RowdMap at DATALAB at Health Datapalooza 2015

PhDs can use open health data

But the goal is to open it to the masses and let 1000 flowers bloom.

In other words, can these guys use it?

Let’s give it a shot

Liz YoungEnglish major

Working with open health data at RowdMap, Inc. for about a year

Skier

Born in 1991

Government is releasing lots of data….

And it’s been hard work….

But now you don’t need a PhD to use this data in a meaningful way …

For mechanics of how to do this: http://goo.gl/Y64Fa2

Have an Idea? Attend Bootcamp:HealthCare Entrepreneurs’ BootCamp

Tomorrow , 4:15pm Lincoln 2-3-4

So… there’s a lot of data and talk out there

Government performance

data

Government provider etc.

data

Government socio-demo

data

Consumerweb / social

data

Analysis-based deriveddata

Sentiment as a Key Driver (psychographic) - measured by Index scores for: - Domains (chronic, wellness, quality of care, customer satisfaction, customer service);- Brands (parent org and you individually)

Market Growth; Census; Healthy Food; County Health Rankings & Indicators; Behavioral Health Factors; etc.*

Dartmouth Atlas; STAR; Hospital Compare; Actual, Expected & Predicted Readmissions; Part B & D, etc.*

STAR; Price, Bid, Rebate;Hospitals, Nursing Homes; Market, etc.*

* Dozens of Primary Data Sets, updated at various frequencies

When we say a lot…we mean a lot.

Let’s cut through

the buzz

And it’s powerful, disruptive, game changing

David Wennberg,RowdMap Advisory Board

New Government Released Referral Data(Patient flows between PCPS, specialists, hospitals and post acute centers)

Dartmouth Atlas for Unwarranted Variation(Decades of research and data on unwarranted variation by condition and geography to keep things apples-to-apples for comparisons, hence “Unwarranted” in the name)

New Government Released Performance Data (Individual providers, groups, hospitals and post acute centers including the new part B&D)

Provider Pattern Intensity Profiles and Risk Readiness for every provider, hospital, post acute center in the US. All preloaded with no IT.

OPEN DATA – Particularly powerful when pulled together

Affordable Care Act data to determine Risk-Readiness of Providers / Networks

CMS: 50% of FFS will be gone by 2018

The business context has changed- health plans, government payers, providers, and hospital systems need to develop Risk-Readiness SM

strategies to excel as they transition from fee-for-service to pay-for value.

Featured NationallyUS CTO on RowdMap: “Visionary Genius”

What you can do [without a PhD]With mashups of gov’t data (CMS HHS, Gov, CDC)

Chronic prevalence & physician supplyPopulation Health ReportPopulation Report Card

Match practice patterns to the right risk arrangements – PFV ReadinessGroup Risk-Readiness SM ReportPhysician Risk-Readiness SM ReportHospital Risk-Readiness SM ReportPost Acute Center Risk-Readiness SM ReportRisk-Readiness SM Arrangement Match-Maker

Manage clinical care and costs – Remove No Value CareGroup Unnecessary Cost ReportPhysician Unnecessary Cost ReportHospital Unnecessary Cost ReportPost Acute Center Unnecessary Cost ReportUnnecessary Cost Referral and Value Chain Report


Chronic Prevalence &Physician Supply

Match Practice Patterns to the right Risk Arrangements – PFV Readiness

Manage Clinical Care and Costs – Remove No Value Care

Diabetes Prevalence - Westchester

Use this data to allocate providers and care management resources around condition-specific population needs by zip.

Locate clinics, health fairs, etc. based on chronic needs.

Income

Obesity

Depression

Health Opportunity Index

Demand and Supply

Lots of diabetics but few PCPs

Lots of diabetics and lots of PCPs

What type of populations?

Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT Medicare FFS Part B: http://go.cms.gov/OCmyoy Medicare FFS Part D: http://bit.ly/1mGyBxk

PCP Density –Westchester

http://go.cms.gov/1D8j7LE

http://1.usa.gov/1PzcisT

http://go.cms.gov/OCmyoy

http://bit.ly/1mGyBxk

15

Demand and SupplyCounty Profiles

Largest Counties In Ohio

People use this data to calibrate expectations for profitability by incorporating population health and provider performance into product strategy. Use excess to subsidize operations in

counties with fewer high-performing resources

Risk Scores

Total Cost

PMPM Reimbursement

Overall Star

Chronic Star

Health Rank

MA Profit Opportunity

- MA

Profit Opportunity - Exchange

MA Eligibles

MA Enrolled

Exchange Subsidize

d

ExchangeEnrolled

Compare to National and Regional Benchmarks

Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT Medicare FFS Part B: http://go.cms.gov/OCmyoy Medicare FFS Part D: http://bit.ly/1mGyBxk

http://go.cms.gov/1D8j7LE

http://1.usa.gov/1PzcisT



At the core of Risk-Readiness SM is

Unwarranted Variation:

RowdMap applies the Dartmouth Atlas for Unwarranted Variation methodologies to data on Medicare Parts B & D. This research has been repeatedly validated over the last 30 years and we now have a national data set to apply the methodologies at a large scale.

The estimated 30% of medical expense that goes to unnecessary care. This unnecessary spend drives billing in a fee-for-serve economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation.

Every provider has a unique practice pattern that informs Risk-Readiness SM

Pay for Value Readiness

Los Angeles, CA

Compare to National or Regional Benchmarks


Provider Profiles

Identify highly efficient, Risk-Ready practices and physicians to profitably grow into. Improve profitability of lower performing practices with large panel sizes through

modified arrangements or performance improvement plans.

Medicare FFS Part B: http://go.cms.gov/OCmyoy Medicare FFS Part D: http://bit.ly/1mGyBxkReferrals: http://1.usa.gov/1FzoEOV



http://1.usa.gov/1FzoEOV

Identify high and low performing hospitals and post-acute facilities— are there post

acute facilities that hospitals with poor chronic readmits are routing members to?


EOL Hosp Days: Which hospitals fewer end-of-life days than their peers?

Chronic Admits: Which hospitals see their most chronic population repeatedly/ with the most

frequency?

Cardiac Imaging: Which hospitals are more likely to over-utilize cardiac imaging compared to their peers?

Dartmouth Atlas: http://bit.ly/1GXvlJpCMS Hospital Compare: https://goo.gl/p8MtoICMS Hospital Readmissions: http://goo.gl/02KnQdCMS Nursing Home Compare: https://goo.gl/3DpT8m

http://bit.ly/1GXvlJp

https://goo.gl/p8MtoI


Great profile for aggressive risk

Tread carefully for some risk

Match appropriate risk arrangements based on provider practice patterns and Population characteristics within a geography.

Remove no-value CareManage Unnecessary Spend

Risk-Readiness℠ looks at a different category of spending

Shift focus from clinical edits, audits, and recovery efforts to identifying care that is clinically appropriate, but unnecessary. Historical efforts have shown returns, but they only look at a fraction of total spending. Unnecessary care can account for up to 30% of total spending and provides significantly larger opportunities for cost containment and quality improvement.

Clinically Appropriate, but Unnecessary Care

(30% of spend)

Claims Spend for a Health Plan

Necessary Utilization(70%)

“It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we

eliminate the unneeded care, there are more than enough resources in

our system to cover everybody.”

- Dr. Elliott Fisher,Dartmouth Institute for Health Policy


RowdMap tackles the 30% of the U.S. health care spend that goes to clinically appropriate, but unnecessary care

Over $9B in Orange County, CA

How much unnecessary spend is in your market?

Over $66B in Florida

$850 Billion Unnecessary Spend* in 2014

Least Unnecessary Spend

Most Unnecessary Spend

RowdMap tackles the 30% of U.S. health care spend that goes to clinically appropriate, but unnecessary care. RowdMap’s models identify the cost-savings opportunities in a geography based on the collective intensity of care delivered by doctors in that area.

* Unnecessary Spend = (Dartmouth Avg cost) * (Population) * (RowdMap Network Opportunity Index)


Unnecessary Spend in Florida

In Broward Co. alone, there is over $7.6B in unnecessary spend.

Let’s look at which hospitals, groups and physicians account for this and for what conditions

Physician Marketshare by Major Clinical Categories


Match appropriate risk arrangements based on provider practice patterns and Population characteristics within a geography.

Hospital Marketshare by Major Clinical Categories

Provider Group Marketshare by Major Clinical Categories

Unnecessary Spend in BrowardBy condition across hospitals, groups and physicians

This Physician.Let’s start hereThis GroupThis Hospital

Circulatory

Muscular-skeletal

Respiratory


All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents

without the prior written consent of the Company, is prohibited.

Physicians Driving Unnecessary Care in Broward

Musculoskeletal care is major contributor to unnecessary spend in Broward. Let’s take a physician who is not an outlier but in the middle of the pack such as Dr.

Spend*. Let’s walk through what his clinically acceptable, but medically unnecessary, practice pattern creates in unnecessary spend.


Referral Patterns and Physician Value Chains

Identify high performing providers and downstream referral patterns. Encourage referrals to

high-performing specialists.


Least Unnecessary Spend Most

Unnecessary Spend

Option 2: Reinforce highest-performing referral

and care pathways. Increase the number of patient interactions

with green dot doctors.

Option 1: Change provider behavior. Requires lots of provider education. Requires

payer to make up a significant portion of a provider’s revenue. Increase the number of

green dot doctors.

Zoom to zip


If had same ratio as :• His decompression rate would drop from

6.01 to 0.436 per patient.• Which translates to 2,608 fewer

decompressions per year.• At an average cost of $332 per

decompression, this represents potential savings of over $850K

If decompression to fusion rate were average for orthopedic surgeons:

• He would have 1629 fewer decompressions for a potential savings of $540K.

*Actual physician names have been changed.

For every 10 back fusions, does 103 decompressions

For every 10 back fusions, does 2 decompressions.

Dr. Save*

Dr. Spend’s

Dr. Spend*

Dr. Save*

That’s one physician, with one procedure, in one clinical condition. This savings would not be picked up in unit cost or utilization analysis,

but cumulatively dwarfs fraud, waste and abuse outliers. Intense practice patterns like this power FFS arrangements

but success in Pay for Value comes from identifying Risk-Ready providers.

Dr. Spend*

Start with Data for Business Context then add Tech.

The ACA at your finger tipsFor Payers & Providers

RowdMap at DATALAB at Health Datapalooza 2015

Data & Analytics

Transcript of RowdMap at DATALAB at Health Datapalooza 2015