CISummit: Zach Henderson, Data-tastick: A Deep Dive on Data Driving Networks

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Zach HendersonClick icon to add picture

SVP, Healthcare Markets

Connected Insight Summit

DATA-TASTICK

A Deep Dive on Data Driving Networks


It’s time to get excited about data…

We all think of

Data

in different ways


If you’re like me, as a bunch of 1s and 0s flowing through the pipes of healthcare processing streams…

3


To many, it’s simply the content in spreadsheets…

4


For some, data is a little more simple than that…

5


Data often gets front page billing…

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And some think of “Data” quite differently…

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Data is sometimes frustrating…

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And data became worse when it got “Big”

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But when we finally understand Data, it is great!

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We are in the Healthcare track at this conference after all

BUT LET’S GET MORE SPECIFIC


Type of Data Benefits Caveats

Prescription/Rx Claims

• Concentrated sources… easier to collect• Excellent for tracking retail pharma products• High coverage with weekly updates available• Known denominator

• Only usable for retail tracking• Variable correlation between Rx activity and medical activity

Medical Claims

• Tailored to diagnosis and procedure codes of interest• Covers both retail and non-retail settings• Best for identifying “splitting” behavior of procedures • Closest correlation to actual referral networks

• Severely fragmented• Difficult to source• No standard denominator/total• Latency

What types of data are available?

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Where do medical claims come from?

Payers

+4,000

835

State Databases& Collaboratives

Office Practice Management Software

+500

Claims Switches/Clearinghouses

837

+50


• UB-04• Institutional claims for services provided by hospitals, hospices,

and long-term care facilities (e.g. SNFs) are billed on Uniform Bills (UB-04 or CMS-1450, formerly UB-92)

• All services are summarized by revenue codes

• For inpatient claims, UB-04 describes procedures primarily by ICD-9 procedure codes

• For outpatient claims, UB-04 describes the services and supplies provided by using CPT and HCPCS codes

• 1500• Professional claims for services provided by physicians, labs,

ambulances, and DME vendors are billed on CMS 1500 forms (HCFA 1500 or 1500 forms)

• CMS 1500 always describes the services and supplies provided by using CPT and HCPCS codes

Types of Claims Forms (UB-04)

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Medical Claim Form

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174 9

197 7

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx

John Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

• Glean useful information:› Physician ID,

diagnoses and procedure codes, facility ID, etc


01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx


123-45-6789 xxx xx

174 9

197 7

Diagnosis Code:ICD-9-CM code for appropriate diagnosis or nature of illness

Office Visit Code:CPT code for services provided to an established patient

Procedure Code:CPT code for an injection

Required: Drug CodeAppropriate HCPCS Drug Code

for medication administered


We almost forgot the most important part…

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174 9

197 7


01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx


123-45-6789 xxx xx

174 9

197 7


01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

Patient Information:The details on the unique patient


But that is HIPAA data!!!

Patient 123456

Date of Birth

First NameLast Name

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Magical Encryption/De-identification


So what?

SpecialistPatient 123456

Cardiac SurgeonPatient 123456

PCPPatient 123456

WHY DO YOU CARE?

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Grow system/ACO through acquisitions, partnerships and recruitment

10% 20% 30%

Understand where there is opportunity to grow referrals

Identify areas of patient leakage

70%

20%

10%

Know where splitters are “splitting”

First off, healthcare companies can do a lot with data


Physician to Physician relationships are important

Medical claims data can be used to derive physician-physician relationships based on shared patients for a disease state of interest.

Analytic methodologies can leverage longitudinal tracking of patients across physician visits by leveraging an anonymized patient ID.

A pair of physicians that share a statistically significant number of patients within a specified time window are assumed to have a professional relationship.

Is it a leap?


Example Network for a Service Line

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Georgia network

Atlanta networkZoom in to portion of Atlanta network

Dr. Ruth O’Regan

Dr. Ashesh Jani

Dr. Monica Rizzo

Relationships for Dr. O’Regan


Barbara VizyFamily Practice3690 Orange PlBeachwood, OH

A Provider Centric View of Competition in Cleveland

Dr. Michael WalkerSurgery, Orthopedic9500 Euclid AveCleveland, OHOrtho National Rank - 9

Xian JinInternal Medicine9500 Euclid AveCleveland, OH

Ranjit TamaskarInternal Medicine20000 Harvard AveBeachwood, OH

Strength of Relationship

10

10

Andrew BrobbeyInternal Medicine25701 N Lakeland BlvdEuclid, OH

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7

Walker

Jin

VizyBrobbey

Tamaskar

10

7

8

10


Shows a Referral Source that has relationship with 2 different systems

Dr. Ranjit TamaskarInternal Medicine2000 Harvard AveBeachwood, OH

Michael WalkerSurgery, Orthopedic9500 Euclid AveCleveland, OH

William PetersilgeInternal Medicine20000 Harvard AveBeachwood, OH

Strength of Relationship

10

6

Tamaskar

WalkerPetersilge

10

6


Now that you can “see” how the data relates, it’s time to put data into action

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Zach Henderson

SVP, Healthcare Markets

QUESTIONS

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Date post:	14-Nov-2014
Category:	Health & Medicine
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CISummit: Zach Henderson, Data-tastick: A Deep Dive on Data Driving Networks

Health & Medicine