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

Transcription

1 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, Allina Health

2 Conflict of Interest Ross Gustafson, MBA Ownership interest: Health Catalyst options

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

4 Learning Objectives Discuss the direct effect quality improvement has on cost containment and why it is key to moving to a value-based model of payment Demonstrate how Allina Health is using advanced analytics to bridge historical, current and predictive information to improve quality while lowering the cost of care Describe the effect care coordination driven by predictive analytics has made in improving the overall quality of health experienced by Allina Health patients and how it has helped reduce unnecessary hospital admissions and readmissions Describe how transparency of data with physician community supported engagement and improved triple aim outcomes for Allina Health

5 STEPS: Patient Engagement & Population Management Improved Outcomes to be Leader in Diabetes Optimal Care Management >60% Care Management Engagement with Patients vs Health Plans

6 Allina Health Context & Strategy

7 About Allina Health Largest Healthcare System in the Twin Cities and Region 13 hospitals 1,812beds 59 Allina Clinics, 22 hospital-based clinics 15 community pharmacies 3 ambulatory care centers 8 Clinical Service Lines Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice Over 26,000 employees Allina Integrated Medical Network representing over 3,000 employed & independent physicians Key statistics (2014) $3.6 billion in revenue 108,124 inpatient admissions 1.3 million outpatient admissions 3.5 million total clinic visits

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

9 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

10 All About Creating Value and Advancing Outcomes Based Delivery Strategy Value = Quality (in its full definition) Cost the one outcome that unites all players in health and health care

11 Four Measures of Success: 2016 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

12 Triple Aim Integration Initiatives Quality Roadmap Goal Initiative(s) 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 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

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

14 Data Analytics Structure & Tools

15 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

16 Enterprise Data Warehouse: Data to Information

17 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?

18 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

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20 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

21 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

22 Analytics & Outcomes Experience

23 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

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

25 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 Resources to Support Patients

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

27 Care Management Interventions for Hospital Transitions 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 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 Jun 2015 Jul 2015 Aug % 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Follow-up Appointment within 5 Days at Allina Clinc Readmissions Actual to Expected PPR Trend by Rolling 3 Months

28 Example: Supporting Cohort Management Providing Care to Patients with Diabetes Challenge Provide superior care for Allina Health s diabetic population Solution Results 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 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

29 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

30 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 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 Results 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 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 Colon Cancer Screening Optimal Care Goal = 73% 76.0% 71.0% 66.0% 61.0% 56.0% Mammogram Optimal Care Goal = 85% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0% 76.0% 74.0%

31 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

32 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

33 2014 Northwest Alliance TCOC Trend HealthPartners Commercial Population

34 Summary

35 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

36 Value Easier to share information & identify opportunities Evidenced based protocols deployed Data available right time, right place Individual and Population Health planning backbone Efficiency

37 Questions?