Create a Data Driven Process to Manage the Quadruple Aim

Create a Data Driven Process to Manage the Quadruple Aim Session 301, March 9, 2018 Angie Massey, Director, Strategic Analytics Memorial Hermann Paul J. Lampi, Director, Enterprise Analytics Memorial Hermann 1

Conflict of Interest Angie Massey and Paul J. Lampi Has no real or apparent conflicts of interest to report. 2

Agenda Overview of the Quadruple Aim Memorial Hermann overview Focus on Analytics Building a population health strategy 3

Learning Objectives Describe Memorial Hermann s process for data mining and data management to meet the Quadruple Aim for healthcare improvement Explain the benefits of creating a cross functional team to drive the analytics process to meet the healthcare operational needs of today s leaders Illustrate how to create a longitudinal view of a person s medical record to a enable quality, cost effective care 4

Improved consumer experience Improved cost per capita Improved population outcomes Improved provider experience Improved consumer experience Improved provider experience Quadruple Aim Better health outcomes Lower health care costs 5

Improving population health and the patients experience of care while reducing costs How do we get there? U.S. health care accounts for 17% of the GDP with estimates that percentage will grow to nearly 20% by 2020 1. Measurement principles 2 : 2 Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012. (Available on www.ihi.org) 6 CHI St. Luke s Houston Methodist 1 National Healthcare Expenditure Projections, 2010-2020. Centers for Medicare and Medicaid Services, Office of the Actuary. Need for a defined population Need for data over time Need to distinguish between outcome & process measures, and between population and project measures HCA Value of benchmark or comparison data

Company Snapshot - 2017 The Market Leader $6.0B Total Assets 1 $5.3B Net Operating Revenue 1 24,000 Employees; 5,000 Physicians 267 locations Market share ranking 1st: Aggregate Market Share 1st: Burns 1st: Cardiology 1st: ENT 1st: General Medicine 1st: General Surgery 1st: Neurology 1st: Neurosurgery 1st: Ophthalmology 1st: Orthopedics 1st: Rehab 1st: Spine 1st: Thoracic Surgery 1st: Urology 1st: Vascular 2nd: Gynecology 2nd: Neonatology 2nd: Obstetrics 2nd: Oncology 7 Inpatient market share 5% 6% 7% 4% 4% 4% 7% 2%1% CHI St. Luke s Houston Methodist 15% 25.0% Memorial Hermann Greater Houston MSA 6.6 million population, projected to 7.1 million (2020) HCA 20% >35% share based on total medical spend MHHS total revenue more than double HCA- Houston 7

Our Promise Memorial Hermann employees and physicians will provide exceptional end-to-end patient care experiences anchored by superior quality, clinical excellence and affordable care with a commitment to advance the health of our patients and members. 8

Integration of Pluralistic Physician Model ~4,000 MHMD Physicians, ~3500 CIN Clinically Integrated Network Private, Employed & Faculty Integration Integration of pluralistic physician model 3 DISTINCT PRACTICE MODELS Employment Private Faculty Population health infrastructure 9

Assuming Varying Degrees of Risk Degree of risk shifting to providers TIER III Value driven TIER II Gain sharing TIER I Partial -full fisk High Moderate 501,447 members Community Health Choice 54,740 CMS MSSP 47,400 Aetna Commercial 85,000 Humana Commercial 18,700 Aetna Medicare Advantage 5,800 Humana Medicare Advantage 5,000 United Healthcare Medicare Advantage 8,800 BCBS Commercial 75,000 United Healthcare Commercial 100,000 MH Health Plan Commercial MHHS 39,136 Other 28,881 MH Health Plan Medicare Advantage 6,790 Aetna Whole Health 26,200 345,700 lives 101,007 lives Low Fragmented Transitioning Integrated 10 Delivery system readiness for risk Increasing degree of integration

Population Health Platform Applications Algorithms Analytics Consumer Sepsis TOC Readmissions HCC Suspected 3M Truven SmartData Primary EMR EMRs Paid claims On-site biometrics Foreign EMR 1 Foreign EMR 3 Foreign EMR 4 11 11

Payer Data MH Health Plan enrollment and claims Aetna enrollment and claims Medicare ACO enrollment and claims Humana enrollment and claims BCBS enrollment and claims EMR Data Primary EMR 36 Primary Care and all Specialty Practices, Inpatient Data Foreign EMR 1 101 Primary Care Practices Foreign EMR 2 - UT Provider data Foreign EMR 3 Primary Care Practice Biometric Screening Data HIE (CCD) RediClinic, USPI Surgery Centers, 12 Point Click Care, Homecare/Homebase

HeI/Registry Contract Signed opulation Health Timeline Data Onboarding Analytics Validation Point of Care Report Everyday Well Employer Solutions Registry Go-Live Analytics Launch Alignment Deal: PI EDW & MHiE HeI SmartCare HealtheLife Extension Registry API SmartCare Recommendations 13

Consumer experience Improved consumer experience Improved provider experience Quadruple Aim Better health outcomes Lower health care costs

Digital Experience in Our Daily Lives Susan has a busy day ahead of her. She wakes up to her iphone alarm checks her Yahoo! Weather app to decide what to wear takes a quick call from her boss while she s stuck in traffic using and is faced Bluetooth with half a dozen paper forms on a clipboard that take her 15 minutes to fill out even though she has come to this office for 5 years! listens to Spotify in a busy receptionist her car who asks to see her paper ID card so that she can make a photocopy At the office, Susan texts a coworker that she s running late for their next meeting uses Slack to collaborate with her project team uses Waze for so after surgery she driving is directions given 15 pages of discharge instructions checks Yelp for a good lunch spot with a colleague who recently retired opens her Wells Fargo app to check her account balance as she arrives at the restaurant browses CNN on her ipad while eating breakfast uses the Starbucks app on her phone to pick up coffee for her and a coworker on the way to the office and as she arrives at her physician s office, she finds a TURN OFF YOUR CELL PHONE sign on the front door and bills from 6 different providers and an EOB from her insurance company pays for lunch using Apple Pay Before leaving the office for her doctor s appointment, she checks the MyCigna app to see her HRA balance 15 and confirm her copay amount and enters her lunchtime calories into MyFitnessPal before returning to work

Past State Classes and events MH release MyMemorialHermann PayMyBill ScheduleNow 16 Virtual Care Check Shop/Buy/Enroll

Fixing the Strip Mall of Apps Before After With no single user experience or identity, we offer: Too many logins Desktop-only Up to 7 steps to access some features 17 Through Digital Engagement we will provide: One login, one customer identity A single, consistent user experience Mobile-first design that is device agnostic Customer-managed preferences No more than 3 steps to access a feature

EveryDay Well App Memorial Hermann Primary EMR Forms Mobile ID Card Labs Health Record Physician Finder Dashboard Messaging Profile Integrated Scheduling Health Plan Claims Everyday Well MU Allergies Medications Health Plan Summary Symptom Checker Arrival Bundle Shop, Buy, Enroll (Connecture) Proxy Appointments EOBs Treatment Plans Find My Way (Connexient) Pay My Bill (Simplee) Gaps of Care Health Assessment Preferences Pediatric House Calls (PediaQ) Hold My Place in Line (ClockwiseMD) Coaching Physician Messaging (TBD) Patient Reviews (TBD) Physician Ratings & Reviews (Reputation.com) 18 Third Parties Advanced Care Planning (TBD)

Current Dashboard Susan Family 19

Q3 Dashboard 20

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Additional detail for facility and provider list as well as detail patient view 23

HCC Tools - CMS Payment Model Prospective workflow tool for providers to help identify documentation requirements Persistent diagnoses Previously documented diagnoses which have not been documented yet in the calendar year on the patient. Suspected conditions Diagnoses that are supported by data within SmartData (HealtheIntent), but have not ever been documented before, especially during this current year. Management dashboard Retrospective supplemental data chart chase list 24

HCC:Prospective Integrated Workflow/POC PowerChart/PowerChart Ambulatory users have integrated and streamlined access to the HCC data. Available on Point of Care Report as well. 25

HCC Chart Chase 26

Categories for Tracking Need Chart Review Patients with a kept appointment greater than 90 days that have HCCs which need to be on a claim. Schedule Appointment Patients with suspected and/or persistent HCC gaps and need to be scheduled for an appointment. Conduct Visit Doc/Code Patients with a scheduled appointment who need to have any HCCs documented and coded. Outreach for Future Patients not seen this year who have no suspected or persistent conditions and need to be seen. 27

Categories for Tracking Pending Claim Validation Patients seen in last 90 days with potential HCCs waiting to be on a claim. Healthy (No Opportunity) Patients with a kept appointment in current year with no identified HCCs. Entirely Validated Patients with all suspected and persistent HCCs fully validated. 28

HCC Chart Chase HCC Patient Chase 29

Outcomes Improved consumer experience Improved provider experience Quadruple Aim Better health outcomes Lower health care costs

List of Registries Senior Wellness Adult Wellness Pediatric Wellness Adult Diabetes Ambulatory Urgent Care Asthma COPD Back Pain Depression Heart Failure Ischemic Vascular Disease Coronary Artery Disease Hypertension Rheumatoid Arthritis 31

Adult Wellness: Annual Office Visit Blood Pressure Measurement Blood Pressure Re-Screen Body Mass Index Body Mass Index Follow-up Plan Breast Cancer Screening (ages40-64) Cervical Cancer Screening (ages 21-64) Colorectal Cancer Screening (ages 50-64) Depression Screening Depression Follow-up Plan Influenza Vaccination Post-Osteoporotic Fracture Evaluation Women Post-Osteoporotic Fracture Evaluation Men Tobacco Use Screening and Cessation Senior Wellness: Annual Office Visit Blood Pressure Measurement Blood Pressure Re-Screen Body Mass index Body Mass Index Follow-up Plan Bone Density Screening Breast Cancer Screening (ages 65-69) Colorectal Cancer Screening Depression Screening Depression Follow-up Plan Fall Risk Screening Influenza Vaccination Post-Osteoporotic Fracture Evaluation Women Post-Osteoporotic Fracture Evaluation Men Pneumonia Vaccination Pediatric Wellness: Annual Office Visit Adolescent Depression Screening Immunization Status Age 2 Tobacco Exposure Screening Tobacco Use Screening and Cessation COPD Registry: Semi-Annual Office Visits Adult Diabetes: Antiplatelets for DM with IVD/CAD Blood Pressure < 140/90mm Hg Diabetes Tx Mgmt ACE Inhibitor or ARB Therapy Eye Exam HbA1C Monitoring HbA1C <8% HbA1c Poorly Controlled HbA1c >9% Lipid Panel LDL < 100 mg/dl LDL Poorly Controlled LDL >= 130 mg/dl Nephropathy Screening Semi-Annual Office Visits Tobacco Use Screening and Cessation Heart Failure: Beta Blocker for Low EF (<40%) Beta Blocker Therapy After AMI Semi-Annual Office Visits Hypertension: Blood Pressure < 140/90 mm Hg Ischemic Vascular Disease Coronary Artery Disease: AMI or CAD: ACEI or ARB if diabetic or EF <40% Antiplatelet Therapy Lipid Panel LDL < 100 mg/dl Lipid-Lowering Therapy Asthma: Medication Management Back Pain: Imaging Studies for Low Back Pain Rheumatoid Arthritis Management: Rheumatoid Arthritis Management Ambulatory Urgent Care: Avoidance of Antibiotic Treatment in Patients w/ Acute Bronchitis Appropriate Treatment for Children w/ URI Appropriate Testing for Children w/ Pharyngitis 32

SmartRegistry: Integrated Workflow/ Web Tool PowerChart/PowerChart Ambulatory users have integrated and streamlined access to the SmartRegistry module. Web-based access to SmartRegistry portal also an option. 33

SmartRegistry: POC/Right Chart Panel ecw Current Workflow: Providers/Staff can access a daily report showing gaps of care for patients ecw Integrated Workflow: A fully integrated panel showing gaps of care for patients Test, Patient 01/01/1960 MRN_1234 34

SmartRegistry:MSSP Claims + ecw Encounter Data MSSP claims data XXX EMR encounter with physician 35

Quality Dashboard Filters Top areas for improvement 36

Quality Dashboard Quality provider/practice 37

Tracking Contract Metrics Supporting value-based care & fee-for-service contracts 38

But Wait There s More!!! 39

Provider experience Improved consumer experience Improved provider experience Quadruple Aim Better health outcomes Lower health care costs

SmartRegistry: Integrated Workflow PowerChart/PowerChart Ambulatory users have integrated and streamlined access to the SmartRegistry module. Web-based access to SmartRegistry portal also an option. 41

SmartRegistry: MSSP Claims + ecw Encounter Data MSSP claims data XXX EMR encounter with physician 42

Direct access to SmartAnalytics where reports and dashboard are exposed in project groups to specified users Allows us to get claim level detail directly out to the report audience. 43

Our providers love having data integrated into their workflow. The seamless integration makes providers lives easier and their use of the EMR and Registry tool more satisfying. Alan Weiss, MD AVP, CMIO - Ambulatory

Received additional dollars from Aetna due to using SmartAnalytics to show additional care gaps closed meeting a higher threshold. In October, used 3M Episodic grouper to analyze and respond to a bundle RFP Visualization of network utilization by providers is providing insights into how we can better server the community. Productivity Previous analysis method consisted of pulling data and reporting each time something was needed. Time spent on requests is converting from creating the analysis to evaluating the analysis. We can tell the story instead of spending all our time putting the story together. 45

Continued workflow tools and analytics dashboards and reports to improve quality, optimize network and reduce overall cost Potentially preventable events Care redesign/performance improvement Incentive payment reporting Employer solutions HEDIS submission for health plan 46

Preparing for Bundled Contracts Understand physician performance in an episodic context Especially important for specialists Provides different lens for cost in care continuum Ability to group across different types Episodes, Diagnoses, Risk Setting up for employer Centers of Excellence 47

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Population Health Platform Improved consumer experience Improved Improved provider provider experience experience Quadruple Aim Better Better health health outcomes outcomes Applications Algorithms Lower health care costs Sepsis TOC Readmissions HCC Suspected 3M Truven Analytics SmartData Consumer EMRs Paid 49 claims On-site biometrics 49

Questions Angie.Massey@memorialhermann.org Paul.Lampi@memorialhermann.org Please complete the online session evaluation 50