The Industrialization of Healthcare: Driving Value Through Technology & Analytics Brad Ryan, M.D....

The Industrialization of Healthcare: Driving Value Through Technology & Analytics Brad Ryan, M.D.

General Manager IMS

Payer and Provider Solutions

Oct. 16, 2012

2

Market opportunity

IMS Provider & Payer Solutions – StrataRx ConferenceCopyright © 2012 IMS Health. All Rights Reserved.

Sources:1—Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Med. 2009;360(14):1418–282— MedPAC. Report to Congress: Promoting Greater Efficiency in Medicare, Oct 20083— David Blumenthal, MD, “More focus on high-cost patients could save $300B,” Healthcare Finance News, Apr. 20124,5,7— IMS Institute, Advancing the Responsible Uses of Medicines, October 20126— Lars Osterberg and Terrence Blaschke, “Adherence to Medication,” New England Journal of Medicine, 2005

PharmacyCoordination of CareReadmissions

1 in 5 Medicare FFS patients readmit

within 30 days of discharge1

13.4% or 21,000 AMI Medicare admissions readmit within 15 days,

at a cost of $136M2

Treating 60% of high-cost chronic

condition patients yields $300B in

savings over 10 years3

1.1% of global total health expenditure

or 62B worldwide, can be avoided with

timely treatment4

Prescriptions not taken as directed6

drive $260B in additional care costs7

8% of total health expenditure =

$500B globally can be avoided with

optimized use of medicines5

20% $500B

$62B

$300B

50%AMI readmissions

21K

3

In·dus·tri·al·i·za·tion


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2

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A historical phase, producing overall change in circumstances and resources of production or industry

Characterized by individual judgment; manual labor replaced by mechanized mass production, use of technological innovation to solve problems, as well as more efficient division of labor

The large-scale introduction of manufacturing, advanced technical enterprises, and other productive activity into an area, society, country

a historical phase, producing overall change

in circumstances and resources of production

or industry

characterized by individual judgment; manual

labor replaced by mechanized mass production,

use of technological innovation to solve problems,

as well as more efficient division of labor

the large-scale introduction of manufacturing,

advanced technical enterprises, and other

productive activity into an area, society or country

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New expectations of what’s possible

+ Quality + Safety + Cost

• Point-in-time

• Apprentice model

• Judgments

• “Art of medicine”

• Highly specialized

• Technology & clinical advances

• Vast treatment options

• Disparate patient experiences

• Limited comparisons

• Patient-centered

• Technology-enabled

• Clinical evidence driven

• Guidelines & protocols

• Reduced treatment variation

Intelligent Systems

Foundation of Any Industry + Quality + Safety - Cost

Intelligent Tools

Intelligent People


55

What would it take to create this intelligent system?


66

Mobile Tools

Insights at Right Time, Right Place

Big Data Capabilities

Technology

Patient Centric Data

Physician Engagement

What would it take to create this intelligent system?

IncentivesCollaboration


7

Comprehensive, connected healthcare data & analytics

Treatments70+% Dispensed Prescriptions

Healthcare Visits 9M Inpatient & 96M Outpatient / Year

Clinical SpecialtiesAll, including cardiology, neurology, oncology

Consumers 130M Consumer Profiles

Medical ClaimsIntegrate 7 Billion Transactions / Year

Prescribers1 Million Tracked Weekly

Providers1M+ professionals,1M organizations& 2M affiliations

Payers / Plans8,000 Plans

Groups/IDNs760 Entities

Longitudinal Rx 2.4 Billion / Year

Unique Patients260 Million / Year

Rx Information3.0 Billion / Year

A SINGULAR VIEW

• Near-census treatment insights

• Dynamic representation of total patient care

• Disparate data sources integrated

• Privacy protected, encrypted


8

The power of linked, real-world patient dataWhat is known about patients outside a facility? membership? episode?

Medical Office/Clinic

Pharmacy/ PrescriptionRetail OTC

Behavioral &Demographics

Hospital Inpatient/Outpatient

Laboratory/ General

EMR Labs

Long–TermCare

Patient ID Patient ID Patient ID Patient ID Patient ID

Physician IDs(referring & rendering)

Prescriber IDs Physician IDs(referring & rendering)

Physician IDs Physician IDs Physician IDs

Patient/Consumer ID


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“Big Data,” more than a data warehouse

Stage 0: Data

Preparation

Stage 1: Data Collection

Stage 2: Data Transformation

Stage 3: Building Intelligence

Stage 5: Knowledge

Management

Identification

Qualification

Preparation

Implementation

Quality Assurance

Validation / Certification

Product Integration

Training

Medical / RX

EMR

Wholesaler

Hospital

Survey Data

On-Site Clinic

OTC

Dental / Vision

Lab Results Data

Proprietary Methods

Episodes of Care

Performance Measures

Disease Staging

Norms / Benchmarks

Market Scan

Provider

Clinical Measurement

SFE

Commercial Analytics

R&D

Pharmacy

Pharmacy Benefit

Strategies

Consumer

Program Integrity

Government

Data

Analytics

Consulting

Services

Privacy Protection

Standardization

Customization

Enhancement

Quality Assurance

Quality Improvement

Integration

Stage 4: Application

Delivery

Data Lifecycle

GLOBAL


1010

In what ways can big data add system intelligence?


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ACCESS

Convergence of unmet need

Players and roles differ by geography or constructCommon themes across stakeholders and geographies

Manufacturers& Distributors

Hospitals & Health Systems

Clinicians

Patients, Consumers, Caregivers

HIT, HIE, EMR, Portals

Government

Employers

Health Plans

PBMCare/DiseaseManagement

Pharmacies,Other

Suppliers

UNCERTAINTY

COST

QUALITY


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Key applications for advanced analytics Four areas of greatest impact to improve value

Measure, benchmark,

and track performance

to reduce wasteful variations and achieve best practice in

care delivery

Profile, segment, attract,

and engage at the physician and patient level

Recognize and reward

performance for risk sharing, value-based purchasing

and other alternative incentive models

Influence and optimize site, channel and resources

with a longitudinal view of the patient

journey

Engage Physicians and Patients

Support Pay-for-Performance

Coordinate Integrated

Patient Care

Reduce Wasteful Variations


13

Increasing quality and efficiency in prescribing, ensuring appropriate Rx use and spendA large national health plan’s pharmacy program

Multiple doctors and patients, prescribing and

compliance behavior

Inform formulary strategies to drive cost savings and improve patient

outcomes

Identified over $10M in savings in program’s first year

Efficiencies via more informed decisions and management of analytics

Reduce Wasteful Variations

Identify opportunities to optimize cost and utilizationDemonstrate quality

& efficiency

Gain insight from comparative benchmarks – national, state, local

Generic switch/formulary change impact

Compliance and adherence, care gaps

Integrated pharmacy and medical view for chronic management

Specialty


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Engage Patients

Align resources and engage patientswith targeted solutions to reduce readmissionsA multi-state health system

Reduce readmissions for FY2013-focus DRGs by 34%

Increase case management efficiency and resource allocation

Hundreds of daily discharges

Multiple local pharmacies

Identify patients at high risk for post-

discharge non-compliance

Prioritized at-risk patients refreshed daily,

post-discharge census

Outreach, engagement, intervention

Improve patient outcomes

& avoid readmissions

Case managers target right 50% day 1; target additional 25% day 3

18-25% readmits within 30 days of AMI, HF, PN admit

Monitor Rx fills, compliance, refill history


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Engage Physicians

Track physician referral and prescription patterns to empower alignment strategiesProminent health system, competitive market

Enhance relationships with key market championsDrive nearly $6M of annual top-line growth for target service lines

Lack of visibility into highly complex physician/patient networks

Doctors affiliation, referral relationships, patient flows, practice

patterns/profiles

Target right physicians with tailored messaging

for engagement and education

Meaningful, quantitative goals

Targeted campaigns, tracked effectiveness

PCP-to-specialist

Key management relationships

Translation to inpatient/outpatient

procedures


16

Pay-for-Performance

Align payers, providers, manufacturers around real-world performance valueIntegrated smoking cessation service - Germany

Order to deliver service & treatment to the patients

Requests administration

services & reimbursement

Reimbursement on behalf of

manufacturer

Data processing and project management on behalf of provider

Referral of patients

Requests patient treatment

Win. Win. Win.

Reduced HC utilization savings and insight into customer health needs and strategies

Understand utilization & success

Demonstrate drug value

Reduce total utilization

Pharmaco SHIProvider

IMS


17

Third party perspectiveThe service center generates revenues on patient base

Outcomes-based payment - economics

Service Center Revenue

Patients

Payer perspectiveReduced utilization by patients who stop smoking expected to generate considerable savings

SHI Savings from Better Outcomes

Patients

Client perspectiveBoth cessation service and drug sales generate revenue streams

Volume

Manufacturer Revenue & Brand Sales


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Coordinate Patient Care

Actively managing patient care quality and reducing cost per patientPCMH of a large regional health plan

Online tool to track and understand performance, manage real-time appeals

PCP grades improve outcome and share financial

benefits

Patient history & benchmark treatment paths

73 performance KPIs

Objective analytics and benchmarks

Achieved 2% admissions reduction & saved over $500k annually

Actively managed catastrophic & multiple chronic conditions to save >$35k per patient

Improve patient quality, reduce spend

Support provider care management

Measure outcomes, ROI

ID high/low performers

Calculate illness burden scores

Disseminate care gaps, care alerts

Patient-level results to practitioner


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IMS Institute: Unbiased information for policy and decision makers

•Global health research program

•Treatment/drug utilization trends and expenditures

•Comparative effectiveness research

•Geographic variations in care

•Real-world practice

Examples of IMS proprietary research to improve healthcare


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Interconnected view across healthcare If we did these 4 things well…what would be different?

Hospitals & health systems

Physicians & HC Professionals

Consumers, caregivers

Treatment sites: pharmacies, labs,

imaging, etc.

Health plans

Government & Employers

Manufacturers& distributors

Patient


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