intro of data analysis in healthcare for triple aim

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INTRO OF DATA ANALYSIS

IN HEALTHCARE

Yaxing Liu, PhD

Analysis, Reporting, Action with Triple Aim

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Todd Park, CTO, Department of Health and Human Services

Source: http://www.forbes.com/sites/nicoleperlroth/2011/11/02/tim‐oreilly‐the‐worlds‐7‐most‐powerful‐data‐scientists/

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Triple Aim

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Better Care

Lower Cost

Better Population Health

In 2011, current estimates by World Health Organization put U.S. health care spending at approximately 17.9% of GDP.


Healthcare Ecosystem


Source: http://www.infosys.com/industries/healthcare/industry‐offerings/Pages/interface‐factory‐CoE.aspx

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Data Warehouse Modeling


From the book: Healthcare Risk Adjustment and Predictive Modeling


Programs


ACO: Accountable Care Organizations.

HIE: Health Information Exchanges.

Patient‐center care.

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Chronic Condition

Development

Enrollment

TrendCosts

Chronic care reporting Utilization Quality measures Enrollments/trends Costs: PMPM HEDIS measures

Reporting

Priority Score ED Visits ReadmissionHospital

Admissions

Prediction

Care AlertsChronic Care Management

Identifyhigh‐risk/high‐opportunitypatients

Automated Tracking

Medication scheduling and reminder

Screening/Assessment/Care Plan

Transitional Support

Actions?

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Medicaid Enrollment


Source: https://www.ccwdata.org/cs/groups/public/documents/digitalmedia/a2_race_2009_image.jpg

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Medicaid Enrollment


Source: https://www.ccwdata.org/cs/groups/public/documents/digitalmedia/a2_age_2000_2009_image.jpg


Track Enrollment Trends


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Enrollment Analysis



PMPM Cost


Source: http://www.objectivehealth.com/our‐offerings/strategy‐solution/value‐based‐care

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Cost and Savings


State Fiscal Year

Per‐Member,Per‐Month

Total Annual Savings

2007 $8.73 103,000,000

2008 $15.69 204,000,000

2009 $20.89 295,000,000

2010 $25.40 $382,000,000

$984,000,000

Source: https://www.communitycarenc.org/our-results/ccnc-saves-money/


When

• Admit date

• Discharge date

Who

• Member

• Provider

Why

• PRIMARY_DIAGNOSIS

• SECONDARY_DIAGNOSIS

• DISCHARGE_STATUS_CODE_DESC

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PROCEDURE_CODE

• Hospital outpatient and Acute Inpatient ED claims are identified by revenue center codes equal to ‘0450’,’0451’,’0452’,’0456’, ‘0459’

• PROCEDURE_CODE = '450'

Revenue center code: 0981.

• Revenue_Codex in (450, 451, 452, 456, 459)

Place of Service

• [PLACE_OF_SERVICE] like '%emerg%'


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ED Visits Reports Number of visits: 129.8 million

Number of injury‐related visits: 37.9 million

Number of visits per 100 persons: 42.8

Percent of visits with patient seen in fewer than 15 minutes: 25.1%

Percent of visits resulting in hospital admission: 13.3%

Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.1%

• Source: National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables, tables 1, 4, 14, 24


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Claim Header + Claim Line

• Claim Num

• Claim Type

• Claim Status: Paid, adjusted, denied, rejected

• Dates

• Amount

Data Dictionary

• Medicare:

• https://www.ccwdata.org/web/guest/data‐dictionaries

Form

• UB‐04


Inpatient

Outpatient

SNF/swing bed

Hospice

Physician encounter

DME


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Patient

• Age

• Race

• Gender

Provider

• NPI / name / address

Diagnosis/procedure

• CPT

• HCPCS

• ICD9‐CM Diagnosis, ICD9‐CM Procedure, ICD10

• LOINC


Origin

• The International Classification of Diseases (ICD) is updated and maintained by the World Health Organization (WHO)

• ICD‐9‐CM developed in 1970s

• WHO’s 9th revision of ICD (ICD‐9) had attained wide international recognition by 1970s

Modifiction

• The U.S. National Center for Health Statistics, part of Centers for Disease Control, modified ICD‐9 with clinical information

• Result was the International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM), commonly referred to as ICD‐9, which precisely delineates the clinical picture of each patient, providing exact information beyond that needed for statistical groupings and analysis of healthcare trends

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Professional (CMS‐1500)

• diagnosis codes

• V‐codes (V01‐V91)

• E‐codes (E000‐E999)

Institutional (UB‐04)

• diagnosis codes

• V‐codes

• E‐codes

• procedure codes


Definition

•3 digits followed by a decimal, then followed by no, 1, or 2 digits,3‐5 characters in length

•First digit may be alpha (E or V) or numeric; digits 2‐5 are numeric

•All claims, whether CMS‐1500 or UB‐04, must have at least one ICD‐9 diagnosis code

•On UB‐04, the first diagnosis code must describe the principal reason for the care provided.

Guideline

•Providers should code only the current condition that prompted the patient’s visit

•When the diagnostic statement identifies an acute condition, providers should use the code that specifies “acute” whenever it is available

•Providers should be as specific as possible in specifying diagnosis

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Include:

• ICD‐10‐CM – diagnosis codes

• ICD‐10‐PCS (Procedure Coding System) –procedure codes, only for UB‐04 (primarily hospitals)

Definition

• 3‐7 characters in length

• First digit is alpha; digits 2 and 3 are numeric; digits 4‐7 are alpha or numeric

• specific


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Definition

• 2 digits followed by a decimal, then no, 1, or 2 digits

• Used to document procedures performed during the encounter

• Ranked in priority of significance

• Used only on UB‐04 claims


CMS ICD‐9 coding guidelines Identify each service, procedure, or supply with an ICD‐9 diagnosis

code to describe the diagnosis, symptom, complaint, condition, or problem

Identify services or visits for circumstances other than disease or injury, such as follow‐up care after chemotherapy, with V codes provided for this purpose

Code the principal diagnosis first, followed by the secondary, tertiary, and so on.


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CPT: Current Procedural Terminology

• Developed and maintained by the American Medical As sociation (AMA) in 1966

• Five‐digit codes with descriptions

• CPT and HCPCS codes also used to reimburse most non

• ‐physician

• health professionals

Six major sections

• Evaluation and management (E&M) (99201‐99499)

• Anesthesiology (00100‐01999)

• Surgery (10040‐69990)

• Radiology (70010‐79999)

• Pathology and laboratory (80048‐89399)

• Medicine (90281‐99199 and 99500‐99999)

Subsections

• Procedures are divided into subsections according to body part, service, or diagnosis


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Definition

• HCPCS means HCFA Common Procedure Coding System

• Allows providers and medical suppliers to report professional services, procedures and supplies


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CMS NDC 5‐4‐2 Segmentation


The first segment: the labeler code assigned by FDA. A labeler is any firm that manufactures, repacks, or distributes a drug product.

The second segment: the product code, identifies a specific drug, strength, and dosage form of that drug.

The third segment, known as the package code, identifies the package size.

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NDC Examples


NDC Codes NDC Descriptions

99073070827 FreeStyle Lite Test Strips‐ 100 ct

99073070822 FreeStyle Lite Test Strips‐ 50 ct

99073070819 NFRS FreeStyle Lite Test Strips 50 ct

99073071230 NFRS FreeStyle Insulinx Test Strips 50 ct


HEDIS measures

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intro of data analysis in healthcare for triple aim

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