Health Care Analytics and the Transformation of the American System The American Health Care Industry is facing a fundamental transformation;

Transcription

1 Health Care Analytics and the Transformation of the American System The American Health Care Industry is facing a fundamental transformation; comparable to the introduction of Prospective Payment (1980 s), the creation of Medicare/Medicaid (1960 s) or even the formation of the health insurance industry during the Great Depression. While health care now consumes 17% of the American Gross Domestic Product of and represents nearly a quarter of both the Federal and State expenditures; all levels of government, employers, and reimbursement intermediaries are embracing policies and strategies that will alter the fundamental economic incentives of American Health Care delivery system. To achieve these goals various forms of bundled payment, such as Accountable Care Organizations, are being created to achieve the Triple Aim of higher quality, lower costs, and better patient experience (access). And this is not just confined to the United States, as health care inflation has impacted Counties around the world as expensive technologies have expanded and significant numbers of the population reach unimaginable ages.

2 While it will be many years before seamlessly integrated delivery systems and the advances of the electronic medical records can actually provide diverse populations with patient centered care coordination; the fee-for-service economic model is being displaced with a model in which the entire provider community will be at economic risk for costs associated with community wide resource consumption. As such, the industry is ill-prepared for such a transformation from volume to value. While health care has traditionally focused on patient episodes, disease conditions and restoration; the new paradigm will be population health, prevention and wellness initiatives in which the best practices of clinicians must be identified and applied in a decision support environment consistently during every stage of care delivery. The information technology does exist to transform massive amounts of data and clinical experiences into these types of Clinical Best Practices as well as the more traditional Operations Management and Business Intelligence. However the analytical, decision support and dissemination techniques have not progressed to the same degree as raw data collection and the management of transaction systems. Two years ago we presented to this same body, the opportunities to mine large scale health care data repositories, focusing at that time on Congestive Heart Failure and the BIG Data Challenges. At a cost in excess of $39 Billion (2009), 550,000 new cases per year and a population of 5 million in the United States alone; it is the most expensive chronic condition among a rapidly aging population and even today the delivery is fragmented and inconsistent. The time and urgency has come to address long term, chronic health conditions and significant actions among academics, providers, regulators and payment intermediaries are now becoming evident. And as such we will attempt to describe for you some of these initiatives and corresponding difficulties.

3 It is from this perspective that the Center for Health Care Analytics in the Hagan School of Business at Iona College has been created. The focus of this Center is the Analytics of Big Data and the management of massive repositories that are available to researches and business professionals. As a Business School we are seeking to expose our graduates to the diverse skills necessary for an analytics-based organization in which clinical and business intelligence are essential for achieving quality, performance and economic success. The Center for Health Care Analytics is a multi-disciplinary program drawing professional expertise from across several University faculties and practitioners, recognizing Information Systems, Health Care Management, Finance/Accounting, Statistics, Econometrics, Operations Research and other programs, necessary to compliment the health care focus. And as necessary, existing relationships with nearby Medical Schools have complemented the clinical and business dimensions of these efforts. With an emphasis of Community Health Status and population health, the academic participation in large scale regional planning initiatives is now being felt. In essence what is being presented here is a Data Scientist perspective in which an understanding of the business and the business environment are just as important as the infrastructure and modeling techniques being applied.

4 Massive data bases or repositories already exist within the industry from State, Federal and commercial entities, some of which are already in the possession of our faculty. However, the provider silos are relatively inexperienced in dealing with longitudinal data or Episodes of Care in which a patient is treated in the inpatient setting, has several Emergency Room visits and again finds the patient being admitted for care. In the original volume driven economic environment this is the definition of success, but in a value driven system this is unacceptable. To make this type of transformation we must prepare business leaders and managers at all levels to understand the scope of work and the limitations of data and predictive analytics. And as it happens the payment intermediaries have been developing the recognition and identification of high risk patient populations and risk stratification. Once again there is an understanding that the interaction of multiple conditions within a particular patient not only drives the specific cost of care but is also a significant determinant of longer term economic and clinical risk. Currently our faculty provides business intelligence and consultative services to industry, regulatory and association leaders. The techniques and infrastructure for securing and managing these highly confidential repositories currently exists along with decades of experience in data mining, decision support modeling and operations research. The specific focus on the needs of executives, governance, regulatory and clinical leaders in the health care field has allowed us to quickly demonstrate the value of analytics within an industry unfamiliar with such tools while providing our graduates meaningful capabilities for their careers and entry to all aspects of public health, provider organizations and ancillary health care businesses, from pharmaceutical to insurance and medical device industries.

5 The need for such an Analytics program in the New York Region is borne out by recently published studies and the development of such programs at some of our most prestigious Universities from across the country. And because this is a relatively new area for academic pursuit, it is more than the study of public health epidemiology, or the development of Information Systems infrastructures (communications, data management & security), or traditional mathematics and statistics. It is necessary to explore the range of Systems Infrastructure and Data Governance, Descriptive Analytics (exploring what has occurred and the patterns of activity), Predictive Analytics (concentrating on what will occur in the future) and Prescriptive Analytics (differentiating what should occur). But for this to happen a great deal of value must be added to the transaction data environment ( Billing & Electronic Medical Record) in the form of clinical classifications and decision support modules which are not inherently present in the traditional, transaction based records and systems. Merging disparate information for cost accounting, quality assessment and comparative clinical pathways will add value while challenging and enhancing the quality of data collection. Learning to navigate the many data resources of the health care industry from a business perspective is at the core of the Center for Health Care Analytics along with challenging the students to take a broader perspective in the delivery and management of Health Care. In addition to developing a graduate level curriculum for Health Care Analytics (NYS Dept. of Education certification), the Center is active in the research arena, seeking grants and making applications to entities throughout the country while participating in other professional activities with industry associations, regulatory agencies and public entities in which we are recognized as industry stakeholders.

6 A current example of these efforts is a State and Federal initiative to redesign the Medicaid health care program, largely focused on the poor population. Approximately $8 Billion has been identified over the next five years to change the delivery mechanisms and outcomes based on improving Community Health Status. It is necessary to specifically define community health metrics, disease prevalence and a host of quality performance metrics while providers at all levels commit to measurable improvements. On the one hand it is necessary to identify, in some cases for the first time, the clinical hot-spots for populations which represent disparities in the community as a whole. These may be cardiovascular conditions, cancer prevalence, strokes, Diabetes, obesity, smoking cessation, or mental health conditions. But in essence, the institutions and providers, at all levels, are being asked and expected to become responsible for the health and behaviors of those in the community.

7 To achieve this remarkable task of measurement and forecasting requires an incredibly large database in which many venues of service are identified as well as the longitudinal or time dependent transactions of individual patients which are monitored and measured for economic impact, risk of continuing expenditures, and the detritions of the quality of life. The means to achieve these outcomes may actually involve stratifying the risk and hence the population which are at greatest risk of disease progression, rather then attempting to treat and intervene with everyone in a given population. But it is in this backdrop that 180 million patient records, representing 15 years of clinical activity and a population of 24 million people has been assembled. The objectives are to support the analytics necessary for the transformation a health care delivery system, embracing the science and technology espoused by the International Institute of Forecasting. Paul Savage paulsavage@iona.edu Health Care Management, Program Director, Hagan School of Business (914) Director, Center for Health Care Analytics

8 Paul Savage Health Care Management, Program Director, Hagan School of Business (914) Director, Center for Health Care Analytics