Data Analytics for Accountable Care

Shawn Griffin, MD Chief Quality and Informatics Officer,

MHMD – Memorial Hermann Physician Network shawn.griffin@memorialhermann.org

Memorial Hermann Healthcare System • 12 Hospitals: 9 Acute, 2 Rehab, 1

Children’s • Heart & Vascular Institutes: 3 • Imaging Centers: 29 • Sports Medicine & Rehab

Centers: 25 • Diagnostic laboratories: 25 • Ambulatory surgery centers: 17 • Retirement/nursing center: 1 • Home Health agency: 1

• Annual admissions: 138,351 • Annual emergency visits: 411,591 • Annual deliveries: 26,731 • Employees: 20,840 • Beds (acute licensed): 3,581 • Medical staff members: 4,857 • Physicians in training: 1,821 • Annual payroll: $1.088 billion

MHHS National Safety and Quality Leadership

15 Top Health Systems; Top 5 Large Health

Systems (2012)

National Quality Forum National

Quality Healthcare Award (2009)

National Patient Safety Leadership

Award, Sponsored by VHA Foundation &

the National Business Group on Health

(2009)

Texas Hospital Association

Bill Aston Quality Award (2011)

Joint Commission-NQF

John M. Eisenberg National Patient Safety & Quality

Award (2012)

2011 Texas Healthcare Foundation Quality

Improvement Awards (9 Memorial Hermann

Campuses)

Healthcare’s “100 Most Wired” 7th

consecutive year

HealthGrades®

America’s 50 Best Hospitals (2010, 2011 & 2012)

Distinguished Hospital for Clinical Excellence (2011)

America‘s #1 Quality Hospital for Overall Care

(2011 & 2012)

MHMD – Memorial Hermann Physician Network

• Includes 3,900 Physicians – Employed < 200 – University of Texas ≈ 650 – Clinically Integrated ≈ 2400 (> 500 PCP’s)

• Average Practice Size = 1.8 Physicians • 24 Member All-physician Board of

Directors • ~ 2,000 Signed for ACO

Corporate Structure

Memorial Hermann Healthcare System

Memorial Hermann Foundation

Memorial Hermann Community Benefit

Corp. Memorial Hermann

Hospital System

Health Professionals

Insurance Co. Ltd.

The Institute for Rehabilitation and

Research Memorial Hermann

Group TIRR Rehabilitation

Centers MHS Physicians of

Texas

MHMD Memorial Health Ventures, Inc.

MHMD History 1982-2004: Messenger Model IPA • Most Memorial Hermann Physicians are members (account for

90% of admissions) • Successful in managed care contracting until FTC order against • “Arms-length” relationship with MH System • Standardizes system formulary through CPC structure • Subsidizes EMR deployment to independent physicians 2005: MHMD Board commits to Clinical Integration (CI) as the model

for quality, cost efficiency and managed care contracting 2008: MHMD Compact articulates organizational and physician

commitments • First contract with hospital system employees (a willing partner)

for shared savings program • First 1200 sign Network Participation Agreements

MHMD History • 2009: 2100+ physicians in CI

• Quality measures defined and reporting begins • First CI contract provides higher reimbursement and bonus

for CI doctors, but few other contracting successes • System Quality Board designates MHMD Clinical

Committee as source of EBM Order Sets and Quality Standards

• 2011: MHMD – MHHS commitment statement • Patient-Centered Medical Home initiative launched. • MH ACO formed

• 2012: “One Memorial Hermann” Vision • Expansion of ACO contracting – MSSP Program • Largest commercial contract in our history.

Clinical Programs Committee Structure (2009-2012)

MHMD Physician Board of Directors

Clinical Programs Committee

H&V

Cardiology

CV Surgery

Neuro

Neurology

Neurosurgery

Woman/Child

Neonatal

OB/Gyn

Surgery

Anesthesia

Bariatrics

Orthopedics

ENT

Allergy

Medicine

Critical Care

Emergency

Surgery

Hospital Medicine

Post Acute Care

Oncology

Oncology

Contract

Imaging

Pathology

PCP

Peds

Support

Informatics

E-ordering Editorial

Board

Ethics

Peer Review

ANALYTICS APPLICATIONS

Analytics Applications • Beneficiary Tracker • Claims-based Population Management

– Physician-level Scorecards – Aggregate Reporting

• Ambulatory EMR-based Rules and Alerts – Physician-level Scorecards – Patient-level Profiles – Aggregate Reporting

Beneficiary Tracker • Required to Track Outreach to MSSP ACO

Members to Request Claims • Feeds Inpatient and ER Data Systems to

Track ACO Enrollees for Case Management and Contracted Hospital Programs

• Provides HIPAA Umbrella for Case Management Differentiation and Data Access

Each Practice Has Multiple Payer Populations Payer Data 1

Payer Data 2

Payer Data 3

Entire Practice

Analytic Engine

Payer and TPA Data Hospital and Practice Data

Payer-focused application

• Plan modeling • Financial reporting • Utilization reporting • Employer reporting • Product management

Population Management

• Risk Stratification • Utilization Tracking • Disease Management Eligibility • Comprehensive MD

scorecards/profiles to engage physicians

• “Value reports” for plans

Point-of-care

• Intuitive, “real-time” alerts to gaps in patient care

• Case management tools • Disease Management Eligibility • Comprehensive MD incentive

scorecards/profiles to engage physicians

• “Value reports” for practices

Claims Data

Claims Data EMR Data

EMR Data EMR Data

EMR Data

EMR Data EMR Data EMR Data

EMR Data

EMR Data

Claims Processing • Pros:

– Complete Population Overview – All Claims, All Locations – Prospective Risk Stratification – Final PCP Attribution – Official Contract Metric Tracking – Generic Prescription Information

• Cons – Time Lag

EMR Data

Claims Data EMR Data

EMR Data EMR Data

EMR Data

EMR Data EMR Data EMR Data

EMR Data

EMR Data

Clinic EMR Data • Pros:

– Real-time – Includes Significant Data Not Found in Claims – All Patients Included, Not Limited to Single

Payer – Better Measure of Physician Performance

• Cons – May Differ from Payer Claims Data – Data from EMR Highly Variable

Case/Care Management Workflow • Needs:

– Both EMR and Claims Data – Track Disease Management Enrollment /

Progression – Follow All Patient Contacts / Outreach – Track Productivity of Care Coordinators – Work as Extension of Physician Offices, Not

Hospitals or Payer – Has to “SCALE”

POPULATION MANAGEMENT TECHNOLOGY

Analytic Engine

Payer and TPA Data Hospital and Practice Data

Payer-focused application

• Plan modeling • Financial reporting • Utilization reporting • Employer reporting • Product management

Population Management

• Risk Stratification • Utilization Tracking • Disease Management Eligibility • Comprehensive MD

scorecards/profiles to engage physicians

• “Value reports” for plans

Point-of-care

• Intuitive, “real-time” alerts to gaps in patient care

• Case management tools • Disease Management Eligibility • Comprehensive MD incentive

scorecards/profiles to engage physicians

• “Value reports” for practices

Population Management Technology

• Population Analysis with Internal and External Benchmarking

• Stratifies Disease and Intervention Opportunities

• Administrative Dashboard Tracking Contract Performance

• More Current than Most Payers Data • Timely and Granular for Managing Plan

Population Dashboard

PMPM Dashboard

Contract Dashboard (Utilization)

Contract Dashboard (Quality)

Readmissions

Avoidable Admissions

Outpatient Imaging

ED Utilization

Generic Utilization

Generic Switch Analysis

Generic “Drug-Level” Detail

Chronic Condition Tracker

“Disease Tracking”

High Priority Members

Evidence-Based Measure Tracking

Patient-Level Detail

Physician Scorecard

Physician Scorecard

“POINT OF CARE” TOOL

Analytic Engine

Payer and TPA Data Hospital and Practice Data

Payer-focused application

• Plan modeling • Financial reporting • Utilization reporting • Employer reporting • Product management

Population Management

• Risk Stratification • Utilization Tracking • Disease Management Eligibility • Comprehensive MD

scorecards/profiles to engage physicians

• “Value reports” for plans

Point-of-care

• Intuitive, “real-time” alerts to gaps in patient care

• Case management tools • Disease Management Eligibility • Comprehensive MD incentive

scorecards/profiles to engage physicians

• “Value reports” for practices

42

eCW AllScripts GE EMR #4 EMR #5 EMR #6

CCR CCR CCR CCR CCR CCR

Panel Reporting

Panel Reporting

Panel Reporting

Panel Reporting

Panel Reporting

Panel Reporting

Enterprise Reporting

eCW 89 APCPs (38%) 117 CI PCPs

AllScripts 19 APCPs (5%) 21 CI PCPs

GE 64 APCPs (27%) 65 CI PCPs

Other EMR 24 APCPs (10%) 47 CI PCPs

None/Unknown 47 APCPs (20%) 376 CI PCPs

MHMD TOTAL 243 APCPs 626 CI PCPs

Where the EBM protocols “live”

The PCP EBM Layer – 69 Rules engines

Practice Reports

COORDINATING EFFORTS AND AVOIDING DUPLICATION

Clinical Programs Committee Structure (2009-2012)

MHMD Physician Board of Directors

Clinical Programs Committee

H&V

Cardiology

CV Surgery

Neuro

Neurology

Neurosurgery

Woman/Child

Neonatal

OB/Gyn

Surgery

Anesthesia

Bariatrics

Orthopedics

ENT

Allergy

Medicine

Critical Care

Emergency

Surgery

Hospital Medicine

Post Acute Care

Oncology

Oncology

Contract

Imaging

Pathology

PCP

Peds

Support

Informatics

E-ordering Editorial

Board

Ethics

Peer Review

JOC DVT/PE

JOC End of Life Care

JOC Pediatric Head CT

JOC Surgical Home

Joint Operating Committees Cardiovascular Services Review

– individual data by campus – overall campus data on

mortality, renal failure, vascular complications monthly

Physician Champions by campus

Establish rapid response team for palliative care

Standardized pre-op STS assessment

Approved credentialing and privileging document for Cardiothoracic and Vascular Surgery Service

JOC– DVT/PE Attending physicians are

accountable for completion of the DVT risk assessment/Advisor which is mandatory.

Alert to nursing task list if advisor not complete

Development of correct timing/dose mapping in EMR: – 12 hours pre surgery; 2-12 post

operatively Metrics reported monthly CME program (mandatory) Marketing effort Pop up alert until completed

Coordination with MEC’s

Inpatient Quality and Safety Initiative Standard Order Set Usage

– > 60% by campus (or e ordering 75% by hospital)

System Adult IP Iatrogenic Pneumothorax

– Rate/1000 Discharges for Secondary Diagnosis

System Adults PPE/DVT

– Rate/1000 Surgical Discharges with an Operating Room Procedure

CLABSI, SSI, & VAP Rollup – (HAI Roll-up)

– Rate/1k line days + Rate/1k vent days + Rate/100 surgeries

Saving Lives – Serious Safety Events

– Rate/1000 Adjusted Patient Days

OB Initiative: APS Obstetrics Curriculum Path

– Rapid CME Compliance

IPQS Results

Campus E-Orders /

Order Sets

Iatrogenic Pneumx DVT / PPE

Hospital Acquired Infections

Serious Safety Events

A B C D E F G H I Total 9 6 8 8 9

Measures of Excellence 2012 – All Contracts

Final Thoughts • Communication is Your Most Important Tool for

Success • Understand Your Current People, Processes, and

Technology • Resist the Urge to Believe Technology Solves

People or Process Issues • Very Active Vendor Space – Vapor Abounds • Adopt Best Practices – Ask Advice • Successful Analytics Starts While Contracting • Understand Your Organizational HIPAA Stance

Bridge at Choluteca

QUESTIONS? shawn.griffin@memorialhermann.org