMAAlternativeQualityContract
24*MedicalGroupsareprotectedfromcatastrophicclaims
BCBSIL- HMOI
GlobalPayment(Professional/OutpatientServices)
76.4%oftotalfinancialpackage
14.9%ProviderRewardsforCareManagement,PharmacyManagement,QualityImprovement
8.7%CatastrophicClaimRiskSharing*
Source:BCBSofIL,MT,NM,OK,TX
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*ClaimsDatafromJanuary2016throughDecember2016runoutthroughMarch2017.*Newfor2017isariskadjustmentwhichisbasedonDxCG riskscoremodel.ThegeographicadjustmentisbasedonthecostdifferentialbetweenChicago&DownstateILalongwiththedistributionofmembershipbygroup.
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
25.7%
21.1% 21.5%19.6%
23.3%24.2% 24.0% 23.4%
19.3%*
BCBSIL- HMOI- SavingsRelativetoPPO
Source:BCBSofIL,MT,NM,OK,TX
26Source:https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-big-data-revolution-in-us-health-care
InsightGeneration- Claims
Source:Boncura HealthSolutions– DataAnalytics
NetworkLeakage– PartIVisualizingout-ofnetworkspendingbyservicecategory
Source:Boncura HealthSolutions– DataAnalytics
NetworkLeakage– PartIIComparingutilizationpatternsamongPCPpatientpanels
Source:Boncura HealthSolutions– DataAnalytics
ERUtilizationDoctor-LevelERUtilizationProfiles
Source:Boncura HealthSolutions– DataAnalytics
InsightGeneration- QualityPopulationlevelqualitymeasureswithdrilldowns
Source:http://www.inovalon.com/howwehelp/indices
InsightGeneration– Cost,Efficiency,Quality
Source:http://medeanalytics.com/solutions/plans-population-health
InsightGeneration– EpisodeEfficiency
Source:BCBSofIL,MT,NM,OK,TX- ProviderandNetworkDecisionAnalyticsTeam
Dx basedgroupingofclaimstocreateefficiencyprofiles
Whatelsedoesthepresenthold?
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Source:https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-big-data-revolution-in-us-health-care
PredictivePower• HattiesburgClinic(SouthernMississippi)createspredictivemodel• Modelcalculatesahospitalizationriskscoreforpatientswithchronicconditionsusing150factors
• ScoreembeddedintheirEHRhelpsstratifypatients:• Findthe1%ofmemberstheycouldoutreachto• Theyaccountedfor23%ofED;7%hospitalizations
• Participatingpatientsgetmessagesorphonecallsfromchroniccaremanagement(CCM)program nurses,alongwithotherservicestohelpthemmanagetheirconditions
• Outcomes:• TwiceasmanypatientsenrolledinCCMinthefirstsixweeksafterprogramimplementation• Improvedclinicalqualitymeasuresforpatientswithchronickidneydisease,cardiovasculardisease,anddiabetes
• A12%decreaseinhospitalizationsforpatientsenrolledinCCM
35Sources:CasestudyfromHattiesburgClinic(BryanBatson,CMIO,2016;https://www.epic.com/epic/post/2709;
Telemedicine
• BannerHealth(Arizona)- heavyinvestorinTelemedicine(since2004)• IntensiveAmbulatoryCare(IAC)pilot(2017)targetingsickestpatients(atleastfivechronicconditions)
• Outcomes:• N=128• Overallcostsdropped34.5%,• Hospitalizationsdroppedby49.5%.• 30-dayreadmissiondroppedfrom20%to5%
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Sources:https://www.fiercehealthcare.com/mobile/banner-health-telemedicine-program-targets-complex-chronic-patientshttps://www.beckershospitalreview.com/healthcare-information-technology/a-glimpse-into-banner-health-s-telemedicine-success.html
PrecisionMedicine
• Rady Children’sInstituteforGenomicMedicine(California)• Createdfroma$120milliongrantfromErnestRady• Holdsworldrecordforfastestgeneticdiagnosisfrommappingthehumangenome:26hours
• NationalInstitutesofHealth(NIH)alsosupportedwitha$6milliongrant• BabySebastiana (born2017)
• Seizuressincedayofbirth• Unknowncauses• Genetictesting• DNAresultsinformeduseofananti-seizuredrugrarelyusedforinfants• Seizuresstopped
• Programstillinstudyphase
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Source: http://time.com/4951200/genetic-testing-providing-hope-babies-ailments/?xid=homepage
38Source:https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-big-data-revolution-in-us-health-care
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Whatdoesthefuturehold?
Source:IEEEPulse;https://pulse.embs.org/may-2017/cognitive-computing-and-the-future-of-health-care/
PersonalData• Continuedgrowthindatacollected• Inputtovariousmodels– predictive/prescriptive• Meaningfulinsights- “WithAI,YourAppleWatchCouldFlagSignsOfDiabetes”
• Alerts/IntegrationwithEHRs/linkintoclinicianworkflow
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Sources:https://www.wired.com/story/with-ai-your-apple-watch-could-flag-signs-of-diabetes/https://www.cedars-sinai.edu/About-Us/News/News-Releases-2018/Analysis-Shows-Lack-of-Evidence-That-Wearable-Biosensors-Improve-Patient-Outcomes.aspxhttps://www.nature.com/articles/s41746-017-0002-4https://developer.apple.com/healthkit/
"Asofnow,wedon’thaveenoughevidencethattheyconsistentlychangeclinicaloutcomesinameaningfulway,"saidseniorauthor BrennanSpiegel,MD,directorofHealthServicesResearchatCedars-Sinai."Butthatdoesn’tmeantheycan’t.”(Jan2018)
Continuedrefinementof“BigData”
• Usefulapplicationsofnaturallanguageprocessing
• Integrationofweather,air-quality,socio-economicdatasets
• Interpretationofimagesandcreationofinsightsfromthesetoaiddoctors
• Alerts/IntegrationwithEHRs/linkintoclinicianworkflow
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Source:https://www.forbes.com/sites/tomdavenport/2017/11/05/revolutionizing-radiology-with-deep-learning-at-partners-healthcare-and-many-others/#3f0e7d5d5e13https://www.ibm.com/ca-en/marketplace/weather-company-data-for-analytics
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• Continuedeconomicincentivealignment• Continueddatasharingacrossstakeholders• A“moreperfectunion”ofClaims,EHR,Personaldata• Moreinsightgeneration• Moreinsightsharingintheclinicalworkflow• Morepredictiveandprescriptiveanalytics
Whatelsedoesthe(glasshalf-full)futurehold?
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Congratsongettinghere,butwehavemilestogobeforewesleep!Here’stothewoodsaheadinbeinggoodstewardsofourhealth
caredollar!
Thewoodsarelovely,darkanddeep,
ButIhavepromisestokeep,
AndmilestogobeforeIsleep,
AndmilestogobeforeIsleep.
RobertFrost,“StoppingbyWoodsonaSnowyEvening”from ThePoetryofRobertFrost, editedbyEdwardConneryLathem.Copyright1923
