Leveraging Big Data Improving Performance University of Missouri Thomas J. Selva, M.D. - CMIO
University Hospital and Clinics Ellis Fischel Cancer Center Women s and Children s Hospital Missouri Orthopaedic Institute Missouri Psychiatric Center Missouri Rehabilitation Center in Mt. Vernon, MO More than 50 primary care and specialty clinics throughout mid- Missouri
Human resources Active medical staff: 626 Other MU Health Care staff: 5,200 Volunteers: 530 Volunteer hours: 83,110 Staffed beds University Hospital and Ellis Fischel Cancer Center: 253 Women s and Children s Hospital: 144 Missouri Rehabilitation Center: 63 Missouri Psychiatric Center: 58 Missouri Orthopaedic Institute: 18 Total beds: 536
Patient Services Patients transported by helicopter: 977 Births: 1,728 Patient admissions: 22,108 Patient days of care: 120,985 Clinic visits (total for all sites): 553,300 Emergency and trauma center visits: 51,632 Major surgical operations: 22,774 Cardiac catheterization procedures: 3,968 Radiological exams and treatments: 271,177 Laboratory tests: 1,825,480 Pharmacy orders: 5,996,036
Agenda Health Information Exchange CMS Grant Smart Room Technology Enterprise Business Management Provider Workflow Optimization 7
HIE Enables Connectivity Across Venues Imaging Center Physician Office Hospital Long-Term Care Facility Lab
Information Shared via Bi-Directional HIE Vital Signs Radiology/Imaging reports History and Physical Lab Results Discharge Summaries Provider Reports Clinic Notes Operative/procedural notes Visits (pending/recent) Demographics Problem list/conditions Medications (active/past) Allergies Lab Orders Immunizations Microbiology Anatomic Pathology Results Procedures
Where Our Patients Live Boone County: 186,799 Cole County: 91,362 Callaway County: 38,815
Health Alliance Membership Tiger Institute Health Alliance Membership Organization Hospital s Clinics SNF Provider s University of Missouri Health Care 5 55 0 500 Capital Region Medical Center 1 27 0 64 Carroll County Memorial Hospital 1 3 0 6 Community Health Center of Central Missouri 1 4 0 11 Compass Health (Royal Oaks Hosp. & Pathways Behavioral Health) 1 28 0 24 Cooper County Memorial Hospital 1 3 0 8 Family Health Center 0 3 0 13 Howard A. Rusk Rehabilitation Center 1 0 0 0 Iron County Hospital 1 1 0 2 Jefferson City Medical Group 0 8 0 79 Missouri Rehabilitation Center 1 0 0 0 Nevada Regional Medical Center 1 3 0 11 Samaritan Hospital 1 1 0 6 Scotland County Hospital 1 3 0 10 Office of Dr. Sparks 0 1 0 2 The Bluffs 0 0 1 0 The Neighborhoods 0 0 1 0
Population Health Platform 13 De-identified Research (HealthFacts) Person Client Opt In/Out Person Clinic Hospital Device HL7, CCD, EDI, PHR, Batch, Crawler Org or Patient Consent Raw Data Claims Clinical Wellness Big Data Data Transformation Structured Data Longitudinal Record Analytics Evidence Programs Algorithms Learned Knowledge Health Coach Primary Care Physician HIE Satisfaction Identify Predict Measure Attribute Intervene Analyze Home Health Assistant Payer Pharmacy What is a program? A systematic approach to identification, prediction, and management of an objective or condition at population, provider and person level VP of Population
Hypertension Hyperlipidemia Depression Acquired Hypothyroidism Anemia Chronic Obstructive Pulmonary Disease and Bronchiectasis Chronic Kidney Disease RA/OA (Rheumatoid Arthritis/Osteoarthritis) Diabetes Ischemic Heart Disease Atrial Fibrillation Asthma Stroke / Transient Ischemic Attack Heart Failure Female/Male Breast Cancer Benign Prostatic Hyperplasia Cataract Hip/Pelvic Fracture Alzheimer's Disease and Related Disorders or Senile Osteoporosis Glaucoma Prostate Cancer Colorectal Cancer Endometrial Cancer Lung Cancer CMS 27 Chronic Conditions - 10.00 20.00 30.00 40.00 50.00 Percentage of Patients
Risk Stratification 5000 4500 4000 3500 Number of Patients by Tiers 3,398 (34%) 4,518 (45%) 3000 2500 2000 1500 1000 500 1,187 (12%) 847 (9%) 0 Tier 1 Tier 2 Tier 3 Tier 4 Tier 1 = Healthy (no CMS chronic condition) Tier 2 = Chronic condition, but stable (low utilization) Tier 3 = Chronic condition, but unstable (moderate utilization) Tier 4 = Complex care (high utilization)
Sustainability Increased efficiency? Increased provider satisfaction? Increased panel size? Improved outcomes? Aligned incentives?
18 Technology Linking Patient, Provider, Care Manager Data
19 EMR Integration Widgets Provider Dashboards
Focus on the Vital Few - Balanced Scorecards Monthly Operational Reviews Look Forward 80% and Back 20% Breakout by imperative with dashboards - Drill down analysis of exceptions Use the Funnel - Provide clear contingency/risk management plans Follow Up and Follow Through - Action items clearly communicated - Completed prior to next cycle 20
Balanced Score Card By Service Line
Scorecard Popup Trends & Definition
Providers (residents excluded) CFTE Actual wrvus YTDA WRVU Target Adj for CFTE Pat Sat %ile MGMA** RVU %ile adj for CFTE % of NP/EP that can be seen within 10 days MTD 3 rd Avail NP/EP in Days MTD Bookable Clinic Hours (monthly) % of Scheduled Time Unrestricted Total Clinical Salary as a % Salary Teaching Salary % of total salary Med Dir Salary as a % of total salary Internal Dept Med Directo rships as a % of total salary Research Salary as a % of total salary Incentive pay as a % above and beyond total base salary Cardiology-Non-invasive Alpert, Martin Chockalinga m, Anand.6 8080 3900 77 >75 69% 8 16 100% 49% 30% 17% 0 4% 7% 1.0 3527 6500 50 <25 73% 17 8 100% 81% 13% 0 0 6% 15% Dellsperger, Kevin Dohrmann, Mary.1 2815 650 100 >75 NA NA 0 100% 5% 0.1% 0 0% 94.9% 2%.66 8017 4290 96 >75 59% 8 24 100% 88% 7% 5% 0 0 10% Fay, William.11 2709 715 64 >75 39% 25 4 100% 3% 2% 0 21% 74% 0 Politte, Lenard Senthilkuma r, Annamalai Total Non- Invasive.1 848 650 88 >75 3% 7 4 100% 93% 7% 0 0 0 14% 1.0 4951 6500 100 25-50 68% 9 4 100% 96% 4% 0 0 0 0 3.6 30,947 23,205 60 Note: * Individual Provider Patient Satisfaction Responses <30, may not be statistically significant **MGMA Academic wrvu production table 29 of the 2012 survey: 25 th =4,670 50 th =6,500, & 75 23 th =8,486 **MGMA Non-Academic wrvu production table 61 of the 2012 survey:25 th =766, 50 th =1300, & 75 th =1,998
Managing the Provider Experience
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