advocate cerner partnership creates big data for health · advocate cerner partnership creates big...
TRANSCRIPT
Advocate Cerner Partnership Creates Big Data Analytics for Population Health
Scottsdale Institute TeleconferenceSeptember 19, 2016
Tina Esposito, VP – Center for Health Information ServicesRishi Sikka, MD, Senior VP – Clinical Operations
2
Copyright Scottsdale Institute 2016. All Rights Reserved.
No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the
author(s).
You may contact us [email protected] / (763) 710‐7089.
Advocate Health Care Hospitals (12)4 teaching 1 children's (2 campuses)1 critical access 5 level 1 trauma centers
Physicians 1,500 employed5,000 Advocate Physician Partners6,300 medical staff
Post‐acuteHome health, hospice, long‐term acutecare hospital and palliative care
35,000 associates$5.5 billion total revenue17.9% market share
3
Accountable Care Footprint
4
Contract Lives Total Spend
Commercial HMO 275,000 $1.0 B
Medicare Advantage 39,000 $0.3 B
Advocate Employee 33,000 $0.1 B
Commercial Shared Savings 300,000 $1.2 B
Medicare Shared Savings 137,000 $1.6 B
Medicaid ACO 94,000 TBD
Total 878,000 $4.2 B
Reimbursement Model Shifts
5
Why the Advocate Cerner Collaborative?• Fundamental shifts in healthcare business model
• New model, new focus, new thinking, new partnerships
6
Acute Care Focus
• 12 Hospitals & over 250 sites of care
• $5.5 B in revenue• Cerner Millennium EMR• Valuable but largely IT relationship
• Facilitating collaboration among various internal Advocate groups
• Rapidly deploy existing solutions and pilot key innovations
Population Health Focus“Clinical Integration”
• 5,000+ physicians• 900K @ risk members• $3.4 B Value Based revenue• $100 M incentives in 2012• Non‐Cerner EMRs• No Cerner relationship
• New long‐term relationship• Healthe Intent Platform and Population Health Solutions
• Strategic partner
Advocate CernerCollaborative
• 3 year agreement starting April 2012
• Innovation in Pop Health• Start in acute care, expand to broader population
• Enhance relationship outside acute care
• Become the data platform for all of Advocate Health Care
Advocate CernerCollaborative
• 3 year agreement starting April 2012; renewed in 2015
• Innovation in Pop Health • Start in acute care, expand to broader population
• Enhance relationship outside acute care
• Become the data platform for all of Advocate Health Care
Advocate Cerner Collaborative (ACC)
7
Shared Vision• Mission
– Leverage Advocate experience as a provider and Cerner’s experience in health care technology and automation to improve population health capabilities
• Together the ACC will:– Identify and risk stratify patients at most risk– Facilitate appropriate and early interventions – Guide care across the continuum
8
ACC Guiding Principles• Create intelligence that expands population health
understanding• Integrate innovation into workflow• Lead the industry in actualizing population health in an EMR
agnostic world• Provide benefits to both organizations beyond ACC• Enhance team with skills that support the goals and objectives
of population health management
9
Advocate Cerner Collaborative 2015 Accomplishments• 2 Accepted peer reviewed publications
– BMC Medical Research Methodology– Implementing a New Intelligence Solution Using DMAIC
Principles
• 6 Posters presented– Institutes for Healthcare Improvement (2 posters)– American Statistical Association (3 posters)– Russel Institute (1poster) (Awarded “Most outstanding
safety project”)
• 15 Industry presentationsSelect highlights below– HIMSS– Readmission Congress – HMA Big Data Collaborative– Institutes for Healthcare Improvement
• 6 Industry news stories• Information Management • Becker’s Health Review
• 3 Provisional patents• Medication Adherence• IRF Acute Care Transfer• Transitions of Care
• 3 New models• Transitions of Care Risk ‐ Rehab• Medication Adherence• Ambulatory Sensitive Care Management Models
• 1 System go‐live and 2 successful pilots• Medication Adherence Tool• Transition of Care pilot conclusion
10
ACC Team Core CompetenciesModel
Deployment
Analytic Models
Data Platform
11
1100100101010111100010101000101010101010101001000011001001010101111110010010101011110001010100010101010101010100
1000010110100110010
10101111001001010101111000101010001010101010101010010000011010011001010101111001001010101111000101010001010101010101010010000011010011001010101111001001010101111000101010001010101010101
010010
Advocate Use of the HealtheIntent PlatformBilling dataACO claims
8 hospitals (Cerner)AMG (Allscripts)APP (eCW)BroMenn (Meditech)Dreyer (Epic)Sherman (Cerner)
Home Health &post‐acute data (Allscripts)
Advocate eMPI (IBM)
IdentifyAttributePredict
MeasureInterveneAnalyze
ACO PBM
Workflow enhancement
PhysiciansCare ManagersCare Team
ACO support
PhysiciansCare managersAnalystsAdministrators
Big data analytics
ReportingAnalyticsBig Data Innovation (Advocate Cerner Collaborative)
Raw data Big Data Platform capabilities Workflow & roles impacted12
HealtheIntent UsesSolution development Business needs
Registries Clinical integration, physician alignment, research
Business intelligence for ACO Patient‐centered operational improvement across the continuum
Longitudinal record Near real‐time aggregated patient information
Outpatient care management Improved information to support appropriate patient interventions
HealtheRegistriesSM HealtheEDWSM HealtheRecordSM HealtheCareSM
Serves as the backbone for all HealtheIntent‐powered solutions
Analytics
14
Readmission Outcomes
• Leading the industry – ~ 20% better than industry (Yale, LACE, etc.)– Solution purchased by 200+ non-Advocate Cerner clients
• Gaining efficiency – ~ 3.5 FTE productivity savings across system– Automated continuous calculation of risk score in EMR
• Reducing readmissions– 20% reduction in readmission rates (for high risk patients that received
interventions)– Statistically significant reductions observed for sub-populations (e.g., COPD and
HF)
15
Readmissions and Impactability
• Education• Days to PCP follow‐up
Assess interventions
• Build patient profiles
• Align profiles to historic success
Create model• Build recommendations in EMR
Integrate through technology
• Follow‐up evaluations to determine real effectiveness
Evaluate
16
Where is the most appropriate location for our patients?
17
Hospital
Skilled NursingAssisted
Living
Home Care
Retail Pharmacy
Behavioral Health
Rehab
Acute Transitions of Care (ATOC) overview
18
• Find patients with similar clinical profiles
• Identify where this patient type is most successful (lower actual readmission rate)
• Quantify the recommendation’s impact on readmission risk
Home Home health
Skilled nursing facility
Acute inpatient rehab
Acute long‐term care
Risk of medical instability
Intensity of services
19
Population Health ‐ Issues with the Pyramid
Community‐based Care Management Framework
20
Intervention Target Population ROI
Acute CaseManagement Hospital < 1 year
Episodic Care Management
Risk of acute hospitalization < 1 year
Disease Management
Chronic disease management, e.g.,Diabetes, Heart Failure
2-5 years
Complex Care Management
Multi disease, multicomplication, renal failure, transplant,cancer, etc.
2-5 years
Barriers:
• Behavior• Social• Adherence• Education
Enablers:
• Readmission Prevention (TOC)
• HealtheLive(Patient portal)
• HealtheCare(OPCM)
Roles: NP, RN, NA, SW, CHW
Guiding Principles• An Effective OPCM Program is…
– Short term (currently not exceeding 120 days)– Focused on potentially preventable events– Evidence based– Measureable
21
Targeting the ‘Right’ Patients• Potentially Preventable Events are:
– Clinician identified preventable events most appropriate for care management.
– Events where OPCM intervention can reduce hospital encounters (ED/IP/OBS) within a 120 day time period.
– Impactable in a measurable way, with defined outcomes.
22
What is impactable?• Clinician‐identified ‘potentially preventable events’ where OPCM intervention can reduce utilization and complications within a 120 day time period.
23
Risk of Hospitalization with Asthma, Enteritis,
Heart Failure, or dementia/Parkinson’s
Preventable Hospitalizations: Conceptual Model
24
Risk of SAME CAUSE Hospitalization
Any encounter for desired population age 18 years
and older
2. Evaluate risk factors 3. Calculate Risk
Patient Demographics
Social Determinants
Medical History
Procedures
Utilization
Lab Results
Vital Signs
Medications
Current encounter with UTI, Pneumonia, COPD age 18 years and older
Risk of Hospitalization with Asthma, Enteritis,
Heart Failure, or dementia/Parkinson’s
Risk of SAME CAUSE Hospitalization
Any encounter for desired population age 18 years
and older
3. Calculate Risk
Patient Demographics
Social Determinants
Medical History
Procedures
Utilization
Lab Results
Vital Signs
Medications
1. Identify population
Population Health ‐ Issues with the Pyramid
25
Population Health Spectrum
Opportunity
Value
26
Medication Adherence as a Priority• Adherence is important to controlling utilization and cost, as well
as improving outcomes and quality of life.• The CDC lists the estimated direct cost of non-adherence as
$100-$289 billion dollars• Adherence is a multi-faceted problem with many disparate causes• Medication adherence is a major gap at clinical point-of-care
27
Medication Adherence Patterns
28
$872
$700
$1,049
$1,435
$‐
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
High Moderate Low Mixed
Cost (p
mpm
)
Adherence Level
Mixed adherence patients nearly cost double what moderate or high adherence patients
29
Correlation Between Cost and Adherence
Physician’s office
Provider
Home care
Patient
Patient Centered Care
HospitalEnabling
Hospital
Physician’s office
Provider
Scorecard
Home care
Integrated View of Care
The Journey
APP Physician’s office
AMG Physician’s office
Home care
ACOHospital
Fragmented View of Care
30
