breaking all the rules: what the leading health systems do differently with analytics and data...

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What the Leading Health Systems Do Differently with Analytics and Data Warehousing

Break All The Rules

© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 2

Health Catalyst’s PhilosophyWe educate, we don’t sell. An educated person decides what’s best for them to buy.


Overview & Context• Healthcare Data Warehousing Association

(HDWA), 2001• How do we create role models for analytic success in

healthcare?• Can we recreate it?

• Health Catalyst is the commercial manifestation of HDWA

• Today’s webinar• What are the common traits of the leaders?


• I was hoping for checklists, recipes and algorithms for Analytic Success

• No such luck

• It’s much squishier than that, but it’s still replicable

• Today’s discussion will be more about intangible qualities of culture, leadership, and attitude


It Starts With CultureFollowed closely by strategy and execution


Leaders Are Operating Consistently At Level 6.5


There Aren’t Many LeadersA Few Examples• Intermountain Health Care

• Quietly, consistently, leading for 30+ years

• Allina• Becoming the Intermountain of Minnesota

• Kaiser• Per-capita prepayment and quality baked into its DNA

• Geisinger• The mindset of Intermountain, the culture of Mayo


Why Isn’t Everyone Doing It?Is it really that difficult or complex?

8



Culture

9


Asked Dear Friends……What key pieces of advice should I emphasize?

• “Be brave with data.”• “The teams that try to plan everything out from the

outset fail. Agile and lean wins in data warehousing as in small businesses.”

• “I believe the most important lesson I have (and still am) learning is to let imperfect but useful things lose into the wild.”

• “…let it lose and iteratively refine…”• “…smart healthcare CIOs expect and “give

permission” to their BI leaders to evaluate rules and precedents based on risk and motives.”

Thank you Eric Just, Steve Catmull, and Mike Doyle


How Do You Identify A “Leader”? Lead Past Competing Interests

• They balance the tension of care delivery, economic risk, affordability of care, and accessibility to care… all under one CEO

Risk Takers• They take risks, on their own, with new care delivery models and population

health… no government mandates required

Consistently Principle-Driven• They do the right thing for patients and their communities, even at the risk of

financial loss in a fee-for-service environment

Data Trumps Ego & Anecdote• They have the courage to face the truth of data• Data drives their decisions, not anecdotes and hunches

Motivate people through Mastery, Autonomy, and Purpose They recognize what motivates people and organizations


What Motivates People?

Thank you, Daniel Pink

Nurture and encourage these…

Be aware to avoid stepping on them…

By accident or design, leaders practice this…


The Motives Behind BehaviorEnlightenmentPeaceJoyLoveReasonAcceptanceWillingnessNeutralityCouragePrideAngerDesireFearGriefApathyGuiltShame

The Turning Point

*-- Power vs. Force, Hawkins

Inherently positive motives as they affect behavior

Generally negative motives as they affect behavior

Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose

Leading Past Competing InterestsBalance is elusive… it moves… and might not always be appropriate


Leaders Are 100% Consistent On This…



Simple EquationLeaders are constantly thinking in these terms, and living in the realm of risk tolerance



Data Quality



Trust With Data



Centralized vs. Decentralized Resources and Staffing


Determination & Commitment



Internal Small Business Mentality

22

Nobody has to do business with the EDW team


Characteristics of Successful Small Businesses

23

Small Business Checklist1. Have you clearly documented your products and services AND the customers that

want/need them?

2. Do you have product line managers and teams?

3. Do you track who uses which of your products and how often?

4. Do you have a strategic product roadmap?

5. Do you have a web site that makes it easy…‒ For new customers to find you, understand your products, and consume them?‒ For existing customers to get the most out of your products and encourage those customers to collaborate?

6. Do you have a team member that leads and executes your marketing strategy to attract new clients?

7. Are you operating with financial efficiency?

8. Do you regularly poll your customers for their satisfaction and suggestions for product enhancements?

9. Do you regularly poll your team members to track their satisfaction?

10. Do you have a Board of Directors (i.e., Data Governance Committee)?


Personality Of The Analytics Leader



Personality Of The Analytics Team




Strategy

27

Leaders Are Covering The Continuum Of Analytic Use Cases

Robert Wood Johnson Foundation, 2014

Requires a collaborative strategy between leaders in healthcare, politics, charity, education, and business


They Invest In Analytics• This is not an “additional duty”

• EMRs required investments in technology and people… so do enterprise data warehouses (EDW). But, luckily, a small fraction of an EMR.



The EMR Is A Means, Not The End



Where Are They Focused?


Aligning Strategy: Data to Monitor Variation

Range 85% - 95%

Range 94% - 98%

The Joint Commission Index Across Hospitals: Demonstrated Progress in Reducing Variation

Thank you, Lisa Shilling, Kaiser Permanente


Analytics StrategyVertical and Horizontal… Tactical and Strategic

33

Lab

Admissions

Radiology

Registration

Pharmacy

Nursing

AR/AP

Materials M

gt

Intensive Medicine

Cardiology

Oncology

Women & Newborns

Primary Care

Step Two:Clinical Excellence Programs

Step One: Operational Excellence Programs

More complex

Less complex


Organize Your Analytics Teams

Boards and C-Levels: Let your clinical and administrative leaders establish their specific clinical and financial goals


Matrixed Collaboration


Move On Parallel Fronts


Replacing Existing Reporting SystemsUse the EDW for its unique capabilities… stop squabbling with the Departments

37



Analytics Tools DogmaThere’s a reason Excel is still so popular… it works

38

Give data analysts what they want; not what you want them to want



Traditional Software Engineering vs. Data Engineering

• The thickness of a requirements document is inversely related to the success of a data warehousing project

• Can you define all the use cases for the books in a library? No… same is true for a data warehouse

• As long as you gather and retain the granular data in its true form, you can repurpose that data, an infinite number of ways



The Data Warehouse Platform… It’s Not Just For AnalyticsSecondary Use of Transaction Data




Execution

41

GeisingerManaging gaps in care

42 Care Gap Examples

Advance Directives

Lipid Panel, HgbA1c

Aspirin for CAD

Depression and Asthma

BP <140/90, LDL <100Clinical Goal

Active Medication

Lab Result

Imaging Result

Scanned Document

Patient Reported Data

Mammogram, DXA

Nephrology for CKD Stage 4

Asthma Action Plan

Heart FailurePatient Education

Clinical Documentation

Referral

Diagnosis Coding HCCs

Thank you, Dr. Fred Bloom

GeisingerRedesign and Care Coordination Delivers Rapid Impact

43


AAA Screening Malignant Melanoma

Adolescent Well Visits—Birthday Model

Medical Weight Management

Adult Preventive Care—Birthday Model

Osteoporosis Program

Colonoscopy Screening Program—Birthday Model

Peds Transition to Primary Care (after age 18)

CKD Stage 4 Sleep Medicine Outreach (BMI 35-39)

Dexa Scans Women’s Health: Annual GYN Exams—Birthday Model

Emergency Department Transition to Primary Care Provider

Influenza, Pertussis & Pneumococcal

Care Gap Programs Thank you, Dr. Fred Bloom

Proven Health Navigator Results for Medicare

45(Am J Manag Care. 2010;16(8):607-614)


PHN Return On InvestmentThank you, Dr. Fred Bloom

Three-Year Results in 25,000 DM Patients

305 MIs Prevented

NNT to prevent one (1) MI

=82 patients

140 Strokes Prevented

NNT to prevent one (1) Stroke

=170 patients

166 Cases of Retinopathy Prevented

NNT to prevent one (1) case of

Retinopathy=

152 patients


Kaiser’s Quality Goals Timeline – 2011 – 2013

Domain 2011 2012 2013

Population Health Self perceived health status data for 15% of members

Self perceived health status data for 20% of members

Self perceived health status data for 25% of members

Population Care Management - Chronic Conditions

Medicare Stars Part C 4 StarsHEDIS composite at 90th percentile

All CV, diabetes, and cancer screening metrics at 90th percentile

Behaviorial Health, Musculoskeletal 90%Medication Management 75%

Medicare Stars Part C 4 StarsAll CV, diabetes, and cancer screening

metrics at 90th percentileBehaviorial Health, Musculoskeletal and

respiratory @ 90%Medication Management 75%

Medicare Stars Part C 4 StarsAll CV, diabetes, and cancer screening

metrics at 90th percentileBehaviorial Health, Musculoskeletal and

respiratory @ 90%Medication Management 90%

Inpatient HSMR TJC Composite

Reduce HSMR: Below US Medicare average, crude mortality 10% from 2010

baselineTJC Composite at national 90th percentile

Readmit rate<15% of all cause readmissions

Reduce HSMR: Below US MedicareTBD - May shift to inpatient outcomes

Readmit rate<10% of all cause readmissions

TJC Composite at national 90th percentile

Reduce HSMR: Below US MedicareTJC Composite at national 90th percentile

Patient Safety Never Events 10% less events than 2010 10% less events than 2011 10% less events than 2012

Workplace Safety Per regional targets Per regional targets Per regional targets

Clinical RiskManagement

0 to 5% reduction in lawsuits with a payout from 2010



Service Hospital

Outpatient

HealthPlan

Medicare Stars

At National 75th percentile (final quarter)

75th percentile in local or national in 3 of 8 regions


4 Stars on Overall CAHPS

At national 75th percentile (rolling 12 months)


75th percentile in local or national 7 of 8 regions

4+ Stars on Overall CAHPS

Above National 75th percentile (rolling 12 months)

8 of 8 Regions at goal

8 of 8 regions at goal

4+ Stars on Overall CAHPS

Equitable Care Identify interventions to reduce the gap Decrease the gap by x% Decrease by x% more over

2012

Thank you, Lisa Shilling, Kaiser Permanente


Intermountain’s Board GoalsSix “Dimensions of Care” goal areas

1. Clinical Excellence

2. Patient Engagement

3. Operational Effectiveness

4. Employee Engagement

5. Physician Engagement

6. Community Stewardship

Thank you, Intermountain web site

Intermountain’s Clinical Excellence Board Goals1. Behavioral Health Clinical Program: Decrease inpatient psychiatric 30-day readmission rate for the Intermountain system.

2. Cardiovascular Clinical Program: Integrate the treatment of heart failure patients across the continuum to improve care and reduce hospital readmissions.

3. Intermountain Homecare: Improve care transitions to and from Homecare through effective communication, collaboration, and coordination among care providers.

4. Intensive Medicine Clinical Program: Decrease mortality in patients diagnosed during their hospital stay with severe sepsis.

5. Oncology Clinical Program: Improve the appropriate utilization of genetic screening to determine if families are at higher risk for colon and endometrial cancer.

6. Patient Safety: Reduce the system rate of catheter-associated urinary tract infections.

7. Pediatric Specialties Clinical Program: Build a care model for children with type 1 diabetes.

8. Primary Care Clinical Program: Establish an individualized approach to diabetic care by engaging patients in self-management, primary care visits, and specialty consultations.

9. SelectHealth: Increase the percentage of SelectHealth members with diabetes who meet four measures of diabetes care: blood sugar control, cholesterol control, kidney function, and eye exam.

10. Surgical Services: A three-part goal that reduces blood utilization, defines clinical outcome measures for specific development teams, and develops and implements a standardized process to decrease intracase supply utilization. Intracase utilization means the processes or units of care used within each health episode.

11. Women and Newborns: Improve care, cost efficiency, and resource utilization in the neonatal intensive care unit (NICU), and accurately estimate the number of babies with early onset bacterial infection.

12. Primary Children’s Hospital: Increase the involvement of infectious disease specialists in decisions to use outpatient antibiotic therapy via infusion, injection, or implantation.

13. Rural Facilities: Implement electronic physician orders to guide evidence-based care for patients with the primary diagnosis of pneumonia, labor induction, pancreatitis, and sepsis.

14. CMS Value-Based Purchasing: The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards hospitals with incentive payments for the quality of care they provide to people covered by Medicare. The focuses for Intermountain’s goal in this area are to:

● Attain a significant improvement in the value-based purchasing process and outcome domains for select measures.

● Sustain progress for those hospitals that already meet or exceed national benchmarks.

Thank you, Intermountain web site



In Conclusion

51


How Do You Become An Analytics “Leader”?

Lead Past Competing Interests• Balance the tension of care delivery, economic risk, affordability of care, and

accessibility to care… all under one CEO

Take Risk• Take risks, on their own, with new care delivery models and population

health… no government mandates required

Consistently Practice Principle-Driven Decisions• Do the right thing for patients and their communities, even at the risk of

financial loss in a fee-for-service environment

Value Data Over Ego & Anecdote• Have the courage to face the truth of data• Data drives their decisions, not anecdotes and hunches

Motivate through Mastery, Autonomy, and Purpose• Recognize what motivates people and organizations


Thank YouUpcoming Educational OpportunitiesHealthcare Transformation Series: Chapter SevenDate: September 4, 1-2pm, ESTPresenter: Dr. John Haughom, Senior Advisor, Health Catalysthttp://www.healthcatalyst.com/knowledge-center/webinars-presentations

Healthcare Analytics SummitJoin top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs.Date: September 24th-25th Location: Salt Lake City, UtahSave the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

http://www.healthcatalyst.com/knowledge-center/webinars-presentations

http://www.healthcatalyst.com/knowledge-center/webinars-presentations

http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright © 2014 Health Catalyst

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Transforming Healthcare Through Analytics

Provide a tangible vision of healthcare analyticsLeading keynote speakersEngage the audience with analytics in a unique wayHands-on learning experiencesInteractive audience engagement, optimized for teamsUser and special interest group follow upProvide meaningful networking opportunitiesShare Health Catalyst vision, products, roadmapsHave Fun

Access to a mobile app will be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics.

hasummit.com

Billy BeaneGeneral ManagerOakland A’s

Glen D. Steele, MD, PhDPresident and CEOGeisinger Health System

Ray KurzweilDirector of EngineeringGoogle and Leading Futurist

James Merlino, MDChief Experience OfficerCleveland Clinic

Penny WheelerPresident and Chief Clinical OfficerAllina Health

Charles Macias, MD, MPHChief Clinical Integration Systems OfficeTexas Children’s Hospital

Governor Mike LeavittFormer Secretary of HHSFounder of Leavitt Partners

Ms. Lizette Yearwood, JPChief Executive OfficerCayman IslandsHealth Service Authority (HAS)

Keynote Speakers


Q&A, Contact [email protected]

@drsanders

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