Medical Informatics: Transforming data into knowledge

Transcription

1 Insert photo here The Evolving Role of the Fiscal Intermediary Arriving At an Assessment of Value Jaan Sidorov, MD, MHSA Medical Director, Medical Informatics EDS Camp Hill, PA

2 Medical Informatics: Transforming data into knowledge Medical Informatics services are in essence Business Intelligence services related to health care and can be defined as the study, invention, and implementation of structures and algorithms to improve communication, understanding and management of medical information. The end objective of medical informatics is the coalescing of data, knowledge, and the tools necessary to apply that data and knowledge in the decision-making process, at the time and place that a decision needs to be made *. * Aamir M. Zakaria, MD, medical-informaticsfaq_ @rtfm.mit.edu, accessed June 12, 2008.

3 Medical Informatics: Transforming data into knowledge The plural of data is not information.

4 Medical Management Continuum of Services Data Mining Data Extraction Data Warehousing Program Design & Communication Utilization Management Targeted Case Management Large or Complex Case Management Disease Management & Nurse Triage Medical Broker Claims Cost Management Healthcare Consulting Clinical Content & Judgment Future State Visioning/Process Flow Analysis Medical Call Center Wellness Management Health Advocacy Services Physician Review & Consulting Decision Support Care Management Workflow Applications & Healthcare Informatics Case Management Identification Predictive Modeling Pre-Certification Prior Authorization Claims Performance Management Healthcare Administration Pharmacy Services Fraud, Waste & Abuse Business Intelligence & Reporting Benefits Planning Claims Processing Eligibility & Enrollment

5 On Demand Analytics Needs & Benefits Key drivers: Health services costs outpace inflation and budget growth Healthcare needs outpace budgets as population ages Health payers are creating innovative approaches that are designed optimize the healthcare spend and improve health outcomes The Ideal Level of Support: Data information insight actionable insight that enables Higher clinical quality at optimum cost Current clinical quality at lower cost The Benefits of Actionable Insight: Deliver innovative benefit designs, then Quickly assess outcomes Reassess, adjust, execute and assess again.

6 On Demand Analytics Consultation & Collaboration What is the research question? E.g.: Are we spending a lot of money on care of chronic wounds? Often an iterative process Part journey, part destination, part relationships E.g.: What is the year-to-year change/trend in PMPM claims expense for continuously enrolled persons with these ICD-9/CPT, vs. this quasi-experimental comparator Many s, phone calls that clarify/simplify Attitude of Yes, if as opposed to No, because to the inevitable new requests Triangulate on the inexact truth using a combination of research, actuarial and statistical approaches.

7 Analytics on Demand Methodology and requirements: Mutual approval of proposed assessment protocol Rely on the peer-reviewed literature Requirement: data access and client communication Manipulation and analysis conducted locally or remotely Simple, simple, simple Brief succinct narrative explanations with caveats Scientific proof vs. reasonable business estimates

8 "Metrics Dashboard Delivery Elements Real time, fact based, graphical depiction of key performance indicators Identify issues and facilitate objective and reasonable decision making Custom dials based on needs or specific areas of interest Example

9 Summary Both Journey AND Destination Huge amounts of innovation at 90 MPH! No time for traditional randomized studies Fiscal intermediaries can help with quasi-experimental analyses Reasonable assurance that triangulates vs. Uni-dimensional scientific proof Measure, adjust, assess again Go to 100 MPH