Decision Support & Business Intelligence. The Next Generation. Derek Morkel, CEO GAFFEY Healthcare

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Decision Support & Business Intelligence. The Next Generation. Derek Morkel, CEO GAFFEY Healthcare"

Transcription

1 Decision Support & Business Intelligence The Next Generation Derek Morkel, CEO GAFFEY Healthcare Measurement is the core of any process "An acre of performance is worth a whole world of promise." - William Dean Howells "Don't rate potential over performance." -Jim Fassel "Goal setting has traditionally been based on past performance. This practice has tended to perpetuate the sins of the past." -Joseph M. Juran "If you can't describe what you are doing as a process, you don't know what you are doing. - W. Edwards Deming "In God we trust, all others bring data." -W. Edwards Deming 1

2 Establishing a culture of measurement 1. What is Business Intelligence? Business Intelligence is the process of transforming all of the raw data that companies (hospitals) collect from their various operations into actionable information. 3 Why the current state has to change CMS Projections for National Healthcare Spending (Amount in Billions) CY $5, % $4,500 $4,353 $4,000 $3,500 $3,000 $2,500 $2,000 $4,062 National Health Expenditures (billions) $3, % 19.8% $3,541 National Health Expenditures as a Percent of Gross Domestic Product $3, % $3,111 $2, % $2, % $2,624 $2, % 18.0% $2,379 $2, % 17.7% $2,113 $1,981 $1,855 $1, % 20.0% 19.0% 18.0% $1, % 17.0% 16.2% $1, % 15.9% 15.9% 16.0% 16.0% $500 $ % Source: Centers for Medicaid & Medicare Services - NHE Projections , Forecast Summary and Selected Tables 2

3 The growth in healthcare spending, combined with healthcare drivers will continue to have major impacts IBM presentation Healthcare 2015 Drivers Globalization Impacts Continued shift from employer-based insurance Consumerism Changing demographics and lifestyles Diseases that are expensive to treat New technologies and treatments Increasing focus on value Increase in consumer responsibility New approaches to promoting health and delivering care Growing resource challenges Data & Reimbursement Landscape Old/Current $ $ 4 Community Dataflow stops at Point 2 $ $

4 Data/Reimbursement Landscape Future Physician Community Hospital $ s & data shared in closed loop Nursing Home Tertiary Care Hospital 7 Current State Data - Fragmented Lab System OR System ED System Pharmacy System Registration System Hard Copy Medical Records Micro Results Hematology Chemistry Results Peri Op Documentation OR Med Admin Time ED Admit Time ED DC Time Medication Name Dispense Order MRN Name ICD 9/10 4

5 Examples Healthcare Data Sources EMR Clinical Data Patient Accounting Physician Practice Management Risk Management Insurance Plan Data Home Health ACO participation PCMH Patient Generated Data Cost Accounting 9 Current Decision Support Model Hospital focused Product Line/DRG/Physician alignment Profitability core calculation Stand alone system & database Complex costing models Monthly calculation Standard reporting packages LESS THAN 50% HOSPITALS DOING THIS 10 5

6 Why New Model Necessary Need to know costs for all aspects of care continuum Without detailed & on demand cost information facilities disadvantage to others Focus on patient away from Facility/PL/DRG Data models allow hospitals function with same capability as insurance company Close the information gap Ability/Flexibility to track & model probability Multitude of data requests/interactions One Month, One Week or even One Day too late 11 New Decision Support Model Patient Focused Focused on cost & clinical efficiency managing high risk patients Equal or better access to data vs. your partners Must include all areas continuum that responsibility for or is included in risk sharing models Real time data critical All activities costed hospital, physician, PCMNH Control own data build/maintain Data Warehouse 12 6

7 Relational Database Basics A relational database is a databasethat has a collection of tablesof data items, all of which is formally described and organized according to the relational model. Data in a single table represents a relation, from which the name of the database type comes. In typical solutions, tables may have additionally defined relationships with each other. In the relational model, each table schemamust identify a column or group of columns, called the primary key, to uniquely identify each row. A relationship can then be established between each row in the table and a row in another table by creating a foreign key, a column or group of columns in one table that points to the primary keyof another table. The relational model offers various levels of refinement of table organization and reorganization called database normalization. (See Normalizationbelow.) The database management system(dbms) of a relational database is called an RDBMS, and is the software of a relational database. 13 Relational Database Basics Primary Key = Unique Identifier Patient ID # Medical Record # SSN# Physician ID Any data store that contains one or more of these elements can be tied to any other data with same elements 14 7

8 The Future of Decision Support Provide Access Transform Data to Information Administrators Developers & Executives CLINICAL IMPROVEMENT Quality Quality Real Time Compliance Compliance Quality Reporting Chronic Medication Chronic Medication Disease Safety Patient Disease High Cost Safety Monitoring Adherence Management Patients Monitoring Dashboard Physicians & Patient Clinicians OPERATIONS EFFICIENCY Electronic Electronic Claims Disease Claims Attachments Registries Attachments (Diabetes) Real-time Real-time Claims Claims Operations Adjudication Adjudication KPI Dashboard Consumer Consumer On Line On Payments Patient Line and Payments and Scheduling Throughput Analytics Aggregate and Integrate Data Enterprise Data Warehouse Generate and Acquire Data Inpatient EMR Pharmacy Med Mgmt Diagnostic Imaging Lab Revenue Cycle Emergency Clinical and Business Transactional Systems Ambulatory Surgery Mgmt Optimize Infrastructure Infrastructure and IT Processes Example What is economic impact of slips & falls? Data Sources Risk management/incident reporting system Patient Accounting data Charges, Payments, Adjustments, Net Revenue Demographics Age, Payor, LOS etc. Cost Accounting Direct Costing by Patient PA Data Demographic Data Cost Accounting Direct Margin RM System DW - Patient ID, Unique ID Output Comparison DM with & w/o falls 16 8

9 Simple Query Example Knee Replacement 2012 ICD-9-CM Diagnosis Code V43.65 Knee joint replacement Short description: Joint replaced knee. ICD-9-CM V43.65 is a billable medical code that can be used to specify a diagnosis on a reimbursement claim. Query Any Variation in Data = Error [Either Charge or Procedure] DESCRIPTI ON Pat ID DOS ICD 9 Proc. Description Rev Code Implant Est Charge Actual Chg S /1/2014 V43.65 Knee Joint Replacement 278 $ 9, $ 9, SOURCE CHG/DEMO CHG/DEMO PROCEDURE/DIAGNOSIS PROCEDURE/DIAGNOSIS CHG DETAIL CUSTOM CALC. CHG DETAIL [COST* MARKUP] 17 Simple Query Example ER Levels 9

10 Simple Query Example AR Analysis Report What are my next steps? What do you want/need to measure Top 5/10 daily priorities Map out data needs for each priority Where data located What is status of Data Warehouse Analytical Tools Owner/Executive Sponsor 20 10

An Introduction to HealthInfoNet s HIE Reporting & Analytics. 6th Annual APS Healthcare Maine Conference May 14, 2015

An Introduction to HealthInfoNet s HIE Reporting & Analytics. 6th Annual APS Healthcare Maine Conference May 14, 2015 An Introduction to HealthInfoNet s HIE Reporting & Analytics 6th Annual APS Healthcare Maine Conference May 14, 2015 Presentation Outline HealthInfoNet Background Current Status of health information exchange

More information

Improving Quality And Bending the Cost Curve: Strategies That Work

Improving Quality And Bending the Cost Curve: Strategies That Work Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth

More information

REVENUE CYCLE BASICS: The Future of Revenue Cycle Clue..It s the Data Warehouse. Derek Morkel, President & CEO, GAFFEY Healthcare

REVENUE CYCLE BASICS: The Future of Revenue Cycle Clue..It s the Data Warehouse. Derek Morkel, President & CEO, GAFFEY Healthcare REVENUE CYCLE BASICS: The Future of Revenue Cycle Clue..It s the Data Warehouse Derek Morkel, President & CEO, GAFFEY Healthcare REVENUE CYCLE BASICS: The Future of Revenue Cycle Clue..It s the Data Warehouse

More information

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Presented to The American College of Cardiology October 27, 2012 1 Franciscan Alliance Overview Franciscan

More information

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker

More information

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University

More information

Population Health Analytics. Ruth Rose Vice President, Clinical Technology Cigna

Population Health Analytics. Ruth Rose Vice President, Clinical Technology Cigna Population Health Analytics Ruth Rose Vice President, Clinical Technology Cigna We Have a Common Enemy - Disease 86% of American adults will be obese by 2030 1 in 4 working adults smoke or use tobacco

More information

Eastern Maine Healthcare Systems Non-Profit Health Care Investor Conference

Eastern Maine Healthcare Systems Non-Profit Health Care Investor Conference Eastern Maine Healthcare Systems Non-Profit Health Care Investor Conference May 21, 2014 M. Michelle Hood, FACHE President and Chief Executive Officer Derrick O. Hollings, CPA Senior Vice President, Treasurer/CFO

More information

Supporting a Continuous Process Improvement Model With A Cost-Effective Data Warehouse

Supporting a Continuous Process Improvement Model With A Cost-Effective Data Warehouse Supporting a Continuous Process Improvement Model With A Cost-Effective Data Warehouse Dave Hynson, Vice President and CIO Juan Negrin, Manager of BI and Data Governance OVERVIEW I. ALIGNMENT TO BUSINESS

More information

Enterprise Analytics Strategic Planning

Enterprise Analytics Strategic Planning Enterprise Analytics Strategic Planning June 5, 2013 1 "The first question a data driven organization needs to ask itself is not "what do we think?" but rather "what do we know? Big Data: The Management

More information

COM Compliance Policy No. 3

COM Compliance Policy No. 3 COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION

More information

The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare

The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare The Future of Revenue Cycle - Big Data and Business Intelligence. You Need a Plan! Derek Morkel, President & CEO, GAFFEY Healthcare The Future of Revenue Cycle - Big Data and Business Intelligence. You

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Analytic-Driven Quality Keys Success in Risk-Based Contracts March 2 nd, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

Population Health 2.0: Bending the Cost Curve by Moving Beyond the Pyramid

Population Health 2.0: Bending the Cost Curve by Moving Beyond the Pyramid Population Health 2.0: Bending the Cost Curve by Moving Beyond the Pyramid Advocate Health Care $5 Billion Annual Revenue AA Rated 12 Acute Care Hospitals 1 Children s Hospital 5 Level 1 Trauma Centers

More information

POPULATION HEALTH ANALYTICS

POPULATION HEALTH ANALYTICS POPULATION HEALTH ANALYTICS ANALYTICALLY-DRIVEN INSIGHTS FOR POPULATION HEALTH LAURIE ROSE, PRINCIPAL CONSULTANT HEALTH CARE GLOBAL PRACTICE DISCUSSION TOPICS Population Health: What & Why Now? Population

More information

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega The Five Pillars of Population Health Management Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega ZeOmega a forerunner in Population Health Management Transformation into

More information

Leveraging Big Data for the Next Generation of Health Care Ken Cunningham, VP Analytics Pam Jodock, Director Business Development

Leveraging Big Data for the Next Generation of Health Care Ken Cunningham, VP Analytics Pam Jodock, Director Business Development Leveraging Big Data for the Next Generation of Health Care Ken Cunningham, VP Analytics Pam Jodock, Director Business Development December 6, 2012 Health care spending to Reach 20% of U.S. Economy by 2020

More information

Accountable Care for Pharmacy Executives

Accountable Care for Pharmacy Executives Accountable Care for Pharmacy Executives A Prescription for Change L. David Harlow III RPh Director of Pharmacy Carilion Clinic New River Valley Medial Center Objectives At the completion of this knowledge

More information

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013 Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013 Topics Introductions Drivers Strategies Imperatives Discussion Page 2 Copyright Kurt Salmon 2013 All Rights Reserved

More information

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network Population Health Management: Banner Health Network s Perspective Neta Faynboym, Medical Director Banner Health Network 29 Acute Care Hospitals BANNER AT A GLANCE Banner Health Network with 400K lives

More information

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Urgent Care Industry Overview

Urgent Care Industry Overview Urgent Care Industry Overview September 2013 Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which

More information

TRUVEN HEALTH UNIFY. Population Health Management Enterprise Solution

TRUVEN HEALTH UNIFY. Population Health Management Enterprise Solution TRUVEN HEALTH UNIFY Population Health Enterprise Solution A Comprehensive Suite of Solutions for Improving Care and Managing Population Health With Truven Health Unify, you can achieve: Clinical data integration

More information

Solution Overview. Fusion Health Advantage Big Data Accelerator Platform

Solution Overview. Fusion Health Advantage Big Data Accelerator Platform Solution Overview Fusion Health Advantage Big Data Accelerator Platform Improve Patient Outcomes And Manage Them Cost Effectively Healthcare reform measures have intensified governmental scrutiny, thereby

More information

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012 Cornerstone Health Care s ACO Playbook Grace E. Terrell, MD January 17, 2012 Mission: To be your medical home Vision: To be the model for physician-led health care in America Values: As a physician owned

More information

US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform

US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform December 2014 Contents Section Slide Number Executive Summary 11 Market Background 19 The EHR Landscape

More information

Insert Presentation Name

Insert Presentation Name Insert Presentation Name Presentation to: Presented by: Date: 1 Title or Chapter Slide One patient, One record (use as needed; feel free to delete) A Journey Praveen Chopra, CPIM VP, Chief Information

More information

Predictive Analytics in Action: Tackling Readmissions

Predictive Analytics in Action: Tackling Readmissions Predictive Analytics in Action: Tackling Readmissions Jason Haupt Sr. Statistician & Manager of Clinical Analysis July 17, 2013 Agenda Background Lifecycle Current status Discussion 2 Goals for today Describe

More information

Using EHRs, HIE, & Data Analytics to Support Accountable Care. Jonathan Shoemaker June 2014

Using EHRs, HIE, & Data Analytics to Support Accountable Care. Jonathan Shoemaker June 2014 Using EHRs, HIE, & Data Analytics to Support Accountable Care Jonathan Shoemaker June 2014 Agenda Allina Health overview ACO framework- setting the stage Health Information Technology and ACOs Role of

More information

Adventures in Orthopedic Data Management

Adventures in Orthopedic Data Management Adventures in Orthopedic Data Management Cleansing and Categorizing Data to Improve Supply Utilization October 15, 2015 Kurt MacDonald 2014 Trinity Health. All Rights Reserved. 1 Topics Overview of Trinity

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural ACO? The National Rural ACO was formed in 2013 to pool knowledge, patients, and resources so that independent community health

More information

Analytics: The Key Ingredient for the Success of ACOs

Analytics: The Key Ingredient for the Success of ACOs Analytics: The Key Ingredient for the Success of ACOs Author: Senthil Raja Velusamy Business Analyst Healthcare Center of Excellence Executive Summary Accountable Care Organizations (ACOs) are structured

More information

Healthcare Information Technology (HIT)

Healthcare Information Technology (HIT) Healthcare Information Technology (HIT) Why State Governments Must Help Create a National Health Information Network Ian C. Bonnet Deloitte Consulting LLP October, 2005 State Leadership in developing a

More information

Split Billing Overview

Split Billing Overview Split Billing Overview June 2, 2008 Doug McGregor Partner, Healthcare Services Feeley & Driscoll, P.C. (617) 742-7788 DougM@fdcpa.com Definitions Split Billing reimbursement A structure under which two

More information

Health Claims Opportunities

Health Claims Opportunities Synpulse Singapore Pte. Ltd. Management Consulting 8 Shenton Way #46-01 AXA Tower Singapore 068811 Phone +65 6229 5770 Fax +65 6229 5771 info@synpulse.com synpulse.com Health Claims Opportunities Taking

More information

The Changing Landscape of Healthcare and What it means to you!

The Changing Landscape of Healthcare and What it means to you! The Changing Landscape of Healthcare and What it means to you! Marc Leighton Imagination at work. How do hospitals/providers get paid? Introduction to Payment Mechanisms DRG- or APDRG-based mechanisms

More information

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA Transitioning from ICD-9-CM to ICD-10-CM Tidewater Physicians Multispecialty Group Williamsburg, VA February 22, 2014 Our Agenda Some guidelines for this morning s presentation Our Transformational Point

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural Accountable Care Consortium? The National Rural Accountable Care Consortium was formed in 2013 to pool knowledge, patients,

More information

A Health Analytics Framework

A Health Analytics Framework ABSTRACT Paper SAS1900-2015 A Health Analytics Framework Krisa Tailor, Jeremy Racine, SAS Institute Inc. As the big data wave continues to magnify in the healthcare industry, health data available to organizations

More information

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing

More information

ACO Update: Trends, Results and the Future of Accountable Care

ACO Update: Trends, Results and the Future of Accountable Care ACO Update: Trends, Results and the Future of Accountable Care David Muhlestein, PhD Director of Research, Leavitt Partners September 16, 2014 Presentation Overview Basics of Accountable Care ACO Trends

More information

PCMH and Care Management: Where do we start?

PCMH and Care Management: Where do we start? PCMH and Care Management: Where do we start? Patricia Bohs, RN, BSN Quality Assurance Manager Kelly McCloughan QA Data Manager Wayne Memorial Community Health Centers Honesdale, PA Wayne Memorial Community

More information

Agenda. Topic Industry Today - Quality Measure Reporting Stage 1 Meaningful Use - Overview - Tenet Experience

Agenda. Topic Industry Today - Quality Measure Reporting Stage 1 Meaningful Use - Overview - Tenet Experience Achieving Meaningful Use Symposium Eligible Hospital Perspective Stage 1 Learnings, Stage 2 Preparation Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC, VP, Applied Clinical Informatics, Tenet Health DISCLAIMER:

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Population Health Management: Advancing Your Position in the Journey to Value-Based Care Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015 Welcome & Introductions

More information

How Big Data is Shaping Health Care Decisions Pat Keran Sr. Director of Innovation Optum Technologies

How Big Data is Shaping Health Care Decisions Pat Keran Sr. Director of Innovation Optum Technologies How Big Data is Shaping Health Care Decisions Pat Keran Sr. Director of Innovation Optum Technologies Cancer is second only to heart disease as the most common cause of death in the U.S. Thanks By 2030,

More information

5557 FAQs & Definitions

5557 FAQs & Definitions 5557 FAQs & Definitions These Questions and Answers are intended to present information that has been acquired as part of the discovery process and provides necessary context for the Policy Directives

More information

Leveraging Big Data & Deep Analytics to Improve Care

Leveraging Big Data & Deep Analytics to Improve Care Leveraging Big Data & Deep Analytics to Improve Care A Complimentary Webinar From healthsystemcio.com Sponsored by SAS Your Line Will Be Silent Until Our Event Begins at 1:00 ET Thank You! Housekeeping

More information

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner

More information

Care Transformation and the Journey to Population Health Management

Care Transformation and the Journey to Population Health Management Care Transformation and the Journey to Population Health Management Richard A Bankowitz, MD MBA FACP Chief Medical Officer, Premier healthcare alliance AMGA Institute for Quality September 26, 2013 Premier:

More information

ADVANCING CLINICAL & BUSINESS INTELLIGENCE AND THE USE OF ANALYTICS IN HEALTHCARE

ADVANCING CLINICAL & BUSINESS INTELLIGENCE AND THE USE OF ANALYTICS IN HEALTHCARE ADVANCING CLINICAL & BUSINESS INTELLIGENCE AND THE USE OF ANALYTICS IN HEALTHCARE James E. Gaston, FHIMSS Sr. Dir. of Clinical & Business Intelligence HIMSS and HIMSS Analytics James.Gaston@HIMSSAnalytics.org

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Toward a Single Source of Patient Truth: Predictive Analytics for Accountable Care

Toward a Single Source of Patient Truth: Predictive Analytics for Accountable Care Toward a Single Source of Patient Truth: Predictive Analytics for Accountable Care Driven by new and emerging models of accountable care, healthcare organizations must determine how to use data to address

More information

Michael J. Tronolone, MD, MMM, Chief Medical Officer Michelle Matin, MD, FAAFP Associate Medical Director for Quality The Polyclinic Seattle, WA

Michael J. Tronolone, MD, MMM, Chief Medical Officer Michelle Matin, MD, FAAFP Associate Medical Director for Quality The Polyclinic Seattle, WA Succeed with Population Health Management in a Fee-for-Service Environment and Improve Clinical Quality Measures While Transitioning to Value- Based Care Michael J. Tronolone, MD, MMM, Chief Medical Officer

More information

Transformational Data-Driven Solutions for Healthcare

Transformational Data-Driven Solutions for Healthcare Transformational Data-Driven Solutions for Healthcare Transformational Data-Driven Solutions for Healthcare Today s healthcare providers face increasing pressure to improve operational performance while

More information

A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure

A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure + A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure + Disclosures: Timothy Harlan: I have no actual or potential conflict of interest in relation to this presentation.

More information

Dual RFI Response Summary

Dual RFI Response Summary Dual RFI Response Summary Improving Care through Integrated Medicare and Medi- Cal Delivery Models Stuart Levine, MD., MHA. Keith Wilson, MD Robert Margolis, MD. Stakeholder Meeting August 30, 2011 1 Organization

More information

Realizing ACO Success with ICW Solutions

Realizing ACO Success with ICW Solutions Realizing ACO Success with ICW Solutions A Pathway to Collaborative Care Coordination and Care Management Decrease Healthcare Costs Improve Population Health Enhance Care for the Individual connect. manage.

More information

EMS Changes, Challenges and Opportunities under Healthcare Reform. Thursday, April 26, 2012 2pm ET 1 pm CT Noon MT 11am PT

EMS Changes, Challenges and Opportunities under Healthcare Reform. Thursday, April 26, 2012 2pm ET 1 pm CT Noon MT 11am PT 1 EMS Changes, Challenges and Opportunities under Healthcare Reform Thursday, April 26, 2012 2pm ET 1 pm CT Noon MT 11am PT 2 Complimentary Live Webinar Today s Speakers: Jay Fitch PhD, Fitch & Associates

More information

Toward Meaningful Use of HIT

Toward Meaningful Use of HIT Toward Meaningful Use of HIT Fred D Rachman, MD Health and Medicine Policy Research Group HIE Forum March 24, 2010 Why are we talking about technology? To improve the quality of the care we provide and

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Healthcare Facilities Accreditation Program

Healthcare Facilities Accreditation Program 1 Healthcare Facilities 2 Moving Accreditation from Standards to Quality and Safety Based Lessons from the Healthcare Facilities Richard Snow DO, MPH Healthcare Facilities Advisory Board Medical Director

More information

Meaningful Use Stage 2 Certification: A Guide for EHR Product Managers

Meaningful Use Stage 2 Certification: A Guide for EHR Product Managers Meaningful Use Stage 2 Certification: A Guide for EHR Product Managers Terminology Management is a foundational element to satisfying the Meaningful Use Stage 2 criteria and due to its complexity, and

More information

DST Webinar Population Health Management

DST Webinar Population Health Management DST Webinar Population Health Management December, 2014 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with

More information

Meaningful Use Is Not the Finish Line

Meaningful Use Is Not the Finish Line Meaningful Use Is Not the Finish Line A White Paper From Health Language CALL 720.940.2900 EMAIL info@healthlanguage.com ONLINE www.healthlanguage.com Meaningful Use Is Not the Finish Line Improved information

More information

Model for a Virtual ACO

Model for a Virtual ACO Today Tomorrow Model for a Virtual ACO An Emerging Primary care Based Multi- specialty Virtual ACO Responding to Need Small practices operate in isolation Can t t compete with hospital-based delivery systems

More information

Issues in Health Care Delivery

Issues in Health Care Delivery BOARD of GOVERNORS Health Initiatives Committee Issues in Health Care Delivery Alma B. Littles, M.D. Special Advisor, STEM/Health Initiatives September 17, 2014 www.flbog.edu www.flbog.edu BOARD of GOVERNORS

More information

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP Lancaster County Business Group on Health, Forecast Breakfast, September 25, 2014 Impact of ACA & Pharmacy on UHC Clients Financial:

More information

Big Data Analytics Driving Healthcare Transformation

Big Data Analytics Driving Healthcare Transformation Big Data Analytics Driving Healthcare Transformation Greg Caressi SVP Healthcare & Life Sciences November, 2014 Six Big Themes for the New Healthcare Economy Themes Modernizing Care Delivery Clinical practice

More information

Impact of the 2010 Affordable Care Act on the California Labor Force

Impact of the 2010 Affordable Care Act on the California Labor Force Impact of the 2010 Affordable Care Act on the California Labor Force Linda L. Zorn, RD, MA Sector Navigator Health Workforce Initiative California Community Colleges Chancellor s Office Project Overview

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Myth, Reality, Facts Why =System Failure Low Quality - IOM report High Cost Quality Cost disconnect Low Value Problems Disconnect between Quality and Cost Care is fragmented

More information

Accountable Care Organizations and Medical Home Transformation at Legacy Health

Accountable Care Organizations and Medical Home Transformation at Legacy Health Accountable Care Organizations and Medical Home Transformation at Legacy Health Melinda Muller, MD, FACP Clinical VP, Primary Care Legacy Medical Group Objectives Review the definition and history of

More information

Building a High Performance Integrated Population Health Infrastructure. Fulfilling Our New Medical Management Responsibilities

Building a High Performance Integrated Population Health Infrastructure. Fulfilling Our New Medical Management Responsibilities Building a High Performance Integrated Population Health Infrastructure Fulfilling Our New Medical Management Responsibilities Presenters Betsy Hampton, RN, MBA Vice President, Population Health Reliant

More information

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

The Changing Face of Medical Necessity under ICD-10

The Changing Face of Medical Necessity under ICD-10 The Changing Face of Medical Necessity under ICD-0 Sponsored by 95 N. Fine Ave #04 Fresno CA 93720-565 Phone: (559) 25-5038 Fax: (559) 25-5836 www.californiahia.org Program Handouts Monday, June 8, 205

More information

Title: Coding Documentation for IHS Affiliated Physician Practices

Title: Coding Documentation for IHS Affiliated Physician Practices Affiliated Physician Practices Effective Date: 11/03; Rev. 4/06, 7/08, 7/10 POLICY: IHS affiliated physician practices will code diagnoses utilizing the International Classification of Diseases, Ninth

More information

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies

More information

An Optum Company. The Journey: From Healthcare To Health

An Optum Company. The Journey: From Healthcare To Health The Journey: From Healthcare To Health June 2014 Cross-Continuum Clinical & Claims Analytics Platform Aggregate data across the continuum Clean, normalize and validate data Transform data into insight

More information

Informatics Strategies & Tools to Link Nursing Care with Patient Outcomes in the Learning Health Care System

Informatics Strategies & Tools to Link Nursing Care with Patient Outcomes in the Learning Health Care System Nursing Informatics Working Group Informatics Strategies & Tools to Link Nursing Care with Patient Outcomes in the Learning Health Care System Patricia C. Dykes PhD, RN, FAAN, FACMI Judy Murphy RN, FHIMSS,

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

CNYCC DSRIP HIT/HIE Webinar

CNYCC DSRIP HIT/HIE Webinar CNYCC DSRIP HIT/HIE Webinar Joe Reilly CNYCC Tim Weldon Aspen Advisors Presentation Agenda Review guiding principles Discuss population health definition as it relates to DSRIP Community vs. Organizational

More information

Financial Implications: The Push from Inpatient to Outpatient Care

Financial Implications: The Push from Inpatient to Outpatient Care Financial Implications: The Push from Inpatient to Outpatient Care Brian Baumgardner & Mitchell Mongell THE TRANSFORMATION TO CONSUMER-DRIVEN HEALTHCARE FINANCIAL IMPLICATIONS:THE PUSH FROM INPATIENT TO

More information

Porter Hospital Narrative FY 2014 Budget Submission

Porter Hospital Narrative FY 2014 Budget Submission Porter Hospital Narrative FY 2014 Budget Submission Summary: Porter Hospital s FY14 budget represents a continuation of the significant and positive financial turnaround commencing from January, 2013 and

More information

Onsite Health Clinics THE PAST, THE PRESENT AND THE FUTURE

Onsite Health Clinics THE PAST, THE PRESENT AND THE FUTURE Onsite Health Clinics THE PAST, THE PRESENT AND THE FUTURE Session Objectives Understand the healthcare landscape Identify the trends in onsite healthcare Highlight the benefits an onsite clinic with employer

More information

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare ACO Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare Not-for-profit serving 3.1 million residents of San Diego County Grew from one hospital in 1955 to an integrated

More information

October 18, 2013. Articulating the Value Proposition of Innovative Medical Technologies in the Healthcare Reform Landscape

October 18, 2013. Articulating the Value Proposition of Innovative Medical Technologies in the Healthcare Reform Landscape October 18, 2013 Articulating the Value Proposition of Innovative Medical Technologies in the Healthcare Reform Landscape Outline The Changing Landscape Evolving Care Delivery and Incentive Models Provider

More information

Anthem Workers Compensation

Anthem Workers Compensation Anthem Workers Compensation ICD-10 Frequently Asked Questions What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the

More information

Commercial ACOs: Trials and Tribulations

Commercial ACOs: Trials and Tribulations Commercial ACOs: Trials and Tribulations June 12, 2015 Agenda: John Jenrette, MD, CEO, Sharp Community Medical Group Moderator Nancy Greenstreet, MD, Medical Director, Physicians Medical Group of Santa

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Data Analytics: The Next Wave in Health IT. Big Data Conference June 17, 2014. Robert Wah, MD. Global Chief Medical Officer CSC

Data Analytics: The Next Wave in Health IT. Big Data Conference June 17, 2014. Robert Wah, MD. Global Chief Medical Officer CSC Data Analytics: The Next Wave in Health IT Big Data Conference June 17, 2014 Robert Wah, MD Global Chief Medical Officer CSC 1 Building a New Health Care System Healthcare is an industry in transition.

More information

Michigan Medicaid EHR Incentive Program. Ryan Koolen - MDCH

Michigan Medicaid EHR Incentive Program. Ryan Koolen - MDCH Michigan Medicaid EHR Incentive Program Ryan Koolen - MDCH Topic Overview 1)Program Basics 2)Participation with the program 3)Program Progress 4)Helpful Information 5)Questions Program Basics Introduction

More information

HCPCS codes should be used to describe outpatient diagnostic laboratory procedures (revenue codes 300 to 319).

HCPCS codes should be used to describe outpatient diagnostic laboratory procedures (revenue codes 300 to 319). 6How Do I Bill Tribal Outpatient Hospital Services? Complete the UB-04 form for outpatient hospital services. Refer to How do I complete the UB-04? in the Billing Guidelines section for specific information

More information

Risk Adjustment ABC s

Risk Adjustment ABC s Medicare Advantage Risk Adjustment and Coding Academy Coding Risk Adjustment Documentation Training Risk Adjustment ABC s What is Risk Adjustment? Risk adjustment is the process by which the Medicare &

More information

SUCCESSES AND CHALLENGES DEVELOPING AN ENTERPRISE CLINICAL ANALYTICS SOLUTION Ambulatory Information Management (AIM)

SUCCESSES AND CHALLENGES DEVELOPING AN ENTERPRISE CLINICAL ANALYTICS SOLUTION Ambulatory Information Management (AIM) SUCCESSES AND CHALLENGES DEVELOPING AN ENTERPRISE CLINICAL ANALYTICS SOLUTION Ambulatory Information Management (AIM) Dennis P. Sweeney, MBA July 16, 2013 Dennis P. Sweeney, MBA Mr. Dennis Sweeney, Tellogic

More information

4 steps of maturation along your journey to becoming an effective, efficient, and profitable ACO

4 steps of maturation along your journey to becoming an effective, efficient, and profitable ACO 4 steps of maturation along your journey to becoming an effective, efficient, and profitable ACO INTRODUCTION This white paper is not intended to explain what an ACO is, but rather how an ACO takes the

More information

professional billing module

professional billing module professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3

More information

The Need to Embrace Profit Cycle Management in Healthcare

The Need to Embrace Profit Cycle Management in Healthcare GE Healthcare The Need to Embrace Profit Cycle Management in Healthcare Justin Steinman General Manager GE Healthcare IT Top 5 Takeaways 1. Healthcare leaders need to start analyzing and controlling costs

More information

Select Healthcare Themes and Investment Opportunities

Select Healthcare Themes and Investment Opportunities Select Healthcare and Demographic Shift Towards Older Population There were around 40 million Americans that are 65 and older in 2010 2 The population of seniors 65 and older is set to grow to 55 million

More information