Session  8:  How  One  Pioneer  ACO  is  Improving  Healthcare  Performance  Through  Analytics  and  Cultural  Transformation    [Kurt]    Keep  an  eye  out  just  before  we  get  started.  Everybody  should  see  a  "Lessons  Learned"  sheet  in  front  of  them.  We  encourage  you  to  use  that  to  take  notes  and  write  down  one  thing;  a  question  I'll  ask  at  the  end  of  the  presentation.      Hopefully  everybody   is   in  session  eight.  You've  got  all  your  apps  connected  to  the  session  eight   because   you’re   going   to   use   the   application   to   ask   the   presenters   questions.  We'd  encourage  you  to  make  sure  you're  on  there.  As  you'll  see,  there's  already  a  polling  question  that's  up.  We'd  ask  you  to  take  a  minute,  look  at  that  polling  question,  and  respond.    Couple  of  other  things    to  note:  you  have  the  ability  to  submit  a  question  through  the  app.  We'd  encourage  you  to  do  that.  For  those  who  have  submitted  questions,  we'd  ask  others  to  look  at  those  questions  and  vote  on  them.  Remember:  all  these  things  earn  points.      You  can  press  applause  at  any  time;  we’d  encourage  that;  especially  if  you  hear  something  that's  caught  your  attention  and  you  think  is  interesting.  Remember:  you  score  points  when  you   participate   in   the   poll,   choose     applause,   or   submit   a   question   (especially   one   that's  voted  on  by  your  peers).      If  anyone  is  having  a  problem  with  their  app,  we've  got  technology  folks  in  the  back  (they're  raising   their   hands   if   anybody  wants   to   turn   around).  We   encourage   you   do   one   of   two  things:  head  on  back  to  see  if  they  can  help    or  wave  your  hand  and  we'll  have  them  come  to  you.  Looks  like  we  may  have  one  person  in  front  that  has  a  technology  question  for  our  group  in  the  back.    Okay.  We've  got   somebody   coming   to   the   front.  Anybody  else  have  a  question?  Oh,   very  good.    Good  afternoon,  ladies  and  gentlemen.  I'd  like  to  extend  a  very  warm  welcome  to  all  of  you.  Thank   you   for   taking   some   time   today   to   participate  with   us.   I   am   very,   very   pleased   to  introduce  Mark  Hohulin,   Senior  Vice-­‐President   of  Healthcare  Analytics   at  OSF,   and  Roopa  Foulger,  Executive  Director  of  Data  Delivery  at  OSF  who'll  be  speaking  on  the   topic,   "How  One   Pioneer   ACO   is   Improving   Healthcare   Performance   Through   Analytics   and   Cultural  Transformation."    Before  we  get  started,  I  want  to  acknowledge  the  analysts  in  the  back  of  the  room.  Susan,  Chris,  and  John,   if  you  want  to  raise  your  hand;  these  are  the  folks  that  will  help  guide  us  this  afternoon.  With   that,   let's   go  ahead  and  get   started.   I'd   like   to   see   if  we  can   see   the  results  of  our  initial  poll  session.  Let  me  turn  that  over  to  the  analysts  in  the  back.    [Male  Speaker  1]    Thank   you,   Kurt.   The   question  was:   does   your   healthcare   organization   currently   have   an  effective  system  for  using  data  consistently?  Let's  go  ahead  and   look  at   the  results.  Mark,  

Roopa;   looks   like   you   have   your  work   cut   out   for   you.   62%   said   no.   Very   good.  Without  further  ado,  let  me  turn  things  over  to  Mark.    

 How   One   Pioneer   ACO   is   Improving   Healthcare   Performance   Through   Analytics   and  Cultural  Transformation  [03:53]    [Mark  Hohulin]  Can  everybody  hear  me  okay?  Sounds  all   right?  Okay,   thank  you.  Good  afternoon.  Before  presenting   and   talking   with   you   about   one   of   our   cultural   transformations   and   journey  around  data  and  analytics,   I'm  co-­‐presenting  with  Roopa  Foulger  who's  been  a  big  part  of  our  team  in  developing  the  technical  side  of  our  data  warehouse  and  a  lot  of  the  analytical  applications  that  we  have  across  OSF.    

 About  the  Organization  [04:21]  Just  some  background  on  our  organization  for  those  who  are  not  familiar,  we're  located  in  Peoria,   Illinois.  We're   an   11-­‐hospital   integrated   healthcare   system.  We   have   one   hospital  left   in   the  UP  of  Michigan,  but  most  all  of   them  are  all   in   Illinois.  We  have  224   locations,  over  700  physicians,  and  16,000  or  more  employees  across  our  marketplace.      To  give  you  a  better  understanding  of  our  size,  we're  about  7.2  billion  in  growth  charges  as  an   organization   in   Illinois,   about   2.4   billion   in   net   revenue,   and    we   serve   about   700,000  patients   (unique   individuals)   across   our   marketplace.   The   population   base   itself   is   much  larger  than  that.  We've  been  a  pioneer  ACO  for  four  years  (currently  in  the  fourth  year).      From  a  performance  perspective,  the  first  two  years  we  were  really  within  that  1%  corridor  for  those  familiar  with  that  methodology  and  process.  It  was  really  no-­‐shared  savings  or  no-­‐payment-­‐back   in  CMS.  The  third  year,  our  performance  improved  quite  a  bit  and  we  were  able  to  earn  about  $4.9  million  in  [Inaudible][05:30]    Some  of  what  we'll  talk  about  today  relates  to  our  transformation-­‐how  the  ACO  effort  and  work  came  about,  and  how  we  supported  that.  Another  frame  of  reference:  we  have  about  180,000  covered  lives  in  a  value-­‐based  arrangement  today;  about  30%  of  our  revenue  and  25%  of  the  patients  we  serve.      We  are  also  part  of  the  Healthcare  Transformation  Task  Force  now,  which  stated  the  goal  of  having   75%   of   our   business-­‐or   lives-­‐as   part   of   a   value-­‐based   arrangement   by   2020.   Big  

movement  is  expected  in  our  marketplace,  which  is  what  we  have  to  be  prepared  for  from  an  analytical  perspective.                                              

 Pursuing  Clinical  and  Operational  Excellence  [06:23]  

 To   give   you   an   idea   of   how   analytics   began,   we   look   at   how  we   can   pursue   clinical   and  operational   excellence.  One   thing  we've  been   fortunate  with   is   that   our   leadership   (CEO)  has  prioritized  that  we  have  to  develop  an  effective  and  price  data  warehouse  and  analytical  capability  to  derive  insights  from  the  data  that  are  key  for  our  future  success.    With  that  in  mind,  we  knew  that  we  had  to  do  analysis  in  search  of  clinical  business  insights  needed  to  derive  improvements.  Again,  the  leaders  prioritized  the  analytics  as  a  component  of  that  strategic  plan.      Part  of  our  development  of  the  plan  involved  strategic  goals  that  were  set  by  our  leadership  group.   Again,   as   a   frame   of   reference,   the   11   hospitals   that   used   to   operate   fairly  independently  as  their  own  operating  unit  separate  from  the  system  perspective;  over  the  last  four  to  five  years,  we    operate  more  as  a  central  organization.        Basically,  the  term  that  we  use  now  is  One  OSF.  Everything  we  do  is  based  upon  an  entire  system.   Each   operating   unit   focuses   on   the   healthcare   system   in   total.   That's   been   a   big  change  and  a  big  part  of  our  cultural  change  that  we've  been  able  to  take  advantage  of  as  well.   That   helps   drive   everyone   in   the   organization   focused   on   total   organizational  improvement  on  clinical,  financial,  patient  experience,  and  employee  experience  across  our  organization.  That's  been  key.    We’ve  been  going  through  lots  of  transformations,  one  of  those  being  analytics.  Leadership  put   our   analytics   group   at   the   front   of   the   transformations   happening   across   the  organization.  We  brought  about  five  different,  independent  groups  across  to  construct  one  analytics  division.      Prior   to   that,  we  were  called  Decisions  Support,  Clinical  Physician  Support,   IT   Informatics,  and   Ambulatory   Informatics.   We've   always   been   different   pockets.   What   we   did   is   we  brought  those  five  to  six  groups  together  and  basically  branded  ourselves  as  the  Healthcare  Analytic.  That  was  two  years  ago.  That's  part  of  our  journey.                                

 The  Pain  Points  [08:32]    The  thing  that  we  experienced  prior  to  doing  some  of  this   is  we  had  some  pain  points  the  organization   realized   that  we  had.  We  had  difficulty   finding   an   effective   system   for   using  data   consistently.  We   had  multiple   locations   and   silos   of   data.  We   previously   had   some  unsuccessful  EDW  implementations.      These  efforts  were  driven  without  a  business  purpose  or  strategic  intent.  A  little  bit  from  a  technical  or  IT  perspective,  this   is  something  we  need  to  have  just  because  it  feels   like  we  should  do  it,  but  it  didn't  have  a  lot  of  ownership  or  accountability  from  leadership  to  make  any  difference.    Ultimately,  as  the  cultural  change  occurred  across  OSF,  leadership  recognized  we  needed  to  have  clear,  aligned  data  and  a  warehouse  and  analytics   to  support   that.  That's  been  a  big  change.      Data  overload;  many  of  you  have  the  same  issues.  Data  is  everywhere.  Our  organization  has  EPIC.  We  are  highly   integrated  epic  organization   from  primary   care   to   specialty  groups   to  hospitals  to  home  care.    Being  a  pioneer  ACO  we  also  have  now  five  years  of  claims  data  for  40,000  beneficiaries;  we  have  other  payors’   claim  data  as  well.  We  have  a   tremendous  amount  of  data,  which  we  knew  we  had  to  be  able  to  organize  and  put  into  a  data  warehouse.    

We  have  the  inability  to  determine  if  we  were  measuring  the  right  thing.  There  was  a  huge  effort  by  our  Chief  Strategy  Officer  and  planning  group.  Our  leadership  put  together  a  focus  around  what  our  organization  should  focus  on,  the  strategic  goals,  and    measures  that  need  to  be  looked  at  regularly  to  understand  how  it's  performing.  Roopa  will  cover  some  of  that  in  a  little  bit.    We  had  difficulty  creating  that  transparency  and  clinical  excellence.  Again,  it  was  in  pockets.  It   wasn't   focused.   Our   cultural   transformation   has   changed   that   quite   a   bit   where  we've  made  great  improvements.  Again,  that's  all  helped  us  from  a  healthcare  standpoint;  from  an  analytics  data  warehousing  perspective;   that's  helped  us   invest   resources   into   those   tools  and  the  technology.                            

 

Our  Approach  and  Results  [10:27]    From   leadership   down   we   wanted   to   deliver   superior   clinical   outcomes   for   all   of   our  patients.  We  need  to  improve  the  patient  experience  across  OSF.  Again,  going  back  to  that  One  OSF  theme,  patients  go  into  any  of  our  locations,  any  of  our  doctors'  offices,  any  of  our  hospitals  they  need  to  have  the  same  exact  experience.  That's  another  focus  that  we've  had.    Enhance  the  affordability  and  sustainability  of  services.  Provide  core  transparency  of  health  through  performing  not  only  financially  but  also  clinically  and  try  to  bring  that  whole  cost  of  ownership-­‐cost  of  care-­‐into  the  forefront    for  leadership  to  understand  and  then  really  drive  that  cultural  shift  to  embrace  becoming  a  data-­‐empowered  system.    As  you'll  see  in  a  little  bit,  when  we  look  at  the  executive  dashboard,  the  leaders  look  at  this  regularly   and  everything's  not   cascading  down   to  different   service   areas;   different   clinical  focuses  for  the  same  purpose.  We're  all   looking  at  measures.  We're  all   looking  at  how  we  can  be  more  accountable  to  improve  performance.    

 Our  Approach  [11:30]    If   you   look   at   our   approach,   OSF   needed   to   drive   the   cultural   shift   throughout   the  organization  to  embrace  becoming  a  data-­‐empowered  organization.  The  question  was,  “Are  we  making  decisions  based  on  data?”  Often,  we  were  not.  We  started  bringing  trying  in  a  lot  of  the  strategic  goals  and  measures  to  increase  accountability.    

What  we   did  with   tools   and   transparency   to   engage   leadership  was   implement   the   EDW  with  the  Health  Catalyst’s  help.  The  late-­‐binding  EDW  aggregated  clinical,  claims,  financial,  and  other  data  to  create  a  consistent  view  of  the  ACO's  data.    Again,   this   has   been   a   journey.   This   has   happened   over   four   plus   years   and   we're   still  growing.  One  thing  that  we've  done  to  that  process-­‐and  again,  it  includes  the  strategic  goals  and  purpose-­‐is  determine  what  do  we  need  to  integrate  into  the  warehouse  and  make  it  an  iterative   process-­‐not   a   big   bang-­‐build   this   entire   warehouse,   have   everything   developed,  and  then  do  something  with  it.    We  wanted  to  determine  what  we  needed  to  accomplish  and  achieve:  the  quick  wins  that  we  could  develop  as  a  team  in  analytics  was  probably  the  most  important  thing  for  us  to  do:  getting   quick  wins,   getting   leadership   to   see   the   results   so   that   investments   and   support  continue  to  grow.      An  example  of  that  ACO  data  is  we  had  to  bring  in  the  claims  data.  Shortly  after  we  started  implementing   the  warehouse,  we   started   bringing   in  millions   of   claims   records.  We  build  analytical  tools  on  top  of  that.  When  we  brought  in  the  claims  data  we  were  able  to  merge  it  with  our  EMR  information  so  we  could  see  the  patients,  who  their  doctors  were,  understand  the  risks,  and  be  able  to  transfer  that  information  to  clinic  managers  and  clinicians.      We  also  had  the  ability  to  look  at  clinical  immigration:  where  those  40,000  people  going  for  care,   how  much   of   it   is   provided   at   OSF,   and   how  much   of   it   is   going   to   other   non-­‐OSF  locations.  That  was  one  big  piece  we  were  able  to  provide  to  leadership.      In   one   year,   we   saw   that   $70   million   worth   of   care   was   going   on   outside   of   OSF.   That  visibility   helped   us   say,   "If   you   just   got   10%  movement   (to  OSF),   that's   $7.2  million,   20%  movement,   $14   million."   Even   though   we're   in   a   value-­‐based   arrangement,   we're   still  getting  paid  at  these  service  levels.    Also,  we  know  that  we  cannot  manage  care  if  patients  go  to  another  system  or  hospital.  We  felt  it  was  very  important  to  bring  those  patients  back  to  OSF,  and  improve  that  care  so  they  don't  have  to  come  back   in  to  the  hospital.  They  can  be  engaged  with  care  managers  and  primary  care.  At  the  same  time,  when  the  care  is  being  done,  we're  able  to  make  sure    we're  getting  that  dollar  amount;  not  someone  else.    That   was   a   big,   quick   win   and   one   of   those   things   that   I   have   said,   from   an   analytical  perspective,  we  have  th  ability  to  see  that  information  and  then  take  action.  That  was  very  helpful  for  leadership.    The  other  thing  that  we  had  to  do  was  form  and  support  improvement  teams.  Again,  with  leadership,   form   a   strategic   goal   and   it   was   imperative   that   it   came   down   clinically.  We  needed  to  focus  on  specific  items  like  heart  failure,  supportive  care,  or  sepsis.      With  that  kind  of  charge  in  clinical  agenda,  we're  able  to  put  together  a  team  and  then  start  identifying   data   sources   that   we're   going   to   need,   the   appropriate   data   format,   and   the  analytics  we  have  to  put  behind  that   information.  That’s  been  the  approach.  As   I  said,   it's  

been  a  considerable  process.  We've  grown  over  the  last  four  years  quite  a  bit.  We  know  we  have  more  to  do,  but  we've  had  a  lot  of  successes  in  those  regards.    One  of  the  items  that  we'll  be  sharing  shortly  will  be  the  Executive  Dashboard.  Before  we  do  that,  I'll  turn  it  over  to  Roopa.  I'm  going  to  ask  that  you  take  a  look  at  this  polling  question  and  use  your  device  again.  Analysts,  maybe  you  can  help  me  out  here.    

 Poll  Question  #2  [15:10]    On   a   scale   of   one   to   five,   how   would   you   rate   your   healthcare   organization's   ability   to  leverage  data  to  make  clinical  and  operational  improvements?    You  can  go  ahead  and  put  those  into  your  apps.    We'll  go  ahead  and  give  you  a  few  moments  to  respond  to  that.    Okay.   Let's   go   ahead  and   show   the   results.   Looks   like   40%  of   you   said   it  was  moderately  effective,  32%  somewhat  effective,  19%  very  effective,  7%  extremely  effective,  and  3%  not  at  all.  Back  to  you,  Roopa.    [Roopa  Foulger]  Not  bad.  Now  that  we  had  a  runway  built,  a  data  warehouse  built,  it  was  time  for  us  to  fly  out   and   start   deploying   solutions.   Data   warehousing,   when   it’s   implemented,   is   usually  

abstract.  Most  people  cannot  relate  to  data.  Collecting  the  information  should  be  the  next  immediate  step  that  any  organization  should  take.  That’s  what  we  did.    As  Mark  said,  as  we  were  defining,  we  were   looking  at  our  organization’s  strategy  and  we  had  a  new  Chief  Strategy  Officer.  The  first   thing  she  did  was   look  at  our  whole  road  map.  She   said,   “We   need   to   have   something   that   everybody   could   align   to   and   look   at.”   We  needed   a   dashboard   that   leadership   and   other   staff   can   look   at   to   understand   our  performance  on  our  strategies.    As   part   of   doing   that,   we  made   sure   the   right   people  were   at   the   table   and   there  were  countless   discussions   on  what   the   right  metrics  were.  Having   the   business   owners   at   the  table  was  critical  because  you  want  them  engaged  early  on.  You  want  them  to  believe  in  the  data    you’re  going  to  put  out  and  that’s  what  happened.  It  helped  our  adoption.                                          

 Executive  Dashboard  [17:06]    The   next   step  was   not   overwhelm   them  with   too  much   information   as  well.   Finding   that  sweet   spot  and  deploying  a   tool   that’s  easy   to  use   that  would  give   them   the   information  that   they   need.   It   doesn’t   show   in   the   screenshot,   but   we   have   red,   yellow,   and   green  indicators  so  they  can  look  at  it  and    know  how  they  are  performing  on  those  metrics.  They  are   doable   to   a   certain   level   because   it   is   for   senior   leadership.   They   could   look   at   the  different  operating  units.  They  could  look  at  all  our  goals.  They  could  also  look  at  trends  to  see  if  the  trending  tool  is  the  right  direction.    This  dashboard  is  now  used  in  most  meetings,  including  cabinet  and  board  meetings.  They  pull   it  up  and  discuss  and    ask  questions.  That’s  engagement  and  adoption.   It’s  difficult   to  drive   initially,  but  once  you  get   there,  people   just  use  that   to  change  culture.  That’s  what  happened  at  OSF.    There   were   a   couple   of   other   projects   that   we   did   as   well.   Mark  mentioned   the   clinical  agenda  and  aligning  the  deliverables  that  we  do  to  the  goals  that  derived  from  our  strategy;  from  our  road  map.  We’ve  deployed  a  couple  of  solutions,  including  Care  Transitions.      The   goal   of   the   Care   Transitions   project   was   to   reduce   re-­‐admission   in   our   acute   care  facilities.   When   there   was   a   counselor   the   committee   put   together,   it   had   people   from  different  care  teams.  It  had  nursing,  physicians,  and  pharmacists  with  a  clearly  defined  goal.  When  IT  was  at  the  table,  we  were  at  the  table  as  well.      

 Improvement  Teams  [18:41]    When  it  was  time  to  define  the  processes  we  needed  to  make  sure  patients  coming  to  our  facility  received  high  quality  of  care,  we  were  involved  so    we  could  give    feedback,  asking  “is  it  measurable  or  not  measurable  from  a  process  standpoint?”    Being  quick  in  deploying  solutions,  we  used  a  jive  methodology.  We  made  sure  that  we  had  a  goal  when  we  engaged  with  the  business  and  made  sure  we  didn’t  try  to  boil  the  ocean.  We   always   tried   to   re-­‐align   with   the   goal   in   terms   of   the   measures   tying   back   into   our  purpose.    One  of  the  key  takeaways  from  lessons  learned,  from  our  experiences  in  working  with  these  teams,  has  been  be  prepared  if  they  rip  it  out.  You  want  them  to  do  that.  You  want  them  to  validate.  You  want  them  to  trust  the  data.  Sometimes  it  could  be  like  you  want  to  pull  your  hair  off,  but  it’s  good.  It  means  that  they’re  engaging.  Once  they  trust  it,  they’re  going  to  use  it  to  drive  action  within  the  organization.    Besides  the  Executive  Dashboard  you  saw  a  sample  of-­‐a  screenshot  of-­‐the  other  dashboard  that  we  put  out   is  not   just  strategic-­‐they’re  operational  too.  We  focus  on  dashboards  that  are  more  operational  that  look  at  not  just  outcomes  that  the  senior  leadership  reviews,  but  also   how   the   different   care   teams   are   performing.   It   can   go   down   to   a   staff   level.   That’s  giving   action   back   to   the   team   because   now   they   can   use   that   for   teaching/educational  purposes.  Getting  the  trust  I  would  say  is  the  most  important  piece  of  this.    

 Value  Realized  [20:20]    It’s  been  four  years  since  we  deployed  the  health  catalyst  model  of  data  warehouse  and  it’s  been  a  value  proposition;  the  fact  that  we  could  have  a  data  warehouse  up  and  running  in  90  days  and  runway  in  30.  Don’t  try  to  boil  the  ocean.  Don’t  try  to  be  perfect  or  you  will  not  engage  effectively.      We’ve   got   good   cost   avoidance   dollars:   nine   to   12   million   over   three   years.   That’s  underestimating.   It’s   probably   more.   Just   faster   access   to   data   and   using   that   to   drive  clinical   operation   excellence.  When  we   engage,   it   includes  multidisciplinary   teams   at   the  table.  That  has  helped  shift  and  change  culture.    

 Performance  Improvement  and  Cost  Avoidance  [21:12]    Some   facts   relating   to  our  effectiveness:  by  deploying   solutions   that  don’t   just   show  your  performance   but   have   some   deliverable;   in   some   cases   it   goes   down   into   the   details.  Thereby,   it   reduces   this   churning  of   single-­‐dimensional   reports.   I  want   this   report.   I  want  that   report.  We’ve   tried   to  eliminate   that  when  we  deploy  a   solution.  Also,   there  were  a  number  of   staff  within   the  different  entities  basically  doing  hunting  and  gathering.  We’ve  been  able  to  reduce  that  and  re-­‐focus  their  efforts  in  analysis  by  taking  on  data-­‐provisioning  activities.    One  example  from  Care  Transitions  is  by  giving  them  information  at  the  detail   level  where  they   could   actually   act   upon   it,  we’ve   reduced   3%   in   defects  within   the   organization   and  thereby  have  9.4  million  possible  cost  avoidance.  That  was  a  good  success  story  for  us.    We’ve   deployed  dashboards   for   productivity  which   they   used  mainly   gathering   Excel   files  using   some   automated   solutions   to   capture   the   data;   this   helped   us   in   terms   of   driving  change  in  culture  within  the  organization.    

 Heart  Failure  Program  [22:35]    There  are  some  more  slides  with  examples  of  projects   that  we  did.  Here’s  one:   the  Heart  Failure   Program.   This   was   the   first   initiative   within   the   organization   that   went   across  different   operating   units:   home   care,  medical   group,   and   acute   care.   The   CV   service   line  engaged  with   us   and   by  working  with   us   and   using   data,   they   have   been   able   to   get   8%  reduction  in  unspecified  coding,  15%  improvement  of  patient  education  best  practices,  and  also   increased   the   five-­‐day   follow-­‐up   on   appointments.   That’s   just   an   example   of  improvements  that  we’ve  had.    

 Cardiovascular  Physicians’  Dashboard  [23:11]    Another  example  is  a  CV  Physician  Dashboard.  The  goal  of  this  was  to  have  physicians  take  ownership   in   terms   of   quality   and   safety.   When   we   deployed   this   dashboard,   every  physician  in  the  CV  service  see  each  other’s  performance.  They’re  not  used  to  this  kind  of  a  transparency.  Enabling  the  transparency  within  seven  months,  you  could  see  every  metric  3%  increase.      The  metrics  were  more  balanced.   There  was  patient  experience.   There  was  adherence   to  medication-­‐some  quality   safety-­‐quickly   available   appointments   access.   You   could   see   that  all  these  metrics  went  up  just  because  they  could  see  each  other’s  data.  We  also  provided  information   down   at   the   patient   level   just   to   gain   trust;   to   have   them   look   at  what  was  missing  in  terms  of  care  for  the  patients  that  we  serve.    

 Palliative  Care  Program  [24:06]    Another   good   example   is   the   Palliative   Care   Program.   There’s   another   breakout   session.  That’s   tomorrow.   We’ll   go   into   more   detail.   Again,   here   we   engaged   with   and   had   the  business  leadership  at  the  table.  It  was  multidisciplinary  team  with  presence  from  different  units:   home   care,   medical   group,   IT,   analytics,   and   brainstorming   through   what   are   the  processes   and  what   do  we   need   to   provide   so  we   can   serve   our   patients.  We   had   some  good  successes  come  out  of  this  as  well.    

 Data  Empowered  Culture  [24:51]    Date-­‐empowered   culture:   to   get   there,   the   foundation   must   include   transparency   and  collaboration.  Thereby,  accountability  will  automatically   come  because  once  you  have   the  CEO   and   senior   leadership   aligned,   it’s   going   to   drive   change   across   the   organization.  Making  data  transparent,  engaging,  listening  to  them  when  they  have  questions,  and  being  willing  to  modify  the  look  and  feel  of  a  dashboard  or  even  change  the  operational  definition  of  metrics  if  it  doesn’t  align  to  the  goal:  I  think  those  are  key  things  in  terms  of  enabling  that  culture.    The   fact   that  we  are  always  aligned   to  our   strategic   goals,  whether   it’s  quality  metrics  or  financial,   has   made   us   successful   in   the   solutions   that   we’ve   deployed.   Stakeholders  throughout  the  organization  see  the  value  and  clinical  impact  of  the  quality  improvement.    

 Future  Plans  [25:58]    Our   plan   is   to   continue   to   expand   the   analytics   solutions   that  we   have.   Two   years   back,  there  was  an  initiative  within  the  organization  to  have  portfolio  management  aligned  to  our  strategic  goals.  We  are  aligning  ourselves  to  portfolio  management,  which   is  what  are  the  projects   that   need   to   happen   within   the   organization   and   which   of   those   projects   need  measurements?  We  make  sure  our  resources-­‐our  scarce  resources  are  effectively  aligned.    We  also  want   to  continue   to  expand  our   infrastructure  capabilities  as  we  grow   in  volume  and  data.  As  people  have  more  access  to  data,  there’s  more  demand.  Being  able  to  keep  up  to   that  demand  whether  we  are   ramping  up  our  data  warehouse  capacity   through  better  storage  or  data  warehouse  appliance.      We’re  also  looking  at  Hadoop  as  infrastructure  looking  at  data  quality  to  work.  As  they  get  engaged,  they  ask  more  questions;  data  quality  questions  and  data  profiling.  To  enable  our  staff  on  that  we  are  going  to  expand  our  technical  capabilities.  We  will  tie  the  feedback-­‐all  these  insights  from  the  data  warehouse-­‐back  into  the  EMR.  We’re  already  doing  it  but  we’ll  be  expanding  on  that  and  doing  more.    

 Lessons  Learned  [27:25]    [Mark  Hohulin]  Just  some  lessons  learned  for  us.  Again,   it’s  been  a  journey.  Engaging  executive  leadership  across  the  organization  is  key.  I  think  that’s  helped  us  be  successful  within  analytics;  having  that  executive  leadership  support  and  engagement.      Assembling  project   teams  with   the   right   technical   capability   has  helped  us   tremendously.  Roopa’s  skills  and  her  team  have  been  a  tremendous  asset  to  our  organization,  helping  us  move  further  down  the  road.  She’s  engaged  the  clinicians,   leadership-­‐you  name   it-­‐to  help  understand  the  importance  of  the  technical  aspects.    Having   system-­‐wide   engagement   that’s   not   just   a   siloed   IT   project   is   very   important.   The  strategic  intent-­‐the  objectives  of  our  organization-­‐drives  what  we’re  developing  analytically.  That’s  much  better  than  saying  from  a  technology  side,  “Here’s  what  we  can  do  for  you.”  It’s  working  with  the  business  and  coming  down.    Setting   up   a   business   plan   and   measurement   up   front   is   something   we’ve   had   success  around.   We’ve   also   had   some   areas   for   improvement,   but   we’ve   had   strong   business,  clinical,   owners,   and   leadership.   We’ve   had   tremendous   success   working   through   the  process  so  that  patient  care  experiences  have   improved.  Where  we  have  not,  we  get  to  a  point   where   the   data   is   available,   but   we   have   no   engagement,   no   action   that   follows.  That’s  a  key  thing,  it’s  having  a  business  plan  and  measurement  set  upfront.    

Achieved  rapid  implementation  of  the  EDW  with  actionable  insights  to  demonstrate  value.  Again,  get  the  small  win.  Focus  on  what  the  system  objectives  are,   the  goals,  get  some  of  those   quick   wins   that   build   support,   success   for   the   organization,   and   then   again,   more  investment  within  analytics.    Those  are  supposed  to  be  some  of  the  lessons  learned.  I  would  say  one  thing    I’d  touch  back  on   that   Roopa   ended   with-­‐one   thing   that   we   really   need   to   do   more   of-­‐is   improve   the  clinical  decisions  forth  by  time  data  and  we’re  having  a  warehouse  back  into  the  EMR.      We’ve  started  doing  it  as  she  referenced.  That’s  the  key  for  the  future  in  my  opinion:  getting  the   clinicians’   information   in   the   EMR   because   that’s   where   they   live   and  make   it   more  actionable  because  they  don’t  want  to  navigate    a  bunch  of  different  applications.  They  just  don’t.   That’s  our   culture  anyway  within  our  organization.  We  know   that  we  have   to  do  a  better  job  at  trying  to  get  everything  back  into  the  EMR  and  that’s  part  of  our  future  as  well.                        

 Questions  and  Answers  [29:29]    With  that,  we’ll  take  any  questions  that  you  may  have.   I  think  we  finished  a   little  bit  early  which  is  fine.    [Kurt]  Test,  test.  There  we  go.  Mark  and  Roopa,  thank  you  so  much  for  a  great  presentation.  I’d  ask  the  audience  to  give  a  great  round  of  applause.    Before  we  jump  in  to  Q  and  A  right  away,  I  just  wanted  to  go  back  to  our  analysts  in  the  back  to  see  if  they  had  any  insights  that  they  could  share  based  on  your  responses  and  based  on  the  information  shared.    [Female  Speaker  1]  Apollo,  our  applause  analyst  has  noted  that  the  pain  points  mentioned  resonated  with  the  audience   and   also   the   comments   on   performance   improvement   and   cost   information  seemed  to  resonate.      Looking   at   our   session   and   summit   polls,   this   is   pretty   much   just   going   to   confirm   the  obvious   and   that’s   that   those   of   you   who   rated   the   strength   and   quality   and   culture   of  quality   improvement   in   your   organization   as   being   high   also   rate   the   health   care  organizations’  ability  to  leverage  data  as  quite  high.  That’s  not  a  truly  amazing  insight,  but  it’s  confirmed  by  the  data.    

Thank  you.  Back  to  you,  Kurt.    [Kurt]  Thank   you.   I   want   to   thank   everybody.   We’ve   got   26   very,   very   good   questions   and  unfortunately  we’re  not  going  to  be  able  to  get  to  all  of  them,  but  we’ll  get  to  them  based  on  the  way  you  voted.      What’s  interesting  is  the  very  first  question  is  how  are  you  dealing  with  the  lag  and  claims  data?    [Mark  Hohulin]  It’s  always  a  challenge.  That’s  one  of  the  first  things  we  experienced  with  the  pioneer  claims  data   that   came   in.   Are   there   any   other   pioneering   fields   in   the   room   or   rather,   ACO  arrangements   where   you’re   getting   claims?   Our   first   experience   with   that,   with   CMS  probably   the   first   six  months,  we  got   files   from  them,   the  data   layout,   file   format  change  almost  every  single  month.  Our  team  really  was  pulling  its  hair  out  every  time  it  figured  out  the  first  time  how  to  do  it,  the  next  file  came  in  and  it  had  to  be  changed  again.    Lot  of  learning  curves  around  that.  Ultimately,  they  improved.  The  fact  of  the  matter  is  it  is  still   lagging.  That’s  where  we  can   take   the  golden  nuggets   that  we  get   from  the  data   in  a  lagging  format  and  try  to  make  it  more  transparent  and  actionable  for  our  leadership.  I  think  linking  it  with  our  EMR  data  has  helped  us  tremendously  to  get  past  that,  helps  us  provide  the  risk  information  on  the  patients,  the  high  utilizers  on  in-­‐patient  or  the  frequent  visitors  in  the  ED.      We’re  able  to  do  a  lot  more  with  our  internal  data  by  just  capitalizing  on  some  of  the  signals  from  the  claims  data.  I  don’t  know  that’s  the  best  answer  or  not,  but  that’s  one  thing  that  we  were  able  to  do  with  the  lag.    [Roopa  Foulger]  I   can   add   more   to   it.   Yes,   the   claims   is   lagging   and   you   cannot   drive   too   many   clinical  improvements   through   that   because   you   need   it   to   be   actionable   right   at   the   clinician’s  hands.  One  of  the  Chief  Clinical  Officers  had  the  care  teams  in  the  frontlines  focus  on  data  that’s  already  available   in  the  EMR  because  they  feed  the  data  back  into  our  EMR  readers  stratified  being  know  who  are  those  high-­‐risk  patients  and  they  make  sure  that  the  clinical  gaps  are  meant  as  BPAs  that  fire  the  EMR.      This  care  gap  report,  they  know  that  an  ACO  is  coming  and  the  visit  puts  the  gold  out  for  the  nursing   staff   to   look   at   so   that   they   can   look   at   the   gaps   and  make   sure   that   those   are  addressed.  Being  more  proactive  has  helped  us.  The  claims  data  we  use  it  more  for  financial  and  utilization  metrics  and  UPM  BM  and  things  like  that.    [Mark  Hohulin]  I   have   this   to   add.   For   those   that   are   involved   with   it,   even   having   the   financial  understanding  of  how  a  performing  is  not  very  clear  with  the  lagging  claims  that  and  getting  the  report  so  far  behind  from  CMS  has  been  very  challenging.  To  say  today  we  know  how  

we’re  doing  in  planning  a  report  precisely,  I  can’t  tell  you  because  again,  the  lag  comes,  the  methodology  tells  me  I  must  calculate  is  lagging.  We  just  have  to  deal  with  it.      I’m   thinking   of   the   earlier   presentation   about   the   big   audacious   goal,   being   part   of   the  Healthcare  Transformation  Task  Force  is  a  big  audacious  goal  our  system  has  because  that’s  a   huge   change   for   us   that  we   know  we   have   to   get   ready   for,   but   it’s   2020.   75%   of   our  business  in  that  value  base  is  kind  of  scary  actually  based  upon  how  the  claims  come  in,  how  we  get   information.   It’s  not  very   fluid  today.  We  only  hope   it’s  going  to   improve  with  our  analytics.    [Kurt]  Beautiful.  Thank  you.  Next  question  is  what  data  visualization  tools  do  you  use?    [Roopa  Foulger]  Excel.   Everybody   loves   Excel.   It’s   from  Excel   to,  we  have  ClickView.  We   also   have   an   SAP  BusinessObjects   Shop.   It’s  mainly   these   three.  Of   course   there’s   SAAS  and  SPSSR   for  data  modeling.  Any  of  our  dashboards  they  mostly  deploy  on  ClickView.  We  also  have  Excel  CS  which  is  now  Crystal  Dashboard  which  are  studying  the  regular  usage  of  that.    [Mark  Hohulin]  We   kind   of   go   off,   but  we   have   a   BI   Portfolio   tool   for   different   purposes   and   audiences.  These   tools   are  picked  based  on  which  one  would  be  best   for   that   audience   and  a   lot   of  Excel  still,  lot  of  BusinessObjects  for  permissions,  and  then  more  and  more  ClickView.    [Roopa  Foulger]  We  have  HPM.  That’s  another  tool.    [Kurt]  Very  good.  Next  question   is  what   specific   findings   from  analytics   contributed   the  most   to  your  cost  savings?    [Mark  Hohulin]  A  lot  of  our  clinical  efforts  are  really  providing  some  of  the  insights  on  how  to  improve  the  costs.  We  do  see  re-­‐admissions.  We  do  see  lengths  of  stay  that’s  occurred.  Again,  it’s  a  little  harder  understanding  those  cost  improvements,  but  we  know  from  working  on  accountable  care,   improving   the   population   of   health   aspect,   that’s  what  we   have   to   do.  We   can   see  within  our  results  and  our  cost  structure  that  that’s  made  a  big  improvement.    We’ve  had  a  three-­‐  or  four-­‐year  financial  cost  goal  and  we’re  moving  $235  million  from  our  system.  We’re  on  a  strong  pace  to  do  that  in  year  two  now.  Again,  analytics  is  part  of  that.  I’m  not   going   to   say  we   take   entire   credit   for   that,   but   it’s   provided  having   the   ability   to  shine   the   light,   enable   the   information   for   our   leaders   and   permissions.   It’s   helped   us  remove  a  lot  of  cost.    [Kurt]  Very  good.  Thank  you.  The  next  question   is  how  are  you  aggregating  data   from  disparate  EMR  systems?  

 [Roopa  Foulger]  The  senior  leadership  made  a  conscious  effort  to  making  sure  that  most  of  our  hospitals  and  other  entities  are  on  Epic.  A  couple  of  our  hospitals  are  on  MEDITECH  and  CPSI.  We  bring  in  more   the   coded   data   and   financial   data;   not   the   clinical   data,   because   that   gives   the  immediate  bang  for  the  buck.  They’re  all  going  to  come  on  Epic  sooner  or   later  within  the  next  two  years  so  we  are  not  going  to  focus  our  efforts.  Most  of  these  other  hospitals  that  are  on  other  EMRs  are  smaller.    [Mark  Hohulin]  Last  five  or  four  years,  about  five  hospital  acquisitions  or  affiliations  have  become…they’re  really   critical   hospitals,   CPSI   or   MEDITECH.   We’ve   taken   a   little   more   of   a   conservative  approach  of  saying,  “Let’s  wait  till  they  get  put  on  Epic,”  because  if  they’re  on  Epic,  all  close  into  the  warehouse.  We  haven’t  gone  after…they  have  a  source  data.    [Kurt]  Thank   you.   In   your   care   transformation   journey,   did   you   restructure   efficient   physician  compensation  models  and  if  so,  what  are  the  key  metrics  there?    [Mark  Hohulin]  I’m  not  going  to  be  able  to  answer  that  the  best  as  far  as  specific  metrics,  but  I  know  within  our  work  around  accountable  care  we’re  actually  doing  a   large-­‐scale  transformation  effort  right   now   with   our   primary   care   group.   The   physician   compensation   models   are   being  framed.  Again,  how  aggressively  and  what  specific  metrics?  I  can’t  answer  that.  I  potentially  could  get  some  of  that  information  for  you  after  the  fact  if  you  give  me  your  business  cards,  but  I  don’t  know  the  details  on  that  one.      We  know  it’s  important.  It’s  going  to  drive  accountability  and  ownership  in  this  work.  That’s  definitely  something  that  we’re  doing.    [Kurt]  Thank  you.  Next  question  is  how  are  you  showing  the  result  and  value  to  frontline  staff  and  providers?    [Roopa  Foulger]  There  are  a  couple  of  ways.  One   is   they  Leverage  Epic  and  they’re  pushing  data   into  Epic.  They’re   able   to   get   to   it.   The   other   is   Epic   Hand   Interface   to   other   BI   tools.   We   try   to  interface.   We   tried   to   reduce   the   amount   of   clicks   outside   of   Epic   that   the   frontline  caregivers  have  to  go  and  that’s  definitely  helped.  In  some  cases,  we  have  automated  PDFs  that  are  shipped  to  physicians.   It’s  mostly  physicians  because  some  of   them  do  print  outs  and  that’s  helped  as  well.    [Kurt]  Very  good.  Next  question   is  what  have  been   the  main  challenges   in   shifting  culture   to  be  more  data  empowered?    [Mark  Hohulin]  

Prioritization.  We  have  a  huge  demand  for  analytics.  It’s  been  a  challenge  just  what  do  we  resource   and   prioritize,   if   anything.   Thankfully,   I   guess,   using   our   strategic   goals   and   the  priorities  that  have  been  set  as  well  as   the  clinical  agenda,   that’s  been  tremendous  for  us  because  then  we  have  something  to  look  at.      When  requests  come  in,  we  can  first  go  to  our  strategic  road  map-­‐our  clinical  agenda-­‐and  say  they  are  either  of  those.   If   it’s  not,  we’re  able  to  say,  “You  know  what?  That’s  a  good  idea,  but  we  can’t  do  that  right  now.  We’re  focused  on  the  position  itself.”  That’s  one  way  we’ve  been  able  to  do  it.    [Kurt]  Next   question   is   how   do   you   plan   to   send   EDW   data   to   the   EMR   and   how  will   the   EMR  actually  consume  and  display  that  data?    [Roopa  Foulger]  As  I  said,  we  haven’t  gone  full-­‐fledge  on  it.  We’ve  just  started  on  that.  It’s  been  a  year  and  a  half.  Because  we’re  on  Epic  platform,  we   leverage   some  of   the   interfaces   that   they  have,  whether  it’s  through  their  Bridges  Interface  or  loading  some  of  the  claims  data  that  we  get  from  the  Pioneer  ACO  to   fill   the  missing  gaps   in   the  EMR.  We  go   through   that.  The  other  thing  that  we  just  finished  up  is  through  Datalink.      We  would  prefer  Epic  coming  in  and  pulling  in  the  data  rather  than  us  pushing  it.  There  are  nightly  processes  where  the  Epic  Datalink  feature  comes  in  and  pulls  the  data  from  the  data  warehouse  and  pushes  that  into  cache.    [Mark  Hohulin]  The  most  recent  one  she  references  is  we  have  a  predictive  re-­‐admission  model  that  we’ve  developed   in  our  warehouse   that  puts  predictive   risk  on  every  patient.   Just  as  of   last   two  weeks,  we’ve  now  been  through  Datalink  pushing  that  back  into  Epic.  It’s  visual  within  every  screen  on  the  patients  for  the  clinicians  to  see.  That’s  a  start.  We  think  we’ll  be  doing  that  same  thing  for  a  more  value-­‐added  element  that  we  can  bring  from  the  warehouse.    [Kurt]  Awesome.  Unfortunately,  we’re  down  to  time  where  we’ve  got  just  one  more  question  that  we  can  share  with  the  group.  This  one  is  what  are  the  trade-­‐offs  you  experienced  with  the  centralized  analytics  approach?    [Roopa  Foulger]  It’s   probably   the   operating   units   where   they’ve   had   an   analyst   and   they   could   ask   the  analyst  to  do  anything  that  they  wanted.  It  being  centralized,  we  align  ourselves  to  what  our  goals  are  and  some  of  the  smaller  things  that  they  couldn’t  get  done  sooner  is  probably  not  happening.    [Mark  Hohulin]  I  would  say  we’re  five  out,  85  to  90%  centralized.  We  still  have  some  of  our  larger  operating  units   that  analysts  have  capability   to  do  some  of   the  work.  They  did  not  come  within  our  transformation   into   our   group   primarily   because   they   do   multiple   things.   They   wear  

multiple  hats.  We  aren’t  just  analytics  so  we  didn’t  feel  we  could  reach  in  and  say,  “You’re  part  of  analytics  solely.”      There  are  still  so  many  visuals  out  there,  but  that’s  probably  some  of  the  change  points  we  have.  We’re   still  working   through   that,   understanding   and   then  having   facilities   rely   on   a  central  resource;  not  individual  resources  at  that  site.                                        

 One  More  Thing  [46:07]    [Kurt]  Very  good.  Before  everyone   takes  off,   I  will   just  ask   for  you   to   fill  out   the  “Ask  one  more  thing”  and   then   if   you  would  please  give  one  more  great   round  of   applause   to  Mark  and  Roopa.    

 Thank  You  [46:26]