transforming data into actionable information

1

© 2005 HHCF All rights reserved1

Transforming Data intoActionable Information

Executing a Data Integration StrategyExecuting a Data Integration Strategy

Neil Sullivan, M.P.H.May 21, 2008

© 2005 HHCF All rights reserved 2

What’s the Value Proposition of DataIntegration?What’s the Value Proposition of DataIntegration?

DATA ININFORMATION

OUTBUSINESS

SOLUTIONS

2


What can data integration do for you?What can data integration do for you?

What specific program evaluation needs do youhave?

What specific data storage needs do you have?

What specific strategic planning needs do youhave?


What types of data will you need tointegrate?What types of data will you need tointegrate?

1. Health Promotion and Wellness data2. Medical and Rx claims data3. Absence data4. Safety, Risk and Disability data5. Human Resource data (who, what, where, when and

how)6. Performance / Productivity data7. Compensation data8. Workforce Transition data (hire, fire, promote, demote)9. Management and Training

3


Why integrate data?Why integrate data?

Aggregate similar types of data into one placeMultiple medical carriers reporting standardized claims dataCompare business functions or locations

Build a more complete composite around an issueThe compounding costs of Medical + Rx + DisabilityThe compounding impacts of indirect costs

Building a person-centric modelLeveraging the complexities of the person vs. the disease

or programUtilizing the entire population when performing analytics


How to integrate dataHow to integrate data

Analytic Team – SpecializedAnalysts And

System Administrators

Interpretation andPresentation Team

Data Management Team –Data Technicians, Database Administrators

And System Administrators

PrimaryGroupsInvolved

DatabaseEngines

Toolsets BI &Analytic

Tools

•WebApplications

•Reports•Presentations

Security

Network, System and Database SecurityHIPAA and other Regulatory Laws

Separation of Roles/DutiesRestriction of Access

Change Management Processes

Systems

Database,Analytic andReportingServers

DatabaseServers

AnalyticServers

Web andApplicationServers

DataInvestigation

and DataCleansing

Data Collection(Log & Load)

DataProduction

Ready

Analysisof the Data

DataInterpretation

and InformationProduction

Outputand SupportProduction

Phase

Building of theServers,

Software andInfrastructure

DataRequirementsand Database

Design

4


HIPAAHIPAA

Health Insurance Portability and AccountabilityAct (HIPAA)Federal law enacted in 1996 to assist in the

healthcare reform initiative

Original Intent/Goals:Reduce costs of administrative overhead Improve efficiency and effectiveness of the

healthcare systemProtect privacy and security of patient health

informationProtect patient rights Improve the quality of careEnhance information availability for decision making


Protected Health Information (PHI)Protected Health Information (PHI)

1. Name2. Geographic (less than 20,000 people)3. Dates except for year (birth date, admission date, etc.)4. Phone Number5. Fax Number6. Email Address7. Social Security Number8. Medical Record Number9. Health Plan Beneficiary Numbers10. Account Numbers11. Certificate/license numbers12. Vehicle identifiers & serial numbers, including license plate numbers13. Device identifiers & serial numbers14. URLs15. IP Address16. Biometric identifiers, finger & voice17. Full face photos or other images18. Any other unique identifier

5


HIPAA DefinitionsHIPAA Definitions

Covered EntityHealth Plans, Healthcare Clearinghouses, and to any healthcare

provider who transmits health information in electronic form

Business Associate A person or organization, other than a member of a covered entity’s

workforce, that performs certain functions or activities on behalf of, orprovides certain services to, a covered entity that involve the use ordisclosure of individually identifiable health information.

Services are limited to legal, actuarial, accounting, consulting, dataaggregation, management, administrative, accreditation, or financialservices.


HIPAA Privacy and Security of DataHIPAA Privacy and Security of Data

Privacy is WHAT IS PROTECTEDSecurity is HOW INFORMATION IS PROTECTED

The Final Rule on Privacy Prohibits a covered entity from using or disclosing an

individual’s protected health information (PHI), unlessotherwise permitted or required by the rule.

Protects PHI transmitted or maintained in any form ormedium and encompasses electronic medical records, papermedical records and oral communication

6


Data Elements of Human Capital

Big Picture Human Capital SolutionsBig Picture Human Capital Solutions

WorkforceTransitionCompensation

Performance andOutput

Big PictureInformation

Safety and RiskManagement

Medical Serviceand Insurance

Attendance

Managementand Training

Prevention andWellbeing


Data Elements of Human Capital

Big Picture Human Capital SolutionsBig Picture Human Capital Solutions

WorkforceTransitionCompensation

Performance andOutput

Big PictureInformation

Safety and RiskManagement

Medical Serviceand Insurance

Attendance

Managementand Training

Prevention andWellbeing

7


Scenario #1: Disability and WorkersCompensationScenario #1: Disability and WorkersCompensation

Workers Compensation and Disability rates for Musculoskeletal & Injury claimsare 65% higher at one of your manufacturing locations.

020406080

100120

A B C D

Accidents and Injury Daysby location

Disability

WC

Statistically controlled for: Gender, age, job type, and tenure.

What’s causing the differences in claims rates across locations?


Scenario #1: Assumptions & fixesScenario #1: Assumptions & fixes

1. Assumption: All of these claims at Location C are truemedical injuriesFix: Fix the injuries with prevention and treatment

2. Assumption: The workers at Location C are older and less fitFix: Alternative duty, Back strengthening, pre-employmentphysical assessments

3. Assumption: Location C has more physically demandingjobsFix: Facility assessment and organizational redesign

8


Scenario #1: DiscoveryScenario #1: Discovery

0

50

100

150

A B C D

Accidents and Injury Daysby location

DisabilityWC

Location Discovery

A Partial salary reimbursement and WC charge back

B Incongruence between STD and WC

C 100% salary reimbursement for 6 weeks

D Incongruence between STD and WC


Scenario #2: Bariatric SurgeryScenario #2: Bariatric Surgery

0

10

20

30

40

50

60

2004 2005 2006 2007

Surg

ery

Cou

ntp

er10

00

Year

Bariatric Surgery

Bariatric surgery rates are on a dramatic rise at this organization

9



1. Assumption: Rates of obesity are increasing at this organizationand thus leading to a higher demand for bariatric surgeryFix: Reduce / prevent obesity in this population and thus reducethe need for bariatric surgery

2. Assumption: Employees are more motivated to loose weight evenif it means undergoing surgeryFix: Conduct additional BMI screening and diagnoses of obesity

3. Assumption: Bariatric surgery reduces obesity related illnessesand related absence and costFix: Promote bariatric surgery



Findings:• Post surgery medical and disability costs were higher than a non-surgical obese group• More than 30% of those undergoing the surgery left the company within 12 months post surgery

Decision:•Benefit Plan design changes including new eligibility criteria and increased cost share

10


Scenario #3: DiabetesScenario #3: Diabetes

$0

$4,000

$8,000

$12,000

$16,000

$20,000

Department A Department B Company Avg.

Integrated Costs of Diabetes

Medical Rx STD WC Presenteeism

Ann

ualI

nteg

rate

dco

sts

per

Em

ploy

ee

Statistically controlled for: Gender, age, #of risk factors, and tenure.

What’s different between Department A and Department B diabetics?

Diabetes costs differ dramatically from one department within your organization



1. Assumption: Department B diabetics are sicker, older and lessadherent to medicationsFix: Implement a diabetes management / prevention program

2. Assumption: Department A diabetics participate in DM/CMprograms and Department B diabetics don’tFix: Increase incentive or disincentive for participation inDM/CM for Department B diabetics

11



$0

$4,000

$8,000

$12,000

$16,000

$20,000

Department A Department B Company Avg.

Integrated Costs of Diabetes

Medical Rx STD WC Presenteeism

Ann

ualI

nteg

rate

dco

sts

perE

mpl

oyee

Location Discovery

A Bonus Compensation policy

B No bonus comp and 100% salary reimbursement for STD


Research Finding: Likelihood of STD byPercent of Variable Pay For Which Employee is EligibleResearch Finding: Likelihood of STD byPercent of Variable Pay For Which Employee is Eligible

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

0% 10% 20% 30% 40% 50% 60%

Relative Variable Pay (Variable Pay/Total Compensation)

Likelih

ood

ofHav

ing

a(N

on-P

regn

ancy)

STD

Cla

im

Likelihood of having a (Non-Pregnancy) STD Claim, controllingfor age and gender.

Likelihood of having a (non-pregnancy)STD claim, controlling for age and gender.

Source: Health as Human Capital Foundation, 2008

12


Various Ways of Helping Others See the“Big Picture”


Integrated Database Value Proposition:Data In → Information OutIntegrated Database Value Proposition:Data In → Information Out

People• Recruit/Retain

Jobs• Type & Performance• Mgmt/Training

Compensation• Wages/Deferred• Incentive Comp• PTOVacation/HolidaySick Leave/FML Disability/WCI

• InsuranceLifeHealth & DentalP&C/WC

Health & Safety• Prevention & Wellness• OSHA

Business Performance

HumanHumanCapitalCapital

ManagementManagementIDbIDb

HCMSHCMSRRDbRRDb

• HumanResource

• Comp & Benefits

• Health & Safety

• Risk, Finance &Legal

• Operations

• Contract Agents

Population BaselineRisk Analysis/DS

Periodic Reporting/DS(Longitudinal Trends)

Ad Hoc Analysis/DS(Query Investigations)

Online Reporting(Portals, Dashboards)

DataData DatabaseDatabase Information ProductionInformation Production& Decision Support& Decision Support

Human CapitalHuman CapitalManagersManagers

Benchmarking, Research, &Predictive Modeling Services

13


HCMS Group Research &Benchmark DatabaseHCMS Group Research &Benchmark Database

• Total People 1,570,000 People• Employees (Payroll and Demographics) 653,000 Employees• Insured Dependents 669,000 Dependents• Social Welfare and Wyo WC Claimants 247,000 People• Medical Insurance 74,975,000 Services• Prescription Drug 33,397,000 Prescriptions• Sick Leave/Other Absence 3,122,000 Episodes• STD Claims 111,400 Claims• LTD Claims 6,900 Claims• Workers’ Compensation Claims 673,400 Claims• Productivity Data 18,100,000 Total Records• Duration 2 to 7 Years


Longitudinal Integrated Health TrendAnalysesLongitudinal Integrated Health TrendAnalyses

$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th

2004 2005 2006 2007

Av

era

ge

Co

st

pe

rE

mp

loy

ee

Employee Medical Employee Preventive Employee DrugDependent Medical Dependent Drug WC

STD LTD Health Account

14


Pareto & Quintile AnalysesPareto & Quintile Analyses

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile

Av

erag

eC

ost

per

Em

ploy

ee

Employee Medical Employee Drug Dependent MedicalDependent Drug W C Med W C IndemSTD LTD

High Risk Group588 Employees

Moderate Risk Group2,987 Employees

Low Risk Group21,425 Employees

N = 25,000Average Cost per Employee: $2,780Aggregate Cost: $69,493,604

Quintile PopulationAvg. Employee

CostAvg. Employee &Dependent Cost

Employee CostRange

1 21,425 (85.7%) $646 $2,276 $0-$3,4732 2,083 (8.3%) $5,994 $9,540 $3,473-$9,3653 904 (3.6%) $14,755 $18,126 $9,367-$18,9764 444 (1.8%) $35,541 $41,919 $19,008-$41,0055 144 (0.6%) $97,690 $100,237 $41,029-$453,662

Based on 12 calendar months

Average cost = $2,780


Pareto Risk Group TrendsPareto Risk Group Trends

Adjusted for Inflation

40% Increase

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd

2001 2002 2003 2004 2005

Ave

rag

eC

ost

perE

mpl

oyee

Low Risk Moderate Risk High Risk

15


$0

$5,000

$10,000

$15,000

$20,000

$25,000

4 Q uartersPre

Q ua rter O fHigh C os tEp isode

4 Q uartersPost

4 Q uartersPre

Q ua rter O fCM Start

4 Q ua rtersPost

No Cas e M anagem ent Case M anagem ent

Av

era

ge

Co

stp

er

Qu

arte

rp

er

Em

plo

yee

M ed ical D rug ST D W C LT D

Statistical Matching for ProgramEvaluationStatistical Matching for ProgramEvaluation


Predictive ModelingPredictive Modeling

0.0%

12.5%

25.0%

37.5%

50.0%

Age

Tenu re

SF-

8O

vera

ll

Cas

eTy

p e2

or4

Prio

rMed

icat

ions

Med

ical

Exa m

inat

ion /E

valu

atio

n

HRA

Parti

cipa

nt

Cas

eTy

pe3

or5

Patho

logy

Lab

orat

ory

Prior

Co st

s

Rad

iolo

gy

Ess

entia

l Hyp

erte

nsio

n

Re

lati

ve

Wei

gh

t

● Blu e bars represent variables that con tr ibute to increased risk.● Red bars rep resent variab les associated with decreased risk.

16


Questions for you to answer:Questions for you to answer:

1. Internal vs. External solution?

2. What’s the investment?

3. What’s the return?

4. Who should be my Integrated Database Partner?

5. Who in my organization should pay for this?

6. Who in my organization should own this?

7. How do I get started?


Questions for me to answer?

17


HCMS Group HHCF ActivitiesHCMS Group HHCF Activities

501(c)(3) Research and Education Arm of HCMS Group

Health as Human Capital Research Approach- People- Incentives- Prevention

Education Activities Include:- Presentations- Seminars and Conferences (Continuing Education)- Blog and Publications


HHCF Blog and Blog BookHHCF Blog and Blog Book

www.hhcfoundation.org

18


Thank you!

[email protected]

transforming data into actionable information

Documents