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Integrating Population Health Analytics and the EHR EnvironmentSession 87, March 6, 2018
Nina M. Taggart, MD, Senior Medical Director,
Population Health and Payer Relations, Lehigh Valley Health Network
Sameera Ahmed, Manager, Clinical and Business Analytics, Populytics
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Nina M. Taggart, MD and Sameera Ahmed have no real or apparent conflicts of interest to report.
Conflict of Interest
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Agenda• Value Based Reimbursement
• Integrating Data Sources
• Integrating Analytics in the EHR
• Integrating Analytics into Organizational Culture and Population Health Strategy
• Outcomes and Metrics
• Keys to Success
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Learning Objectives• Describe the connection between analytics and success under risk-
based contracts
• Explain the benefits of organizations helping physicians engage with data and analytics through the EHR environment
• Discuss how physicians can be engaged with actionable data to improve outcomes
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A Complete Health Network
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Lehigh Valley Health Network Overview
• 8 Campuses
• 1 Children’s Hospital
• 160+ Physician Practices
• 17 Community Clinics
• 16 Health Centers
• 12 ExpressCARE Locations
• 81 Testing and Imaging Locations
• 18,000+ Employees
• 2,005 Physicians
• 834 Advanced Practice Clinicians
• 4,208 Registered Nurses
• 57,272 Admissions
• 212,897 ED Visits
• 1,838 Acute Care Beds
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Cardiology and Heart Surgery
Gastroenterology and GI Surgery
Geriatrics
Orthopedics
Pulmonology
21st
Consecutive
Year
#4Lehigh Valley Hospital
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Value Based Reimbursement
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FEE-FOR-SERVICE
QUALITY
INCENTIVES
FEE-FOR-SERVICE
SHARED
SAVINGS GLOBAL RISK
CONTRACTING
FEE-FOR-SERVICE
Present Near-Term Future
Fee-for-Value
Providers paid for
proactively keeping
populations healthy
Fee-for-Service
Providers paid for
treating an individual’s
health problem
FEE-FOR-
SERVICE
Transition of the Healthcare Industry to Value Based Reimbursement
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Alternative Payment Model
In 2015, HHS announced that it would like to see 50% of all Medicare payments transition to value based reimbursement by the end of 2018.
• MACRA drives clinicians there through MIPS
• APMs encourage innovation and increasingly emphasize delivery system through the progressive categories
Fee-for-
service (FFS)FFS link to
Quality and
Value
Alternative
Payment
Models (FFS
Architecture)
Population
Based
Payment
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Lehigh Valley Physician Hospital Organization (LVPHO)
• 1180 physicians
• 800 employed/aligned
• Independent total – 380
• Supports physician engagement and quality
improvement
• Provides effective, efficient and uniform measures
to support accountable care and population health
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Experience Managing Populations
Observations:
• The National Forecast is based upon the forecast of the yearly medical care cost trend by national authorities including Milliman, PWC, Kaiser and Mercer
• The LVHN Health Plan outperformed both it’s budget and the National Forecast of medical care cost trend in each of the fiscal years subsequent to the analytics launch
• There were cumulative savings of $55M when comparing actual medical care costs to what the medical care costs would have been based upon the National Forecast absent any data driven initiatives
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Value Based Contracts at LVHN/LVPHO
• By the beginning of FY 2018, over $1 billion in insurance-based claims (spend) is projected to be in value based contract arrangements with LVHN
• Evaluating MA & Medical Assistance
Payer Attributed LivesAccountable
Spend
Type of
ArrangementTotal at Risk
LVHN Health Plan (live) 24,000 $130M Full Risk Total Risk
MSSP (live) 40,000 $400MShared
Savings
50% of savings
above target
Commercial Insurer 1 (live effective 7/1/2016)
50,000 $250MLimited
Shared Risk
50% savings
above target,
loss capped at
$3M
Commercial Insurer 2(go-live 1/1/2018)
45,000 $350MMoving to
Full Risk
100% savings
or risk around
target
Commercial Insurer 3 (live)
10,000 $45MShared
Savings
50% savings
above target
TOTAL 163,000 $1,175M
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Foundations for Success: Managing Population Risk
CLINICAL & PHYSICIAN
ANALYTICS
Data-driven review of
populations to identify
and stratify risk to
reveal opportunities
and inform providers
FINANCIAL MANAGEMENT
Strategy to monitor
performance under
accountable care
arrangements
CLINICAL INTUITION AND
SUPPORT
Leverage the experience
of our clinical experts for
the benefit of your
strategic goals
DATA MANAGEMENT
Acquisition, integration
& maintenance of data
critical to the management
of populations
Successful population
health management to
thrive in value-based care
models
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• Integration must occur in three areas for successful Population Health Management:
Data sources (claims, EHR, socio-economic)
Analytics in EHR
Analytics as a part of the organizational culture and population health strategy
Integrating Population Health Analytics
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Integrating Data Sources
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• Success in VBR requires population health management across the care continuum
• Population health management requires data that gives a complete picture of the patients health
• Disparate data sources in health care
EHR systems
Claims
Socio-Economic
Self reported
Data Sources for Population Health Analytics
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• EHR
Provides clinical and social data, but no information on actual cost of care
Missing anything that happened outside of the health system
• Adjudicated Claims
Provides financial information, diagnoses, prescriptions – but not timely
• Matching the right information to the right patient
• Valuable insights come from both, yet both are traditionally not accessible in one system
Data Source Challenges
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Population Health Analytics
Clinical &
Social
Analytics
Population
Management
Analytics
Insurance
Analytics
Claims
Data
Clinical
Data
Care CoordinationOrganizational
Strategy
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High Risk Care Management/
PHO Liaison
Clinical data from EMR Claims data from Payer
Risk Scores & Predictive
Analytics
Registries
Practice Clinical Contact
Referral to interdisciplinary team
membersLinkage to community Resources
Continued education/care
coordination/gap closure
Supporting Care Coordination Process
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Integrating Analytics in the EHR
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• Clinicians work in clinical workflow systems, but actionable data may come from other systems or elsewhere in the record
• Data retrieval may be cumbersome, inefficient, or missed entirely
• Analysts need operational and outcomes metrics to monitor performance with value-based contracts
Integrate Analytics into the EHR
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• Sources of integrated predictive analytics and clinical workflow systems are separate
EHR is used as care management workflow tool
Registries created in BI tool outside of the EHR
• Process to access registries was inefficient and cumbersome
Challenges
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Registry Integration
• Application Programming Interface (API)
Secure, web-based interface
Enter code to request item, get the item back
Result set is raw data that can be used by other applications
Process is automated, removing manual effort involved with simple exports
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Enterprise Analytics
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Integration into Workflow
• Data driven work processes
• Directing resources to patients most at risk
• Registry development incorporating multiple data sources
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Integrating Analytics into Organizational Culture &
Population Health Strategy
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Data Driven Culture
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• Defining patient populations
Attribution vs Empanelment
• Clinical teams wanted all or none
All
o Wanted to understand everything about patients
o “Analysis Paralysis”
None
o Distrust of claims data
o Wrong metrics
o Not timely
Challenges
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Right Data, Right Use Case, Right Audience
• Clinical Analytics that use EHR
data to identify Gaps in Care,
High Risk Patients, etc.
• Risk Analytics that use Claims
Data to track prospective costs
and stratify risk
• Registries with patient level
profiles
• Predictive Analytics
• Easy to use Dashboards
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Analytic Dashboards
• 11 drillable analytic dashboards to
identify achievable opportunities
to improve overall population
health
• Create customized data segments
around demographic, financial
and health information to support
targeted initiatives including:
Clinical pathways
dashboards for COPD,
oncology, CHF & AFIB
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• Semi-Annual Practice-Based Group Incentive Plan: Designed to provide
physicians with incentives to meet the Triple Aim
• Measurement Categories
Better Care: CG CAHPs participation, Meaningful Use standards
Better Cost: Risk Adjusted ALOS, Risk Adjusted Episode Cost, Admissions and Readmissions, ED visits, and generic Rx Utilization
Better Health: Evidence-based Quality Measures, QI Projects
• Funding Sources: Include employer, payers & shared savings distribution
• CME Opportunities/Online Modules
Achieving Clinical Excellence® (ACE)
Clinical & Physician Analytics: Incentive Programs
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Achieving Clinical Excellence® (ACE) – Provider Portal
Clinical & Physician Analytics: Provider Portal
• Provider portal represents an opportunity to share results &
opportunities with providers in a secure environment
Physician progress to incentive goals are reported quarterly
Utilization and quality goals are highlighted for each practice
Member-specific care gaps are reported to drive compliance
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Engaging Our Workforce and Our Partners In Health
• Created a Population Health Academy
• Educational Programs for front-line clinicians and administrators to provide education on topics including:
Vision and Value of Population Health
Quality
Payer and Insurance innovations, metrics, and accountable care arrangements
Population health analytics
Pay-for-value reimbursement
We are on a journey to engage
more partners in this work
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Outcomes and Metrics
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Measure everything Operational efficiency
Pathway compliance
Population Health interventions
Access
• Outcomes
Quarterly review of financial performance under each accountable care arrangement
Dashboard review of ACA clinical trends
Performance on quality incentives by ACA
ROI on specific program performance
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Outcomes: LVHN Health Plan
Observations:
• The National Forecast is based upon the forecast of the yearly medical care cost trend by national authorities including Mill iman,
PWC, Kaiser and Mercer
• The LVHN Health Plan outperformed both it’s budget and the National Forecast of medical care cost trend in each of the fiscal years
subsequent to the analytics launch
• There were cumulative savings of $55M when comparing actual medical care costs to what the medical care costs would have been
based upon the National Forecast absent any data driven initiatives
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Quality Moves with Measurement & Alignment
Measure 7/15 – 6/16 7/16 – 6/17 Aligns with ACE
Adult BMI Assessment 44.10% 79.45% Yes
Appropriate Testing for Children with Pharyngitis 88.15% 89.04% Yes
Breast Cancer Screening 78.42% 78.55% Yes
Colorectal Cancer Screening 62.41% 66.10% Yes
Comprehensive Diabetes Care HbA1c (<8%) 42.57% 56.91% Yes
Statin Therapy for Diabetic Patients-Received 54.94% 58.47% No
Statin Therapy for Diabetic Patients-Adherence 80% 71.98% 71.25% No
Cervical Cancer Screening 74.48% 73.76% No
Use of Imaging Studies for Low Back Pain 75.32% 75.19% Yes
75th percentile or at least 6% improvement
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Outcomes: Medicare Shared Savings Program
• CY 2015
• 37K Attributed Lives
Program Structure
• CY 2016
• 40K Attributed Lives
Program Results
CY 2015
• Total claims cost $340M
• Final shared savings $11.2M
• Performance payment $5.5M
• Quality reported
CY 2016
• Total claims cost $378M
• Final savings $4.8M
• Performance payment $0*
• Quality 97.87% achieved
* Did not exceed MSR – saved CMS $$ but not enough to gain shared savings
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Outcomes: Commercial Accountable Care Arrangement
• Commercial Payer
• 55K Attributed Lives
Program Structure
• 7/1/2016 – 6/30/2017
• 50% Gain Share 30% Risk
Program Results
• Final Year End Trend Comparison (risk adjusted)
LVHN Medical Trend 2.24%
Peer Trend 5.74%
• Final Shared Savings
At mid-year ($4,085,540)
At program year end $7,431,949
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Keys to Success• Integrate Data
Claims & clinical data are necessary to measure success in value-based contracts
Select concepts that are most relevant and meaningful for population health management
• Integrate Analytics into EHR Workflow
Get analytics at the point of care
Make processes easier for care managers and clinicians
• Integrate Analytics into Organizational Culture and Population Health Strategy
Report to all levels of the organization
Provide incentives
Provide education
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Questions
Nina M. Taggart, [email protected]
Sameera [email protected]
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