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Session #11:Partners HealthCare Analytics

Strategy for Bundled Payments and Risk Management

Helen Chan, Senior Manager, Business Planning

Pre-Session Poll QuestionOn a scale of 1-5, how effective is your organization’s population health and accountable care strategy?

1) Not at all effective2) Somewhat effective3) Moderately effective4) Very effective5) Extremely effective6) Unsure or not applicable

Sree Chaguturu, MD, VP, Population Health Management

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About the organization

Two large academic centers, multiple inpatient and outpatient facilities, 6,000 physicians

Not-for-profit integrated delivery system, ACO

Preparing for accountable care, population health management

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Population health management priority programs

Primary Care • Patient-Centered Medical Home (PCMH) • High-risk care management (palliative care) • Mental health integration • Virtual visits

Specialty Care • Active referral management (curbsides)• Virtual visits• Procedural decision support (appropriateness)• Patient reported outcomes • Episodes of care (bundles)

Care Continuum • SNF care improvement (network/waiver/SNFist)• Home care innovation (mobile observation/telemonitoring) • Urgent care

Patient Engagement • Shared decision making• Customized decision aids and educational materials

Infrastructure • Single EHR platform with advanced decision support • Data warehouse, analytics, performance metrics

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And a reminder of why these programs…

Primary Care

Specialty Care

Care Continuum

Patient Engagement

Infrastructure

Develop team-based care

Demonstrate value in bundles/procedures

Reduce post-acute variation

Empower patients in their care

Information -> Insight -> Action

Promote Medical Neighborhood

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Providing the Tools for PHM

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Bundled payment management

Managing at-risk populations

Drivers impacting hospital, outpatient, and physician billing volume and margin

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Partners Population Insights: How are we performing on our risk populations?a) How does our trend compare to prior year and benchmark?

b) What are the major changes in TME trend by key categories?

- Resource area and site of care

‒ Service grouping

‒ Unit of action

‒ Demographics

c) What are effective ways to visualize data to drive managerial action?

d) What ways to leverage data to construct a story about PHM trend performance?

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Partners Population Insights: Dynamic QlikView Application to Analyze Trend

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Partners Population Insights: How the tool engages physicians in risk• Empowered physicians and practices to assess trend

performance of the system and of their own patients

• Used tool to engage physicians using their own data to identify areas of clinical and managerial action

• Developed a self-service model to make data easy, accessible, and not intimidating

• Generated more bi-directional communication between administrators (corporate and local) and clinical practices

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DRAFTPartners Episodes of Care: Improving clinical care while preparing for future payment arrangements

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Identify areas of clinical variation with the greatest opportunity and/or within the physicians’ control

Engage specialists

Manage utilization, cost, and quality

Objective: to reduce cost of episode (TME) and internal PHS costs; improve quality

Prepare for CMS Episodic Payment

Assess Clinical

Variation

Go to Market with

Employers

Commercial Contracting

CMS Mandate on Hips/Knees Bundles to begin Jan 2016 in 75 geographic regions

Objective: to reduce cost of episode (Total Medical Expense TME)

Opportunity to Engage 3rd parties directly (Employers, Other ACOs, etc.)

Minimal traction with commercial payers historically

Expect to follow CMS footsteps

Not immediate priority

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Partners Episodes of Care:Screenshot of Variation Analysis

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DRAFTPartners Episodes of Care: Key questions answered by the tool 1) What is the average cost by episode and how is this

shifting?

2) What is the distribution of episodes by cost and how is this trended?

3) How does my hospital and physician group compare with others and where are the outliers?

4) At the MD level, which cases are driving outlier status and why?

5) What caused complications for outlier cases? Did patients come in with that or caused by hospital/physician?

6) How much unmanaged variation is there month to month, year to year? Does the variation exceed what can be managed?

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Partners Healthcare Directions: Monitor hospital volume and margin trends when system is in both FFS and Risk

Key Business Questions: How are the following impacting PHS volume and margin?

• Cost pressures and changing market dynamics

• Our local / system initiatives

How are our Population Health Management efforts impacting our hospital business?

Focus: System and hospital level

volume and margin trends

1. Site of Care (Shift of

high / low acuity cases)

2. Population Health

Management

7. Patient Consumerism

6. EMASS Referrals /

Market Consolidation

8. Shift in payer mix and other market

dynamics

3. PHS Referral Strategy

Drivers of Volume / Margin Change

5. Partners Employees

Benefit Design

4. Primary Care Growth/ Ambulatory

Planning

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Partners Healthcare Directions: Key questions and intended audiences

• In a fluid market environment, build an analytics tool that monitors actual hospital volume and margin trends in near real time

Purpose

Value Add• Bring together data from multiple sources in one place to

identify key drivers of trend across facets of our business• Generating market context for observed trends• Focus analysts’ time on high value areas

Intended Audiences

• Provide business intelligence to Senior Finance, Clinical, and Administrative leaders to develop strategy and understand trends

• Serve as basis for a new quarterly report to senior system and hospital leaders

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Understanding Impact of PHM on Hospitals

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Poll Question #2

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On scale of 1-5, how effectively is your organization using healthcare analytics to support population health and manage at-risk contracts?

1) Not at all effective

2) Somewhat effective

3) Moderately effective

4) Very effective

5) Extremely effective

6) Unsure or not applicable

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Results

• Developed and implementing a comprehensive PHM strategy

• Successfully integrated hospital, provider, and claims information to evaluate, compare, and improve clinical and financial performance

• Made actionable information readily accessible to managers

• Used customized groupers to develop service and clinical groups to accurately attribute TME

• Identified non-analytic criteria for success

• Made meaningful progress toward a data-driven culture

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Future Plans

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Continue journey to a data-driven culture

Continue to enhance PHM applications

Continue to improve governance capabilities

Increase adoption and tracking of outcomes and effectiveness

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Lessons Learned

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1. Know what business and clinical questions you want to answer

2. Involve the right people

3. Take a rapid-cycle failure and improvement approach

4. Data is not enough – need to build clinical programs that take advantage of the insights garnered from the data

5. Building these self-service tools can become overwhelming for the organization

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Analytic Insights

AQuestions &

Answers

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Choose one thing…

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Write down one thing will you do differently after hearing this presentation

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Thank You

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Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?

1) Not at all satisfied

2) Somewhat satisfied

3) Moderately satisfied

4) Very satisfied

5) Extremely satisfied

2. What feedback or suggestions do you have?

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Upcoming Speakers

3:45 PM – 4:35 PM

16) Delivering Excellence at Stanford Health Care

Amir Dan Rubin, President and CEO, Stanford Health Care

4:35 PM – 5:00 PM

17) The Future World of Value-Based Healthcare (Documentary featuring Michael Porter)

Caleb Stowell, MD, Vice President, Research and Development, International Consortium for Health Outcomes Measurement (ICHOM, Senior Researcher, Harvard Business School)

Location

Grand Ballroom

Grand Ballroom