ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016

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1 ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration, Allina Health 1

2 Agenda Allina Health Context & Strategy Data Analytics Structure & Tools Analytics & Outcomes Experience Summary 2

3 Allina Health Context & Strategy 3

4 About Allina Health Largest Healthcare System in the Twin Cities and Region 4 13 hospitals 1,790 beds 61 Allina Clinics, 23 hospital-based clinics 15 community pharmacies 2 ambulatory care centers 8 Clinical Service Lines Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice Over 27,000 employees Allina Integrated Medical Network representing over 3,000 employed & independent physicians Key statistics (2015) $3.8 billion in revenue 109,00 inpatient admissions 1.4 million outpatient admissions 4.3 million total clinic visits

5 Minnesota Market Leader in quality improvement, reporting & outcomes ICSI MN Community Measurement Competitive provider environment with consolidation occurring Fortune 500 companies seeking greater value 5

6 Connected Care Strategy Allina Health pursuing a strategy of Connected Care Better connect and coordinate care (and support the caregiver s ability to do just that) Advance new payment systems that rewards outcomes Integrate data and knowledge to improve care and health 6

7 Four Measures of Success: Strategic Priorities 1. Optimal Health/Experience for Individuals Personal Primary Care Teams Strategic positioning acute care assets 2. Optimal Health for the Community Allina s readiness to manage population health Community health benefit 3. Affordable Care Payment integration strategy Better Care/ Experience Better Health 4. Organizational Vitality Performance Employee/Physician engagement Brand and member engagement Reduce per capita costs Organizational Vitality 7

8 Triple Aim Integration Initiatives Roadmap Goal 1) Perform under value based payment risk models 2) Align incentives across employed and affiliated providers 3) Give providers the data and information needed to improve outcomes 4) Provide consistently exceptional care without waste 5) Support transformation with new skills development Initiative(s) Accountable care pilots Pioneer ACO Commercial partnerships Medicaid Allina Integrated Medical Network (Clinically Integrated Network) Advanced analytics infrastructure including a robust Enterprise Data Warehouse (EDW) Primary care team model redesign Care management/patient engagement Clinical program optimization Allina Advanced Training Program 8

9 Strategic Partnership with Health Catalyst Why did Allina Health Pursue? Ability to focus on core competency Accelerating analytic adoption Cost stabilization Allina + Catalyst Allina 2014 Allina 2010 Allina 2008 Healthcare Analytic Adoption Model 9

10 10 Data Analytics Structure & Tools

11 11 Allina Health - Analytic Adoption Level 8 Level 7 Level 6 Level 5 Cost per Unit of Health Reimbursement & Prescriptive Analytics Cost per Capita Reimbursement & Predictive Analytics Cost per Case Reimbursement & Data Driven Culture Clinical Effectiveness & Population Management Contracting for & managing health Taking more financial risk & managing it proactively Taking financial risk and preparing your culture for the next levels of analytics Measuring & managing evidence based care 2010 Level 4 Automated External Reporting Efficient, consistent production & agility Level 3 Automated Internal Reporting Efficient, consistent production 2009 Level 2 Standardized Vocabulary & Patient Registries Relating and organizing the core data Level 1 Data Integration Enterprise Data Warehouse Foundation of data and technology 2008 Level 0 Fragmented Point Solutions Inefficient, inconsistent versions of the truth Source: Healthcare Analytic Adoption Model

12 Enterprise Data Warehouse: Data to Information 12

13 General Specific Clinical Intelligence Tools PPR Dashboard Census Dashboard Allina Health Readmissions Model Potentially Preventable Events Enterprise Data Warehouse EHR Dashboard Operational Reports Allina Health Modeling of Potentially Preventable Events Retrospective What happened? Real time What is happening? Predictive What may happen? 13

14 Getting the Predictive Analytics to the Bedside The Census Dashboard Identifies Transition Conference Status Identifies Patient Readmit Risk Identifies Prior IP Visits in Last Week & Month 14

15 Established Data Governance Model ACO Population Health Analytics Focus on identifying Total Cost Of Care Opportunities in valuebased payment populations INPUTS Clinical Ops & Physician Perceptions Payer Reports MNCM, HP Reports Claims Data ACO Applications Internal Data Clinical Variation ANALYZE, SYNTHESIZE & REPORTING TCOC Opportunities ACO Analytics Workgroup RECOMMENDATIONS PRIORITIZATION Network Quality Committee 15

16 Analytics & Outcomes Experience 16

17 Examples of Allina Health s Efforts & Outcomes How have enhanced analytics supported Allina Health in improving its performance? Prioritizes areas for care model changes Risk stratification Patient finding Clinical variation Enables focus on risk-based contract populations Provides insights on efforts, areas for further change, readiness to spread 17

18 Population Health Management Risk Stratification Model Stratify the population with data integration for unique care models Claims Utilization Predictive Models Clinical Assessment Diagnostics Predictive Models Consumer Activity Trackers Biometrics Preferences & Goals High Risk Rising Risk Low Risk Complex Care Management 1-2% Commercial 5% Government Primary Care: Registries Screening Prevention Outreach Health Coaching Healthy Digital Strategy: Education 24/7 Access to Care 18

19 Health Plan Claims Utilization Pharmacy Online Health Assessments Data Sources Allina Health Hands on assessment Predictive models Screening tools Diagnostics Members Identified for Complex Care Management Intake Health Plan Care provided outside of Allina Health Allina Health 19 Resources to Support Patients

20 Care Management: Ambulatory Census Dashboard Case Finding Locating patient populations 20

21 Apr 2012 May 2012 Jun 2012 Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Care Management Interventions for Hospital Transitions 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Apr 2012 Jun 2012 Aug 2012 Follow-up Appointment within 5 Days at Allina Clinc Oct 2012 Dec 2012 Feb 2013 Apr 2013 Jun 2013 Aug 2013 Oct 2013 Dec 2013 Feb 2014 Apr 2014 Jun 2014 Aug 2014 Oct 2014 Dec 2014 Feb 2015 Apr 2015 Jun 2015 Aug Readmissions Actual to Expected PPR Trend by Rolling 3 Months 21

22 Example: Supporting Cohort Management Providing Care to Patients with Diabetes Challenge Provide superior care for Allina Health s diabetic population Solution Identified and stratified diabetes cohorts using registries Identified gaps in care for diabetes patients (e.g. A1c, blood pressure management) Provided workflow capability for care teams to manage the population through ambulatory quality dashboard Results Highest national score for Diabetes Care Quality Measure in 2012 of all CMS Pioneer ACOs U.S. leader in management of diabetes patients and Diabetes Optimal Care results 22

23 Supporting Cohort Management Driving Improvement through Access to Information Select by patient, clinic, provider or any combination Filter by Pioneer ACO Patients Shows performance of composite measure components 23

24 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Example: Supporting Wellness & Prevention Successfully Keeping Patients Well Challenge Avoiding future illness is core to superior population health management Solution Established and reported on optimal care scores for individuals Identified gaps in care and accurately connected them to care teams to close gaps in care Results Eliminated significant gaps in wellness screening and preventative care Allina Health has achieved some of the best ambulatory optimal care scores in the nation through a focused clinician engagement strategy Colon Cancer Screening Optimal Care Mammogram Optimal Care Goal = 85% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0% 76.0% 74.0% 24

25 Supporting Wellness & Prevention Ambulatory Dashboard MD Name Ability to focus on a specific provider or patient population Shows performance on optimal care and component measures with patient detail, provider name and clinic 25

26 ACO Population Focus Northwest Metro Alliance HealthPartners and Allina Health care for nearly 300,000 people in the Northwest Metro together. Serves as a learning lab for Accountable Care to move forward the Triple Aim Data sharing critical across organizations Use of claims and clinical EMR data valuable Physician engagement and collaboration has been core to success Critical shift in mindset from competition to cooperation 26

27 2014 Northwest Alliance TCOC Trend HealthPartners Commercial Population 27

28 28 Summary

29 29 Summary This is Only the Beginning Have patience & prioritize: Utilize Pareto analysis of population data key for determining opportunity and focus Focus on waste: Consistent quality drives lower cost of care Use predictive modeling to focus care management resources Prepare to invest $$ s for tech & talent Engage physicians in data strategy development Integrate and analyze claims and clinical data Transparency and access are critical Use outcome improvement approach Keep the patient at the center of all decisions

30 30 Thank You & Any Questions?

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