Introduction to Clalit and its data platforms

Prof. Ran Balicer MD, PhD, MPH

Director, Health Policy Planning, Clalit Healthcare Services, Israel

Director, Clalit Research Institute, Israel

Chair, Israel Society for Quality in Healthcare

Stanford, January 2017

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Introduction: Healthcare in Israel

»8.5 Million population

»Mandatory enrollment for all

»Provision by 4 national organizations (Sick funds) - Payers AND providers - Non for profit

»Enrollment free of charge (funded by taxes)

Per Capita Healthcare Costs

Population Metrics: Israel

Population Health: Israel

Restricted resources

How does that work? What is the trick?

“The Israeli Healthcare system, shall be

based on the principles of

Justice, Equity and Solidarity”

Israel National Health Insurance Law, 1995

Sick-fund System

»4 national organizations (Sick funds) - Payers AND providers - Non for profit

»Managed competition: Quality & service only

»Easy movement (online form…) - In practice – less than 1% attrition ! -90% happy or very happy…

Aligned Incentives

»(almost) Life-long membership

»State funding - by capitation - Incentive to keep patient healthy (value, not volume)

»Salaried GPs - Capitation based salary - Gatekeepers (i.e. for some specialists service)

Highly regulated hospital funding

»GP gatekeeping, free access in emergencies

»Payment Cap, reduced volume incentives »Bundled payment for procedures »Continuity of care now mandated by Gvmt

Aligned Incentives

Population Health Driven Funding

Source: OECD Statistics 2013

Population Health Driven Funding

30

32

34

36

38

40

42

44

46

48

50

Hospitals

Community Clinics and Preventive care

%

% of Total Health Expenditure, hospital vs. community care

Source: Israel Central Bureau of Statistics

Early adopter of technology (drugs, devices)

Annual entitlement update (increase only, $100M py)

»National, open, structured process of deliberations

»HTA, Evidence based (effectiveness, budget impact)

»People-centered aims: Whole of population view - More life in years + more years of life

Clalit Health Services: Israel’s integrated Sick Fund

»Established 1911

»53% market share - 4.2 million members - Over-representing low SES, minorities, elderly

»All services under one ‘roof’ - >1,500 clinics - 30% of Israel hospital beds - National leader in tele-care, online online services

Teamwork and communication

»Integrated GP clinics - Teamwork: GPs, nurses, administrators, pharmacists - Social workers, allied health professionals - Home teams

»Direct hospital-to-community communication - Fully interoperable data sharing system - Direct contact discharge planning - …

Laboratory data

Community primary care clinic data

Diagnostic and imaging data

Pharmacy, medications data

Allied health services data

Dental, complementary

health services data Socio-

demographic data

Linked to national

database National Cancer

registry

Linked to Ministry of Health

Mental health

Hospital inpatient, ED and discharge data

Administrative data (costs)

Integrated data

Integrated data

* Claims+EMR data, untainted by financial upcoding drive (no DRG)

Integrated data

* Claims+EMR data, untainted by financial upcoding drive (no DRG)

Bridging the coding chasm

»Community care: ICD-9, ICPC, ATC, home-grown

codes, MoH procedure codes…

»Hospital care: ICD-9, ICD-10, CPT…

»Diagnoses: Semi-free text, Free text

»Crosswalks for partners using other coding systems

»Semantic differences

Disease verification algorithm: One example

Validation

Clalit Research Institute

»Multi-disciplinary group

»Mandate: Turn data to insights, insights to policy - Real-life Effectiveness / Outcomes Research - Advanced analytics and predictions - Data-driven care models design

»Innovation hub »Rapid Transition research -> practice

Clalit’s Paradigm

= a requisite and driving force for transforming care

Smart use of data

Renal Failure

Predictive proactive care

8% of the subgroup holds 70% of future deteriorations

Preventing Renal Failure

Preventive Nephrology

Learning system for continuous improvement

Data in action – Physician desktop

‘Opportunistic’ quality management

Generation of a “action guide” for each patient – a list of all the actions that they should follow to meet quality of care standards

Population proactive management

Generation of a list of patients that performed poorly, not achieved control, ranked by urgency and poential impact

Patient Engagement: Patient Health Record

Diagnoses + educational materials Personal recommendations regarding tests/action required

Patient Engagement: Patient Health Record

Educational video per suggested test

Impact on diabetes control

Without pay for performance !

Admissions for uncontrolled diabetes

More data sources

Beyond the structured data

38

2010 2011 2012 2013 2014 2015

Computerized vision

ImageNet Error rates

2015

Human eye

2010 2011 2012 2013 2014 2015

ImageNet Error rates

2015

Human eye

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Computerized vision

2010 2011 2012 2013 2014 2015

ImageNet Error rates

2015

Human eye

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Computerized vision

Getting more out of available tests

Transforming care through data

Proactive care: preventing deterioration

Patient self-care decision support

Precise Tx: Tx selection by personal expected impact

Improving test interpretation accuracy

Safeguards from error & missed care opportunities

De-vesting futile interventions & policies

f d f

HHuge Potential – Yet Untapped

60% 40% 20%

December, 2016

International collaboration

The Stanford Collaboration

»Retrospective data analytics: -Data pre-processing + analytics joint group on-site -Two preliminary focus areas:

« Readmissions and care integration « End of life care

- Big data / unstructured data analytics – next phase

»Prospective data collection: - Selected subgroup of unique interest - Omics, Sensors, PROMs,

We have so much more to do, together

“It is not enough to do your best; you must know what to do, and then do your best.

W. Edwards Deming

Thank you!