Global Sponsor
Predictive Analytics for Healthcare Organizations
Tony JurekBalaji ApparsamyYasim KolathayilMorgann Carlon
30-Sept-2014
Introduction
3 Copyright © 2014 Deloitte Development LLC. All rights reserved.
Contents
Introduction and Kick Off 3
Importance of Analytics for Healthcare Organizations 6
Case Study: The Impacts of Analytics at BayCare 14
Enabling Analytics for ACOs 20
Summary – What Next 26
Q&A 29
4 Copyright © 2014 Deloitte Development LLC. All rights reserved.
Tony JurekDirectorDeloitte Consulting
Minneapolis
Tony is Director in the Information Management practice of Deloitte Consulting. Tony advises healthcare clients in the Business Analytics space
Role – Engagement Director
Balaji ApparsamyDirector, Data Management & Enterprise Web ApplicationsBayCare Health SystemClearwater, FL
Balaji provides strategic leadership and governance over long term data strategy to increase the competitive advantage for Baycare. Leadership over patient centric CRM solution to improve on patient engagement, care coordination to reduce care gaps and financial risks
Role - Director
Yasim KolathayilManagerDeloitte Consulting
Dallas
Yasim is a Manager in the Information Management practice of Deloitte Consulting. Yasim is currently focused on providing value to health care clients in the business intelligence (BI) and business analytics space.
Role – Program Manager
Team resumes
Morgann CarlonConsultantDeloitte Consulting
Minneapolis
Morgann is a Consultant in the Information Management practice of Deloitte Consulting. Morgann is currently focused on healthcare analytics strategies for her clients.
Role – Consultant
Importance of Analytics for Healthcare Organizations
What does “Analytics” Mean to You?
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Healthcare organizations are experiencing the “perfect storm” at the intersection of changing demographics, technological innovation and governmental regulation.
Six Trends Shaping Healthcare
Healthcare Organizations
Demanding Demographics
Personalized health information Individualized risk
assessment Personal health records Genetic screening
Expanding Definitions of Health
Consumer health technologies Medical expense
management Direct-to-consumer tools
and decision support Genotypic diagnostics and
targeted therapeutic interventions
Rising Pressure in Policy, Politics, and Economics
Online platforms for collective action Focus on cost reduction
and improved health outcomes
Communities of interest become communities of action
Expanding Connectivity: Anytime, Anywhere
Mobile health Delivery of information and services Peer-to-peer health management Adherence support and self careSensing technologies Collection of biometric data
Increasing TransparencyTechnology shapes health behavior New technologies integrate
layers of data OTC diagnostics provide real-
time feedback Advancement of data analysisSimulations anticipate risk Patient self-care Public health preparedness
Converging RelationshipsOpen platforms for innovation Connects outsiders to
specific projects inside companies
Encourages cross-disciplinary and external collaboration
Streamlines expert sourcing
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Analytics Can be a Game Charger for Healthcare Organizations
Take an Enterprise View
Use the Right Solutions for the Job
Leaders Need 360O Insight Focus on Excellence
Market Excellence Clinical Excellence Operational Excellence Financial Excellence
You can’t manage what you don’t measure – metrics that matter
Understand what separates areas to better bring them together
Start with the End in Mind
One-Size Does Not Fill All Focus on the Future
1-2 Yr. Target Maturities 2-3 Yr. Target Maturities 3-5 Yr. Target Maturities
Don’t “rip and replace” but “leverage and lift” the value of the systems you already have
Alignment across functions makes everyone successful
Not Everything Looks Like a Nail Focus on Value
Deloitte Products & IP Vendor Technologies Deloitte Advice and IC Partner Network
Solutions, not tools bring the pieces together and drive new insights
Align projects and partners with shared risk and shared reward
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Key is understanding the two sides of Analytics
Predictive Analytics
Future facing
Trending
Pattern Analysis
Scoring to determine “Next Best Action”
Cohort Determination
Should also be insightful
Descriptive Analytics
Reporting
After the fact performance measuring
Static
Should be insightful
HINDSIGHT INSIGHT FORESIGHT
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An 360o Enterprise-View of a Healthcare Organizations Challenges
Innovator
Foundation
HumanResources
Technology& Facilities
Accounting& Finance
Governance &Compliance
SupplyChain
Mergers &Acquisitions
PatientSatisfaction
Quality &Safety
MarketDemographics
Value-BasedCare
Alliances &Partnerships
Research &Development
Developed
Advanced
ClinicalMarket
Financial Operational
CEO
CFO
CMO
COO
Accounting & Finance• Close, Plan & Report• Cost Accounting & DSS• Revenue Cycle Performance
Mergers & Acquisitions• Strategy & Growth• Valuation & Pricing• Post-Merger Integration
Governance & Compliance• Governance & Controls• Security & Privacy• ICD-10• Tax Optimization
Alliances & Partnerships• Joint Ventures• Physician Integration• Strategic Affiliations
Market Demographics• Sizing & Segmentation• Brand & Identity• Access & Pricing
Research and Development• Project & Trials Management• Applied Research• Translational Research
Quality & Safety• Clinical Effectiveness• Perioperative Care• EHSS & HITS
Patient Satisfaction• Environment & Setting• Clinical Integration• Mobile Health
Human Resources• HR Transformation• Bus. Model Transformation• Compensation Alignment
Supply Chain• Sourcing & Procurement• Logistics & Distribution• Demand Management
Value Based CarePopulation ManagementCare CoordinationDisease Management
Technology & Facilities• Infrastructure & Architecture• HIT and ERP Shared Services• Real Estate & Facilities
Re-Admissions Analytics
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Our balanced product portfolio is designed to impact key issues in healthcare, while maximizing value, aligning with the core business, maintaining a competitive position, and enabling innovation.
Deloitte Health Analytics Product Portfolio
Market Issue Impact Product Portfolio
Intellect
Clinical Excellence
Sustainable Margin
Revenue Excellence
Improve business processes, clinical effectiveness and efficiency, patient safety, productivity to lower cost, while maintaining and improving quality
Isolate and quantify revenue leakage
Insight
Value Based Care/ Population Health Management
Improve population health management and outcomes
Reduce unwarranted variation
Improve care coordination and risk stratification
Leverage evidence based guidelines and best practices
Miner
Research Excellence
Real World Evidence
Improve signal exploration and surveillance
Support comparative effectiveness analyses, pharmacovigilance, and other use cases for R&D & outcomes analysis
Improve clinical and translational research/medicine
Enable personalized medicine
Total Cost IntellectHealth System Intellect
Sustainable Margin and
Quality Dashboard
Clinical Intellect Clinical Care Optimizer Readmission Optimizer Quality Optimizer
Performance Intellect PI Workbench Operations Optimizer
Procedure Cost Analysis
Revenue Intellect
Revenue Financial Analysis
Insight
Provider Performance Management
Patient Engagement
Contracting and Reporting
Care Management
Outcomes Miner
Signal Exploration
Statistically Nuanced Analytics
Comparative Analytics
Precision Miner
Biomarker Hypothesis Generation &
Validation
Gene Based MatchingCohort Identification
Descriptive Analytics
Drug Exposure / Response Analysis
Population Miner
Research Knowledge Management
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A powerful combination of capabilities to help meet the demands of the information driven healthcare environment
Oracle Enterprise Healthcare Analytics + Deloitte Analytic Applications
Exception Management System
Metadata Delivery
AllSources
Source Data
ExtractOHADI: WIL
Business Rules
Source Dependent
OHADI: Interface tables > HDWF, business rules,
MDM, and metadata management
Source Independent
MPIUnit of
Measure
Master Data Management & Other Services
De – identification
NLP
Security
Exec
Clinician
Researcher
ClinicalFinancial
AdministrativeResearch
OracleEHA Apps
OBI-EE/Java
ConvergeHealthBy Deloitte
Apps
EHA HealthcareData Model
…
Ad Hoc Query
OLAP
Data Mining
Reporting
“Real” Time
Conformed Data Mart (HCD)
CustomApplications
Validation, Standardization, and
Transformation
HDWF3NF EDW
OHADI: HDWF > Applications
MDM, Conformance,
Metric Definition, Benchmarks, etc.
Master Data Interface (MDI)
MDM: Term.
Master Data
Interface Tables
MDM Loaders MDM
ETL
OHADI: Application
Toolkit
Applications: Reports,
Dashboards, Scorecards, etc.
Case Study: Impacts of Analytics at BayCare
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Introduction
BayCare Health System is a leading community-based health system in the Tampa Bay area. Composed of a network of 11 not-for-profit hospitals, outpatient facilities and services such as imaging, lab, behavioral health and home health care, BayCare provides expert medical care throughout a patient's lifetime.
With more than 280 access points conveniently located throughout Tampa Bay, BayCare connects patients to a complete range of preventive, diagnostic and treatment services for any health care need. In 2013, BayCare provided $243.5 million in community benefit, which includes $110.8 million in traditional charity care
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Readmissions
Common Causes Lack of coordination of care between settings Estimated high volume related to social issues Lack of compliance with prescribed therapy
Prevention Readmission flag on EMR Standard discharge procedure and patient education Discharge phone calls and follow up Improved patient experience
Identification of consistent process (or lack of it) to capture data that causes potential readmission, and make it available at the right time, right place for right people
ProcessPeople
Technology
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Readmissions - ImpactReduction of readmission is a spectrum of process, that leads to the transformation of providing care to the patients
Patients One fifth of the Medicare patients are readmitted within 30 days Huge cost impact on unplanned readmissions within 30 days
Hospitals Reductions in reimbursements Penalties and risks due readmission trends Three fourth of the readmissions are preventable
Fee for Service
Value based(PHM)
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BayCare Strategy
Financial
EMRPharmacy
Clinical
HIE
Predictive Outcomes
Population Management
Dashboard
KPI
Scorecards
Analytics
EDW
DM&ACapabilities
DataCreation
DataStorage
DataMovement
DataUsage
DataRetirement
DG
Financial Sustainability
Labs
Registration
Digitization Integration Data CollectionAnalytics & Predictive Modeling
Act on Data
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2014 Accomplishments
Standard method to identify patients at High Risk for Readmission
Implemented Interdisciplinary Plan of care
EMR ‘task’ to Case Manager and Social Worker when patient identified as
High Risk for Readmission
Monitor Home Care admits and Pilot rollouts
Next stage
Transition of Care Management Process model
Ongoing monitor and improvements
Beginning of the journey, in the right direction
Enabling Analytics for ACOs
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Analytics can address the critical needs of ACOs
Critical ACO needs
1. Integrated Patient Care management
• Access to a holistic 360 degree view of patient data and analyze data overtime to identify trends and spot gaps in care coordination and delivery
• Use predictive modeling techniques and solutions to prevent adverse events and readmissions
5. Technology adoption
• Creation of sophisticated technology platform allowing for longitudinal view of patients and more practice of evidence based medicine
• Analytics system focus on acquiring clinical data and facilitating a care management workflow
3. Population Health Management
• Enables risk stratification and can identify the subpopulations that are most at risk
• Summarize and explain population level outcomes data to budget for the healthcare expenses of a defined population
2. Accountability and Organizational Effectiveness
• Defines shared accountability among the ACO leadership to provide collaborative care
• Measures organizational effectives and key capabilities across excellence areas enables organizational savings and growth opportunities.
How analytics can help ACOs address these critical needs
4. Safety and Quality Reporting Compliance
• Enables ACOs to measure the quality and compliance metrics for CMS shared savings
• Reporting capabilities and detailed metrics are required to operate, manage and measure an ACO
1. Integrated Patient Care management
2. Accountability and Organizational Effectiveness
3. Population Health Management
4. Safety and Quality Reporting Compliance
5. Technology adoption
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Analytics enables a 360 degree view of patient and spot gaps in care coordination and delivery
Integrated care coordination by ACO
• Success of Member Education• Patient Education/Outreach
Participation• Patient Channel
Responsiveness• Young Adult Health Care Survey
(YAHCS)
• Member Insurance Affiliation• Dual Eligibility• Employer Affiliation• YTD Total Medicare Membership
Growth• Termed Group Count
• Communication with Nurses• Communication with Doctors• Call Center - Hold Time• Responsiveness of Hospital Staff
• Medication Reconciliation• 30 Day Post Discharge Physician
Visit • Measure of Processes of Care
(MPOC-28)• Plans Of Care Compliance
Proactive Plan of Care and Follow-
up
Patient/ Care Giver
Experience
Patient Engagement
Patient/ Membership
Analysis
Sample metrics to measure patient engagement, satisfaction, plan of care and membership analysis
Improved patient engagement and care coordination
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Analytics enables shared accountability among the ACO leadership to provide collaborative care
CMOAt Risk Population
Evidence Based Medicine/ Gaps in Care
Patient SafetyPopulation Health Management
Proactive Plan of Care and Follow-up
Quality Improvement
Patient Engagement
Patient Satisfaction
Preventive Health
Healthcare home effectiveness
Practitioner Satisfaction
COOOperational EfficiencyOrganizational AnalysisTransitions and CommunicationReimbursementSecurity and PrivacyCost of CarePractitioner SatisfactionProvider UtilizationPatient/Membership AnalysisPatient SafetyQuality ImprovementSupply Utilization MeasuresPurchasing & Contract Compliance MeasuresInventory Management Measures
CMIO
Technology Adoption
Security and Privacy
Evidence Based Medicine/ Gaps in Care
CFOCost of CareFinancial PerformanceFinancial RiskMarket ShareRegulatory RiskReimbursementPatient/Membership AnalysisPurchasing & Contract Compliance Measures
CMO
CFO
CO
O
CM
IO
Key
Cap
abili
ties
Key
Cap
abili
ties
CEO
CEO
ACO
DashboardsExecutive Management Information System (EMIS)
Revenue Cycle
Note: The capabilities that are in bold are shared across the excellence areas
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Analytics enables ACOs to budget for the healthcare expenses of a defined population
• Does clinician have the capability to evaluate health risks based on year over year comparing assessments?
• Is clinician auto notified of new or conflicting info requiring resolution?
• Can analytics deconstruct the patient groups to examine and manage population sub groups?
• Comprehensive understanding of patient health/risk
• Consumer health segmentation• Patient cohort identification & Stratification• Epidemic monitoring
• What are the cost drivers, at risk individuals in the population?• Can analytics make predictions for given patient groups to offer
most effective intervention?• Can the at-risk patients be prioritized and offer tailored
interventions?
• Track population trends• Clinical campaign management & targeted
outreach• Chronic disease management• Risk-pool stratification• Shared decision making
• Are the at risk patients receiving timely care?• Is physician receiving real time patient and population data at
point of care?• Does the clinician have access to decision making tools to
provide best possible care?
• Improved patient health status• Improved patient satisfaction• Personalized patient care• Evidence based intervention• Enables use of social media
• Does ACOs have tools to measure outcomes and patient satisfaction to compare against national and local benchmarks?
• Does the conclusions make sense?• Does ACOs have access to scorecard to understand and
improve performance?
• Improved patient outcomes• Financial reporting• Risk and regulation compliance• Quality & compliance reporting• Clinical performance management• Reimbursement reporting
Health Assessment
Risk Stratification
Impact Evaluation and
Outcomes Measurement
Patient-Centered
Intervention
Population HealthManagement Objectives
Key Questions Analytics Impact
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Reporting capabilities and detailed metrics are required to operate, manage and measure an ACO
Accountable Care MetricsACO Reports
Regulatory Metrics
• Outcomes Metrics• Guidelines Metrics• Efficiency Metrics• Clinical Process Metrics
Payer Metrics• Payer Mandated Metrics• Outcomes Metrics• Physician Metrics• Process Metrics• Claims for Reimbursement
MetricsACO
Reporting capabilities are required to collect and submit quality and safety data to CMS and private payers.
Reports will provide valuable information allowing ACOs to track performance and identify areas for improvement.
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Sophisticated analytics platform enables longitudinal view of patients and practice of evidence based medicine
Connectivity, Security and InteroperabilityConnects to all the data producers, provides access to data consumers, and validates access rights.
Core Applications and Workflow / AutomationOrchestrates the execution of activities the constitute the care continuum, gathering contextual information from both the transactional systems as well as the data-warehouse.
Data Integration and ManagementRetrieve data from the data producers, in both structured and unstructured form, and transform it to align with core application data requirements as well as end user analytical needs.
Physician/Patient EngagementKey interfaces for both patients and physicians to facilitate their interactions with the VBC system, leveraging workflow & analytics to enhance engagement and satisfaction for both these stakeholders.
Data Analytics and ContentUsing self-actualizing trends and business solution specific heuristics analyzes transactional data and creates enriched information. Data delivery occurs via screen-reports and services/API.
Physician / Patient Engagement
Data Integration & Management
Core Applications & Workflow / Automation
Data Analytics & Content
12 3
4 5
What Next
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Unprecedented Market Changes Are Creating New Challenges for Healthcare Providers
Transparency in cost & quality
Shift from volume to value (e.g., P4P, risk sharing)
Heightened consumer expectations on value, simplicity, and transparency
Ubiquitous technology adoption (e.g. Web, Mobile, Social) combined with always-on consumers
Rise in government programs (e.g., Medicare, Medicaid, Duals, and HIX)
Heightened regulatory oversight
Realignment of relationships and scope of services across healthcare industry
Risk shifts from Health Plans to Providers
Players are seeking new ways to create and deliver value (e.g., disintermediation of traditional players)
The evolution occurring in the industry is driven primarily by four macro-drivers:
These macro trends make it imperative for industry leading provider organizations to adapt to change enabled by their best in class people and processes
HC Delivery
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The Unified Data Platform – Oracle and Deloitte
Level 2 View –
Data Source/Producers
Data Consumers
Data Brokering
Data Ingestion/Enrichment
Data Collection
Where do investments in technologies like Oracle EHA, and Deloitte’s Analytical Applications fit in this future view?
Data IngestionHL7 MLLP FHIR DICOM CDA
Web Services
...
ODBC
JDBC
FTP SFTP
SSH
...
Web Services
ODBC
JDBC
FTP SFTP
SSH
...
Replication Services
Routing Change Data Capture Exception Channel Structural Validation ...
Master Data Hub
Patient Merge Patient Unmerge Lookup Validation ...
Transformation Services
Structural Normalization
ConsolidationData Manipulation /
DerivationBusiness
Tranformation...
Bulk Load Services
Data Authentication Job Metrics Internal Transport Load ...
Metadata Hub
Impact Analysis PurgingData Tagging
(Social/Unstructured)Customizing ...
Common Services
Logging System Monitoring System Caching Data Privacy ...
...
Data Collection
ODBC JDBCFTP
SFTPSSH ...
ODBC
FTPSFTP
...
ODBC SSHFTP
SFTP...
Non Relational
Relational
Master Data
Metadata
Person Location Codes ...
Standards
...
Elements Business Rules Value Sets Lineage
Data Warehouse
Person Event Allergies Medication Lab Results
Clinical Notes Surgery Disease ...
Data Mart
Person Event Allergies Medication Lab Results
Clinical Notes Surgery Disease ...
Operational Data
Patient Event Clinical Notes Lab Results ...
Images Genomics Logs Social Media Voice
…
Virtualization
Security
Orchestration
Data Brokering
Registration Services
Events Routing (Channel) Services
Event Processing Services
In Memory Management
In Memory Analytics Machine LearningReal time Decision
Making
Business Services/Rules
Data Consistency/Parallel Persistence
...
Synchronous Read-Through
Synchronous Write-Out
Asynchronous Write-Behind
Asynchronous Event Listener
Subscriptions Notifications
Coarse Grain Fine Grain
Semantic / Federated View
In Memory StrorageDistributed Processing
Adapter Service
Adapter Service
Adapter Service
Adapter Service
...Adapter Service
Adapter Service
Adapter Service
Adapter Service
Adapter Service
...Adapter Service
Adapter Service
Adapter Service
Adapter Service
Adapter Service
...
Adapter Service
Adapter Service
Adapter Service
Adapter Service
Adapter Service
...
Adapter Service
Data Creation
ODBC JDBC FTP SFTP SSH ...Web
Services
Structured Data
Internal
External
Semi or Unstructured Data
Internal
External
Electronic Medical Record
Financials Lab Orders/Results Pharmaceuticals ...
Extramural Lab – Orders/Results
National Demographics
Electronic Medical Record
...
Device Data
Sys Logs
Call Notes / Logs
Behavioral Assessments
Treatment Plans
Clinical Notes
Images
Clinical Knowledge
Mobile Formatted Data
...
Device Data
Clinical Notes
Mobile Formatted Data
Voice
Treatment Plans
...
Social Media Images
Data Consumption
External Services
Analytics
Data Services
Vendor HubsHIEs
...
Predictive Analytics
Internal Open APIs
Affiliate Information Sharing
BI/Operational Reporting
Internal Data Sharing
Knowledge Delivery
Data Visualization
…
External Open APIs
...
ODBC
FTPSFTP
SSH
...
HL7 MLLP FHIR DICOM CDAWeb
ServicesXDS (HIE)ODBC JDBC FTP SSH ...
Web Services
ODBC
JDBC
FTP SFTP
SSH
...
Oracle- HDM- DBMS
Oracle- MDM- ODI- Data Quality
ConvergeHealth by Deloitte
ConvergeHealth by Deloitte
Oracle - OBIEE
Oracle - OBIEE
Healthcare organizations should enable advanced analytics to provide integrated patient care
Q&A