Advocate Cerner Partnership Creates Big Data Analytics for Population Health

Transcription

1 Advocate Cerner Partnership Creates Big Data Analytics for Population Health Tina Esposito, VP Center for Health Information Services Rishi Sikka, MD, Senior VP Clinical Operations Scottsdale Institute Teleconference September 19, 2016

2 Copyright Scottsdale Institute All Rights Reserved. No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the author(s). You may contact us at / (763)

3 Advocate Health Care Hospitals (12) 4 teaching 1 children's (2 campuses) 1 critical access 5 level 1 trauma centers Physicians 1,500 employed 5,000 Advocate Physician Partners 6,300 medical staff Post acute Home health, hospice, long term acute care hospital and palliative care 35,000 associates $5.5 billion total revenue 17.9% market share 3

4 Accountable Care Footprint Contract Lives Total Spend Commercial HMO 275,000 $1.0 B Medicare Advantage 39,000 $0.3 B Advocate Employee 33,000 $0.1 B Commercial Shared Savings 300,000 $1.2 B Medicare Shared Savings 137,000 $1.6 B Medicaid ACO 94,000 TBD Total 878,000 $4.2 B 4

5 Reimbursement Model Shifts 5

6 Why the Advocate Cerner Collaborative? Fundamental shifts in healthcare business model New model, new focus, new thinking, new partnerships 6

7 Advocate Cerner Collaborative (ACC) Acute Care Focus 12 Hospitals & over 250 sites of care $5.5 B in revenue Cerner Millennium EMR Valuable but largely IT relationship Facilitating collaboration among various internal Advocate groups Rapidly deploy existing solutions and pilot key innovations Advocate Cerner Collaborative 3 year agreement starting April 2012; renewed in 2015 Innovation in Pop Health Start in acute care, expand 3 year agreement starting April 2012 Innovation in Pop Health Start in acute care, expand to broader population to broader population Enhance relationship outside acute care outside Become acute the data care platform for all of Advocate Health Care Enhance relationship Become the data platform for all of Advocate Health Care Population Health Focus Clinical Integration 5,000+ physicians risk members $3.4 B Value Based revenue $100 M incentives in 2012 Non Cerner EMRs No Cerner relationship New long term relationship Healthe Intent Platform and Population Health Solutions Strategic partner 7

8 Shared Vision Mission Leverage Advocate experience as a provider and Cerner s experience in health care technology and automation to improve population health capabilities Together the ACC will: Identify and risk stratify patients at most risk Facilitate appropriate and early interventions Guide care across the continuum 8

9 ACC Guiding Principles Create intelligence that expands population health understanding Integrate innovation into workflow Lead the industry in actualizing population health in an EMR agnostic world Provide benefits to both organizations beyond ACC Enhance team with skills that support the goals and objectives of population health management 9

10 Advocate Cerner Collaborative 2015 Accomplishments 2 Accepted peer reviewed publications BMC Medical Research Methodology Implementing a New Intelligence Solution Using DMAIC Principles 6 Posters presented Institutes for Healthcare Improvement (2 posters) American Statistical Association (3 posters) Russel Institute (1poster) (Awarded Most outstanding safety project ) 15 Industry presentations Select highlights below HIMSS Readmission Congress HMA Big Data Collaborative Institutes for Healthcare Improvement 6 Industry news stories Information Management Becker s Health Review 3 Provisional patents Medication Adherence IRF Acute Care Transfer Transitions of Care 3 New models Transitions of Care Risk Rehab Medication Adherence Ambulatory Sensitive Care Management Models 1 System go live and 2 successful pilots Medication Adherence Tool Transition of Care pilot conclusion 10

11 ACC Team Core Competencies Model Deployment Analytic Models Data Platform 11

12 Advocate Use of the HealtheIntent Platform Billing data ACO claims ACO PBM 8 hospitals (Cerner) AMG (Allscripts) APP (ecw) BroMenn (Meditech) Dreyer (Epic) Sherman (Cerner) Home Health & post acute data (Allscripts) Advocate empi (IBM) Identify Attribute Predict Measure Intervene Analyze Big data analytics Workflow enhancement ACO support Reporting Analytics Big Data Innovation (Advocate Cerner Collaborative) Physicians Care Managers Care Team Physicians Care managers Analysts Administrators Raw data Big Data Platform capabilities Workflow & roles impacted 12

13 HealtheIntent Uses Solution development Registries Business intelligence for ACO Longitudinal record Outpatient care management Business needs Clinical integration, physician alignment, research Patient centered operational improvement across the continuum Near real time aggregated patient information Improved information to support appropriate patient interventions HealtheRegistries SM HealtheEDW SM HealtheRecord SM HealtheCare SM Serves as the backbone for all HealtheIntent powered solutions

14 14 Analytics

15 Readmission Outcomes Leading the industry ~ 20% better than industry (Yale, LACE, etc.) Solution purchased by 200+ non-advocate Cerner clients Gaining efficiency ~ 3.5 FTE productivity savings across system Automated continuous calculation of risk score in EMR Reducing readmissions 20% reduction in readmission rates (for high risk patients that received interventions) Statistically significant reductions observed for sub-populations (e.g., COPD and HF) 15

16 Readmissions and Impactability Education Days to PCP follow up Assess interventions Create model Build patient profiles Align profiles to historic success Build recommendations in EMR Integrate through technology Evaluate Follow up evaluations to determine real effectiveness 16

17 Where is the most appropriate location for our patients? Hospital Rehab Assisted Living Skilled Nursing Retail Pharmacy Home Care Behavioral Health 17

18 Acute Transitions of Care (ATOC) overview Find patients with similar clinical profiles Identify where this patient type is most successful (lower actual readmission rate) Quantify the recommendation s impact on readmission risk Risk of medical instability Home Home health Skilled nursing facility Acute inpatient rehab Acute longterm care Intensity of services 18

19 Population Health Issues with the Pyramid 19

20 Community based Care Management Framework Roles: NP, RN, NA, SW, CHW Barriers: Behavior Social Adherence Education Intervention Target Population ROI Acute Case Management Episodic Care Management Disease Management Complex Care Management Hospital Risk of acute hospitalization Chronic disease management, e.g., Diabetes, Heart Failure Multi disease, multi complication, renal failure, transplant, cancer, etc. < 1 year < 1 year 2-5 years 2-5 years Enablers: Readmission Prevention (TOC) HealtheLive (Patient portal) HealtheCare (OPCM) 20

21 Guiding Principles An Effective OPCM Program is Short term (currently not exceeding 120 days) Focused on potentially preventable events Evidence based Measureable 21

22 Targeting the Right Patients Potentially Preventable Events are: Clinician identified preventable events most appropriate for care management. Events where OPCM intervention can reduce hospital encounters (ED/IP/OBS) within a 120 day time period. Impactable in a measurable way, with defined outcomes. 22

23 What is impactable? Clinician identified potentially preventable events where OPCM intervention can reduce utilization and complications within a 120 day time period. 23

24 Preventable Hospitalizations: Conceptual Model 1. Identify population 2. Evaluate risk factors 3. Calculate Risk Patient Demographics Any encounter for desired population age 18 years and older Social Determinants Medical History Procedures Risk of Hospitalization with Asthma, Enteritis, Heart Failure, or dementia/parkinson s Current encounter with UTI, Pneumonia, COPD age 18 years and older Utilization Lab Results Vital Signs Risk of SAME CAUSE Hospitalization Medications 24

25 Population Health Issues with the Pyramid 25

26 Population Health Spectrum Opportunity Value 26

27 Medication Adherence as a Priority Adherence is important to controlling utilization and cost, as well as improving outcomes and quality of life. The CDC lists the estimated direct cost of non-adherence as $100-$289 billion dollars Adherence is a multi-faceted problem with many disparate causes Medication adherence is a major gap at clinical point-of-care 27

28 Medication Adherence Patterns 28

29 Correlation Between Cost and Adherence $1,600 $1,400 $1,435 Cost (pmpm) $1,200 $1,000 $800 $600 $872 $700 $1,049 $400 $200 $ High Moderate Low Mixed Adherence Level 29 Mixed adherence patients nearly cost double what moderate or high adherence patients

30 The Journey Fragmented View of Care Integrated View of Care Patient Centered Care Hospital Hospital AMG Physician s office ACO Provider Enabling Hospital Provider Scorecard Patient APP Physician s office Home care Home care Physician s office Home care Physician s office 30

31 Thank You! 31