Physician Performance Analytics: A Key to Cost Savings

Physician Performance Analytics: A Key to Cost Savings Session #90, February 21, 2017 Jim Gera, SVP of Business Development, Signature Medical Group, Inc. 1

Speaker Introduction Jim Gera, MBA SVP of Business Development Signature Medical Group, Inc. BPCI Awardee Convener 2

Conflict of Interest Jim Gera, MBA Has no real or apparent conflicts of interest to report. 3

Agenda Signature Bundled Payment Overview Technology and Analytics Physician Engagement and Reporting Results and Next Steps 4

Learning Objectives Identify factors impacting physician performance Examine development of a physician performance analytics tool Analyze the benefits of physician performance analytics 5

Signature Medical Group Multi-specialty physician group in Missouri (150 physicians) Vision Physician-led healthcare Value-based payment activity ACO Maternity Care Home Medicare Advantage Bundled Payment for Care Improvement (BPCI) Why participate Awardee Convener 6

Signature BPCI Overview BPCI Awardee Convener 50+ orthopedic groups 2,000 physicians Geography 26 states and 60 cities 50,000+ annual episodes 7

BPCI overview Retrospective bundled payment covering 90 days Major orthopedic cases including total joints, spine, and trauma Historically orthopedic physicians have not been responsible for care beyond the surgery Bundled payments align with CMS goals to reduce costs, improve outcomes, and improve quality of care Goal = care redesign to achieve better outcomes at a lower cost 8

Care Redesign Goals Shift paradigm from specific clinical focus (surgery) to comprehensive focus (episode) Establish integrated biopsychosocial care model through out the entire episode Use evidence-based medicine to reduce/eliminate over utilized and unnecessary services, reduce adverse outcomes, and lower cost Use best practices to support standardized care pathways while maintaining physician decision making and individualized care plans Health IT value proposition Improve care management and reduce fragmentation with care management platform Improve physician performance with unbiased, targeted, and actionable analytics 9

Case management model Patients receive case management throughout episode Pre-operative phase Acute phase Post acute phase 2-8 weeks 1-4 days 90 days Risk assessments Surgery Care coordination Care plan development Discharge plan Biopsychosocial care model designed to comprehensively address patients needs through a physician-led care model 10

BPCI Results Based on 2015 data for Signature BPCI participants Post acute care cost reduction 33% nationally Adverse outcomes reduction 18% to 41% nationally Variety of pricing benchmarks high and low No change in patient population 11

No Changes in Patient Population 12 Baseline 2009-12

Technology Needs 1. Care management system Track patient Record patient information Initially outsourced brought in house (CareMosaic) 2. Analytics Medicare claims data Clinical data Initially outsourced brought in house (CareAnalytics) 13

Analytical Needs and Solution Identify opportunities to reduce overutilization and unnecessary cost Identify which episodes to enter into risk Focus areas and key performance indicators Solution outsourced data analytics to outside company Data files large and complex Experience Reports Broad and general dashboards Static information 14

Early Report Examples Pros Provide information on major areas which needed focus Identified general comparisons and benchmarks Cons Too broad not specific Did not provided information to recommend specific actions Overwhelming and difficult to manipulate 15

MS-DRG 470 Volume = 1,188 METRICS Readmission % SNF % IRF % HH % SNF LOS Current = 6.1% 47.0% 8.6% 72.1% 23.5 National % 14 71 60 55 35 EPISODE BREAKDOWN Acute $ Readmission $ SNF $ IRF $ HH $ Other PAC $ Total $11,907 $525 $5,008 $1,020 $1,973 $1,956 $22,388 GOAL - TOP QUARTILE Readmission* SNF IRF Utilization = 6.1% 25.3% 1.5% ALOS = 22.3 # Patients 72 301 18 $ per Patient $8,663 $10,108 $11,876 $ per Day $454 Total $ $623,721 $3,041,714 $211,630 Total Savings at Top Quartile = ($3,289) $ per Episode $525 $2,560 $178 Adjusted Episode Spend at Top Quartile = $19,100 Savings per Episode $0 ($2,447) ($842) Reduction in Total Spend = -14.7% 16

483 0% 0% 0% 0% 13% 10% 484 0% 0% 0% 0% 6% 0% INCIDENCE RATE TOTAL 9% 2% 0% 4% 7% 14% SNF 2014 MONTH MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3 YEAR RATE INCIDENCE RATE 469 0% 50% 33% 40% 52% 58% HHA 2014 MONTH 470 23% 29% 0% 22% 34% 27% MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483 0% 100% 0% 33% 25% 40% 469 0% 100% 0% 40% 70% 58% 484 0% 0% 0% 0% 13% 17% 470 80% 76% 65% 75% 71% 79% TOTAL 21% 32% 5% 22% 34% 28% 483 0% 100% 0% 33% 63% 65% 484 33% 0% 0% 33% 44% 48% DIRECT DISCHARGE INCIDENCE RATE - SNF CLAIM WITHIN THREE DAYS OF IP DISCHARGE TOTAL 74% 77% 52% 71% 70% 77% SNF 2014 MONTH MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3 YEAR RATE INCIDENCE RATE 469 0% 50% 33% 40% 52% 46% OUTPATIENT 2014 MONTH 470 20% 27% 0% 19% 33% 24% MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483 0% 100% 0% 33% 25% 35% 469 0% 50% 0% 20% 87% 69% 484 0% 0% 0% 0% 13% 17% 470 67% 54% 18% 51% 80% 79% TOTAL 18% 30% 5% 20% 33% 25% 483 0% 0% 0% 0% 63% 95% 484 0% 0% 0% 0% 81% 93% NON-ZERO AVERAGE LOS TOTAL 59% 52% 14% 46% 80% 79% SNF 2014 MONTH MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 AVERAGE 3 YEAR AVERAGE INCIDENCE RATE 469-18.0 11.0 14.5 36.2 16.3 LTCH 2014 MONTH 470 26.3 16.5 - - 24.8 14.5 MS-DRG JANUARY FEBRUARY MARCH 3MO AVG 2013 RATE 3YR RATE 483-4.0 - - 39.0 13.9 469 0% 0% 0% 0% 0% 3% 484 - - - - 24.0 16.8 470 0% 0% 0% 0% 0% 0.11% TOTAL 26.3 15.7 11.0 17.7 25.9 14.8 483 0% 0% 0% 0% 0% 0% 484 0% 0% 0% 0% 0% 0% AVERAGE COST PER DAY 17

Analytics Improvements Brought analytics in-house Hired IT and developers with prior managed care experience Integrated IT, clinicians, and admin into workgroups Used focused personnel Identified information which would Motivate physicians Impact case managers Assist management Address specific analytic needs and provide real time analytics Integrated analytics, reporting, and care management into one platform 18

Key Performance Indicators Categories - incident rate and frequency IRF (inpatient rehab facility) SNF (skilled nursing facility) HHA (home health agency) OPT (outpatient physical therapy) Readmit Incident rate the percentage of patients utilizing a service Frequency the number of occurrences when a service is used 19

Reports 1. DRG/Episode 2. Physician scorecard 3. PAC Facility (post acute providers) 4. Readmission detail 5. Utilization management 6. Post acute provider scorecards (SNF, HHA, and OPT) 20

DRG/Episode analysis 21

Compare Physicians Compare KPIs to determine differences Review patient episodes Deeper dive and case studies of specific patient episodes Provider Total Cases Total Spend Avg Spend IRF Incidence Rate IRF Average LOS IP Rehab Average Cost/Case SNF Incidence Rate SNF Average LOS SNF Average Cost/Day HH Incidence Rate HH Average LOS HH Average Cost/Case Readmit Incidence Rate Readmit Average Cost/Case Physician 12 63 1,274,752.54 20,234.17 0.0% 0.0 0.00 30.2% 13.7 495.22 69.8% 9.3 3,219.98 3.2% 5,402.25 Physician 13 66 1,575,309.93 23,868.33 0.0% 0.0 0.00 40.9% 38.6 460.50 36.4% 14.1 2,752.40 10.6% 9,299.08 22

Provider Total Cases Total Spend Avg Spend IRF Incidence Rate IRF Average LOS IP Rehab Average Cost/Case SNF Incidence Rate SNF Average LOS SNF Average Cost/Day HH Incidence Rate HH Average LOS HH Average Cost/Case Readmit Incidence Rate Readmit Average Cost/Case Physician 13 66 1,575,309.93 23,868.33 0.0% 0.0 0.00 40.9% 38.6 460.50 36.4% 14.1 2,752.40 10.6% 9,299.08 Patient #13064 1 37,913.84 37,913.84 0.0% 0.0 0.00 100.0% 39.0 518.27 0.0% 0.0 0.00 0.0% 0.00 Patient #13068 1 43,891.54 43,891.54 0.0% 0.0 0.00 100.0% 59.0 218.58 0.0% 0.0 0.00 100.0% 12,222.19 Patient #13071 1 23,814.15 23,814.15 0.0% 0.0 0.00 100.0% 27.0 463.49 0.0% 0.0 0.00 0.0% 0.00 Patient #13072 1 11,990.00 11,990.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.00 Patient #13073 1 14,903.62 14,903.62 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.0 0.00 0.0% 0.00 Patient #13074 1 50,951.54 50,951.54 0.0% 0.0 0.00 100.0% 79.0 472.62 0.0% 0.0 0.00 0.0% 0.00 Patient #13082 1 19,032.86 19,032.86 0.0% 0.0 0.00 100.0% 9.0 384.97 0.0% 0.0 0.00 0.0% 0.00 Patient #13085 1 21,904.61 21,904.61 0.0% 0.0 0.00 100.0% 16.0 368.00 100.0% 1.0 0.00 0.0% 0.00 Patient #13092 1 36,944.49 36,944.49 0.0% 0.0 0.00 100.0% 45.0 415.21 100.0% 31.0 4,790.09 0.0% 0.00 Patient #13093 1 32,221.54 32,221.54 0.0% 0.0 0.00 100.0% 42.0 451.70 0.0% 0.0 0.00 0.0% 0.00 Patient #13094 1 25,986.65 25,986.65 0.0% 0.0 0.00 100.0% 20.0 482.17 100.0% 14.0 3,247.81 0.0% 0.00 Patient #13095 1 54,591.05 54,591.05 0.0% 0.0 0.00 100.0% 54.0 492.42 100.0% 15.0 2,602.01 100.0% 3,511.65 Patient #13096 1 39,325.01 39,325.01 0.0% 0.0 0.00 100.0% 45.0 493.27 100.0% 16.0 3,671.86 0.0% 0.00 Patient #13097 1 31,657.60 31,657.60 0.0% 0.0 0.00 100.0% 33.0 510.22 0.0% 0.0 0.00 0.0% 0.00 Patient #13101 1 31,667.61 31,667.61 0.0% 0.0 0.00 100.0% 48.0 521.14 100.0% 1.0 1,621.54 0.0% 0.00 Patient #13102 1 53,856.54 53,856.54 0.0% 0.0 0.00 100.0% 90.0 453.94 0.0% 0.0 0.00 0.0% 0.00 23

EPI MS DRG with Desc Month Data Source Acute Provider Star Rating Surgery Type 461 - BILATERAL OR... Jan Home Health Hospital East 1 Elective 462 - BILATERAL OR... Feb IRF Hospital North 2 Shoulder 466 - REVISION OF... Mar SNF Hospital South 3 Trauma 467 - REVISION OF... Apr Hospital West 4 (blank) 468 - REVISION OF... May Mountainrange Medical... 469 - MAJOR JOINT... Jun Northeast Hospital 470 - MAJOR JOINT... Jul Northeast Medical Center 472 - CERVICAL SPIN... Aug Northern Health Care Row Labels Episode Ct Total Spend Ave LOS Cost per Case Cost per Day #1 Location Home Health 14 24,828.72 5.43 1,773.48 326.69 #10 Location Home Health 7 15,472.78 7.57 2,210.40 291.94 #100 Home Health Location 1 2,739.17 11.00 2,739.17 249.02 #101 Home Health Location 6 17,764.21 18.00 2,960.70 164.48 #102 Home Health Location 2 5,570.10 13.50 2,785.05 206.30 #103 Home Health Location 11 35,328.40 16.82 3,211.67 190.96 #104 Home Health Location 9 25,157.34 13.89 2,795.26 201.26 #105 Home Health Location 3 6,883.82 11.00 2,294.61 208.60 #106 Home Health Location 13 35,929.56 14.85 2,763.81 186.16 #107 Home Health Location 2 4,857.55 10.50 2,428.78 231.31 24

Facility Report Identify differences between PAC providers Review in conjunction with scorecards Determine is it physician or PAC driven Provider Episode Ct Total Spend Ave LOS Cost per Case #1 Location Home Health 14 24,828.72 5.43 1,773.48 #103 Home Health Location 11 35,328.40 16.82 3,211.67 #106 Home Health Location 13 35,929.56 14.85 2,763.81 25

Provider Engagement Initial engagement Face-to-face meeting with potential client/provider Review DRG/Episode analysis to demonstrate opportunity Ongoing engagement Regular webex meetings every 2 weeks Attendees physician champion, case manager, clinical lead, and/or admin Review reports 1-5 Identify focus area of call and align data review i.e. desire to reduce IRF utilization for Physician 10. Provide information on similar physicians and patient populations and show comparable data. Demonstrate alternatives and the benefits. Bi-annual or quarterly face-to-face meetings Monthly case studies with patient sub-claim level detail. Reviewed with physician, physician champion, case manager and clinical lead Quarterly meetings for case review and best practices with other providers either regionally or nationally 26

Multi-layered Physician Engagement Case Mgr. or Clinical Lead Meets regularly to review data and outcomes. Offer suggestions for improvement and alternatives Physician Physician Peer-to-peer: With similar or well respected peers compare: benchmarks, goals, resources Admin Provide easy to follow data analytics reports Always have detailed data available to address any question 27

Physician alignment Physicians are key to successful bundled payment programs Communication is essential Communicate results once a month Timely performance results Actionable solutions Tied to bonus and money Transparency 28

Factors Impacting Physician Performance Align care pathway to care plan to outcome Adverse outcomes Discharge disposition Cost savings Key performance indicators 29

Key Performance Indicators Clinical Adverse outcome Readmission Infection UTI AMI Sepsis Pneumonia Patient reported outcome Satisfaction Functional level 30

Benefits of Physician Performance Analytics and Tools Identify Opportunities for improvement KPIs Drive Change Use unbiased data Increase physician engagement Results Reduce adverse outcomes Cost savings Physician engagement Meet them where they are at Not all physicians will view or use the same reports Identify the hook which will get a physician engaged Competition Financial incentive Improved patient care 31

Impact on Adverse Outcome 26% reduction in Readmissions within 30 days of discharge 54% reduction in Pulmonary Embolisms during Index Admission 29% reduction in DVT during Index Admission 41% reduction in Urinary Tract Infection during Acute stay 41% reduction in Acute MI within 7 Days 36% reduction in Surgical Site Infection 39% reduction in Pneumonia during Index Admission 18% reduction in Sepsis/Shock during Index Admission Reductions based on all Signature BPCI participants 2015 to Q1 2016 32

STEPS: Savings Increase standardized care pathways and physician performance Cost Savings of 33% 33

Physician Benefits Pathways follow best practices and are supported throughout the episode Engaged in meetings Financial incentive Happier and healthier patients BPCI and my engagement in this program has made me a better doctor John Tessier, MD 34

STEPS Impact Improved communication of physician performance. Improved physician assessment tools. Improved patient outcomes. Improved care pathways. Improved unbiased assessment of performance data. Increased communication of performance data. Increased implementation of evidence-based protocols. Improved assessment of physician performance. 35 Increased savings through protocol modification. Increased cost transparency.

Signature Next Steps Linking CareMosaic and CareAnalytics into research platform and medical literature Refining and further validation of internal algorithms and modeling Furthering the success of our current provider groups Accelerating success of new provider groups 36

Questions Jim Gera, MBA SVP of Business Development jgera@signaturehealth.net Twitter - @jimgera Please complete online session evaluation 37