bridging the gap: bridging the gap: reaching consensus on aco metrics

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Let’s Talk Healthcare with Informatica and Edgewater: Bridging the Gap: Reaching Consensus on ACO Metrics Maury DePalo Director, Healthcare Practice Edgewater Michelle Blackmer Director, Healthcare Product Marketing Informatica Richard Cramer Chief Healthcare Strategist Informatica Special guest: Senthil Balasubramanian, Manager, Decision Support, Penn Medicine

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the greatest challenge to ACO success is the misunderstandings created by the language we use. Baselining is a critical step to ensuring that both providers and payers are pulling in the same direction: • What are the provider's patient population(s)? • What criteria are we using to measure quality? • What does “cost” mean? What is included in a service "cost”? Once baselines are established, it’s critical that both providers and payers are monitoring these metrics regularly, so when gaps appear – which they will – adjustments can be made.

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Page 1: Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

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Let’s Talk Healthcare with Informatica and Edgewater:Bridging the Gap: Reaching Consensus on ACO Metrics

Maury DePaloDirector, Healthcare Practice

Edgewater

Michelle BlackmerDirector, Healthcare Product Marketing

Informatica

Richard CramerChief Healthcare Strategist

Informatica

Special guest: Senthil Balasubramanian, Manager, Decision Support, Penn Medicine

Page 2: Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

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• Bridging the Gap – Achieving Better Data Alignment• Bringing Together Quality & Financial Data

• Success Factors• Aligning Quality & Financial Objectives• Targeting Defined Patient Populations• Reaching Consensus on Baseline Medical Expenditures

• Use Cases• Combining Financial and Quality Performance Analytics• Promoting Accountability across a Shared Process Model

• Q & A

Today’s Agenda

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By Time Frame

By

Ser

vice

Typ

es Inpatient

Outpatient

Professional Fees

Radiology

Laboratory

By Practice Area, By Physician

Cardiology Associates, Inc.

Specialty Care: Dr. Rubenstein

Year over Year, Quarterly, Monthly Performance Tracking

PMPM / Utilization / Adherence to Std / Clinical Risk / Financial RiskDOS Procedure Submit Amt Paid Amt

3/30/2006 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 3/30/2006 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$

Claim Total 150.00$ 150.00$

5/19/2007 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 5/19/2007 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$

Claim Total 150.00$ 150.00$

7/30/2009 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 7/30/2009 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$

Claim Total 150.00$ 140.00$

12/10/2010 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$ 12/19/2010 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ Claim Total 150.00$ 140.00$

Claim Nbr: 2006-1001-00101

Claim Nbr: 2007-1310-00322

Claim Nbr: 2009-1561-00451

Claim Nbr: 2010-1833-00729

ProviderSpecification

PatientSpecification

ProviderPeer Group

ServiceSpecification

LocationSpecification

OtherSpecification

Normative Data

Provider A

Provider B

Provider C

Provider D

Result A

Result B

Result C

Result D

?

Use Case 1: Reporting & AnalyticsIntegrating Quality & Financial Performance & Risk Management

Primary Care: Dr. Jamieson

Primary Care, Inc.

Page 4: Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

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Data Integration

Master Data Management

Information LifecycleManagement

Real-Time Events, Alerts& Decision Support

Data Quality Management

Technology Solutions & Benefits

Core Data Models Population Models

Process Models Business Models

• Primary Entity Reporting• Patients, Providers• Charges, Costs,

Payments

• Partnerships• Gain / Loss / Risk Sharing• Incentive Alignment• Inter-Enterprise Data

Architecture

• Segmentation• Patient Cohorts• Stratification Criteria

• Continuum of Care Models & Analytics

• Care Records: Diagnoses, Treatments, Outcomes

Use Case 1: Reporting & AnalyticsIntegrating Quality & Financial Performance & Risk Management

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Use Case 2: Patient & Physician Attribution

HospitalPrimary

Care Groups

Physical Therapy

Rehab

SNF, LTCSpecialty Groups

Payers

Shared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform

Collaborative, Patient-Centered Care

Page 6: Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

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• Patient Navigation• Patient Access Metrics

Use Case 2: Patient & Physician Attribution

Data Integration

Master Data Management

Information LifecycleManagement

Real-Time Events, Alerts& Decision Support

Data Quality Management

Technology Solutions & Benefits

Core Data Models Population Models

Process Models Business Models

• Triple Aim:• Healthy Population• Quality & Satisfaction• Per Capita Costs of Care

• Participants / Contributors• Clinical Risk Models• Financial Risk Models

• Care Setting Analytics• PCMH / PCPCH

• Patient Engagement• Patient Experience

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Learn More…….

• Register for the third webinar in the series• Bridging the Gap: Reaching Consensus on ACO Metrics • Wednesday, January 23, 2013• 11:00am PT / 2:00pm ET

• Click here to view the other webinars in the series

• Click here to sign up for alerts for future webinars in the series