Analytic-Driven Quality Keys Success in Risk-Based Contracts
March 2nd, 2016
Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst
Brian Rice, Vice President Network/ACO Integration,
Allina Health
Conflict of Interest
• Ross Gustafson, MBA
• Ownership interest: Health Catalyst options
Agenda
• Allina Health Context & Strategy
• Data Analytics Structure & Tools
• Analytics & Outcomes Experience
• Summary
Learning Objectives
• Discuss the direct effect quality improvement has on cost containment and why it
is key to moving to a value-based model of payment
• Demonstrate how Allina Health is using advanced analytics to bridge historical,
current and predictive information to improve quality while lowering the cost of
care
• Describe the effect care coordination driven by predictive analytics has made in
improving the overall quality of health experienced by Allina Health patients and
how it has helped reduce unnecessary hospital admissions and readmissions
• Describe how transparency of data with physician community supported
engagement and improved triple aim outcomes for Allina Health
>60% Care
Management
Engagement
with Patients
vs Health
Plans
Improved
Outcomes to be
Leader in
Diabetes Optimal
Care
Management
STEPS: Patient Engagement & Population Management
Allina Health Context & Strategy
About Allina Health
• Largest Healthcare System in the Twin Cities and Region
– 13 hospitals – 1,812beds
– 59 Allina Clinics, 22 hospital-based clinics
– 15 community pharmacies
– 3 ambulatory care centers
– 8 Clinical Service Lines
– Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice
– Over 26,000 employees
– Allina Integrated Medical Network representing over 3,000 employed & independent physicians
• Key statistics (2014)
– $3.6 billion in revenue
– 108,124 inpatient admissions
– 1.3 million outpatient admissions
– 3.5 million total clinic visits
Minnesota Market
• Leader in quality improvement, reporting & outcomes
– ICSI
– MN Community Measurement
• Competitive provider environment with consolidation occurring
• Fortune 500 companies seeking greater value
Connected Care Strategy
Allina Health pursuing a strategy of
‘Connected Care’
– Better connect and coordinate care (and support the
caregiver’s ability to do just that)
– Advance new payment systems that rewards
outcomes
– Integrate data and knowledge to improve care and
health
All About Creating Value and Advancing Outcomes Based Delivery Strategy…
…the one outcome that unites all
players in health and health care
Value =
Cost
Quality (in its full definition)
Four Measures of Success: 2016 Strategic Priorities
4. Organizational Vitality
Performance
Employee/Physician engagement
Brand and member engagement
1. Optimal Health/Experience for Individuals
Personal Primary Care Teams
Strategic positioning acute care assets
2. Optimal Health for the Community
Allina’s readiness to manage population health
Community health benefit
3. Affordable Care
Payment integration strategy
Better
Care/
Experience
Organizational Vitality
Better
Health
Reduce per
capita costs
Triple Aim Integration Initiatives Quality Roadmap
Goal Initiative(s)
1) Perform under value based
payment risk models
Accountable care pilots
• Pioneer ACO
• Commercial partnerships
• Medicaid
2) Align incentives across
employed and affiliated
providers
Allina Integrated Medical Network (Clinically Integrated Network)
3) Give providers the data and
information needed to improve
outcomes
Advanced analytics infrastructure including
a robust Enterprise Data Warehouse
(EDW)
4) Provide consistently
exceptional care without waste
• Primary care team model redesign
• Care management/patient engagement
• Clinical program optimization
5) Support transformation with
new skills development Allina Advanced Training Program
Strategic Partnership with Health Catalyst
Why did Allina Health Pursue?
– Ability to focus on core competency
– Accelerating analytic adoption
– Cost stabilization
Healthcare Analytic Adoption Model
Allina 2008
Allina 2010
Allina 2014
Allina +
Catalyst
Data Analytics Structure & Tools
Allina Health- Analytic Adoption
• Foundation of data and technology
Level 8 Cost per Unit of Health Reimbursement &
Prescriptive Analytics
Level 7 Cost per Capita Reimbursement &
Predictive Analytics
Level 6 Cost per Case Reimbursement
& Data Driven Culture
Level 5 Clinical Effectiveness & Population
Management
Level 4 Automated External Reporting
Level 3 Automated Internal Reporting
Level 2 Standardized Vocabulary & Patient
Registries
Level 1 Data Integration– Enterprise Data
Warehouse
Level 0 Fragmented Point Solutions
• Relating and organizing the core data
• Efficient, consistent production
• Efficient, consistent production & agility
• Measuring & managing evidence based care
• Taking financial risk and preparing your culture for the next levels of analytics
• Taking more financial risk & managing it proactively
• Contracting for & managing health
• Inefficient, inconsistent versions of the truth
Source: Healthcare Analytic Adoption Model
2013
2010
2009
2011
2012
2008
2014 2015
Enterprise Data Warehouse: Data to Information
Clinical Intelligence Tools
Potentially
Preventable
Events
Census
Dashboard
Enterprise Data
Warehouse
Operational
Reports
Predictive Retrospective Real time
What is
happening?
What happened? What may
happen?
PPR Dashboard
Specific
G
enera
l
Allina Health
Readmissions
Model
Allina Health
Modeling of
Potentially
Preventable
Events
EHR Dashboard
Supporting Cohort Management Driving Improvement through Access to Information
Shows
performance of
composite measure
components
Select by patient,
clinic, provider or
any combination
Filter by
Pioneer ACO
Patients
Getting the Predictive Analytics to the Bedside The Census Dashboard
Identifies Patient
Readmit Risk
Identifies Prior IP Visits
in Last Week & Month
Identifies Transition
Conference Status
Established Data Governance Model - ACO Population Health Analytics
TCOC Opportunities
ACO Analytics Workgroup
Clinical Ops & Physician Perceptions
Payer Reports
MNCM, HP Reports
Claims DataACO Applications
Internal Data
Clinical Variation
Network Quality Committee
INPUTS
ANALYZE, SYNTHESIZE & REPORTING
PRIORITIZATION
RECOMMENDATIONS
Focus on identifying Total Cost Of Care Opportunities in value-
based payment populations
Analytics & Outcomes Experience
Examples of Allina Health’s Efforts & Outcomes
• How have enhanced analytics supported Allina Health in improving its performance?
– Prioritizes areas for care model changes
• Risk stratification
• Patient finding
• Clinical variation
• Enables focus on risk-based contract populations
• Provides insights on efforts, areas for further change, readiness to spread
Population Health Management Risk Stratification Model
High Risk
Rising Risk
Low Risk
Healthy
Complex Care Management 1- 2% Commercial
5% Government
Primary Care:
Registries
Screening
Prevention
Outreach
Health Coaching
Digital Strategy:
Education
24/7 Access to Care
Stratify the
population with data
integration for unique
care models
Claims
•Utilization
•Predictive Models
Clinical
•Assessment
•Diagnostics
•Predictive Models
Consumer
•Activity Trackers
•Biometrics
•Preferences & Goals
Health Plan • Claims
• Utilization
• Pharmacy
• Online Health
Assessments
Health Plan Care provided outside of
Allina Health
Allina Health • Hands on
assessment
• Predictive models
• Screening tools
• Diagnostics
Allina Health
Intake
Members Identified for Complex Care Management
Data Sources
Resources to Support Patients
Care Management: Ambulatory Census Dashboard Case Finding
Locating patient populations
Care Management Interventions for Hospital Transitions
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%A
pr
20
12
Ma
y 2
01
2
Jun
20
12
Jul 20
12
Au
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Se
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Oct
20
12
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Jan
20
13
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Jun
20
13
Jul 20
13
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Se
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013
Oct
20
13
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013
De
c 2
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Jan
20
14
Fe
b 2
014
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4
Ap
r 20
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4
Jun
20
14
Jul 20
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Oct
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Jan
20
15
Fe
b 2
015
Ma
r 2
01
5
Ap
r 20
15
Ma
y 2
01
5
Jun
20
15
Jul 20
15
Au
g 2
015
Follow-up Appointment within 5 Days at Allina Clinc
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20
Ap
r 20
12
Ma
y 2
01
2
Jun
20
12
Jul 20
12
Au
g 2
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Se
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Oct
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Nov 2
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Dec 2
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Jan
20
13
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b 2
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Ma
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01
3
Ap
r 20
13
Ma
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3
Jun
20
13
Jul 20
13
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g 2
013
Se
p 2
013
Oct
20
13
Nov 2
013
Dec 2
013
Jan
20
14
Fe
b 2
014
Ma
r 2
01
4
Ap
r 20
14
Ma
y 2
01
4
Jun
20
14
Jul 20
14
Au
g 2
014
Se
p 2
014
Oct
20
14
Nov 2
014
Dec 2
014
Jan
20
15
Fe
b 2
015
Ma
r 2
01
5
Ap
r 20
15
Ma
y 2
01
5
Readmissions Actual to Expected PPR Trend by Rolling 3 Months
Example: Supporting Cohort Management
Providing Care to Patients with Diabetes
Challenge
– Provide superior care for Allina Health’s diabetic population
Solution
– Identified and stratified diabetes cohorts using registries
– Identified gaps in care for diabetes patients (e.g. A1c, blood pressure management)
– Provided workflow capability for care teams to manage the population through ambulatory quality dashboard
Results
– Highest national score for Diabetes Care Quality Measure in 2012 of all CMS Pioneer ACOs
– U.S. leader in management of diabetes patients and Diabetes Optimal Care results
Supporting Cohort Management Driving Improvement through Access to Information
Shows performance
of composite measure
components
Select by patient,
clinic, provider or
any combination
Filter by
Pioneer ACO
Patients
Example: Supporting Wellness & Prevention Successfully Keeping Patients Well
Challenge
– Avoiding future illness is core to superior population health management
Solution
– Established and reported on optimal care scores for individuals
– Identified gaps in care and accurately connected them to care teams to close gaps in care
Results
– Eliminated significant gaps in wellness screening and preventative care
– Allina Health has achieved some of the best ambulatory optimal care scores in the nation through a focused clinician engagement strategy
74.0%
76.0%
78.0%
80.0%
82.0%
84.0%
86.0%
88.0%
Jan-1
1
Ma
r-1
1
Ma
y-1
1
Jul-1
1
Sep-1
1
No
v-1
1
Jan-1
2
Ma
r-1
2
Ma
y-1
2
Jul-1
2
Sep-1
2
No
v-1
2
Jan-1
3
Ma
r-1
3
Ma
y-1
3
Jul-1
3
Mammogram Optimal Care Goal = 85%
56.0%
61.0%
66.0%
71.0%
76.0%
Jan
-11
Ma
r-1
1
Ma
y-1
1
Jul-
11
Se
p-1
1
Nov-1
1
Jan
-12
Ma
r-1
2
Ma
y-1
2
Jul-
12
Se
p-1
2
Nov-1
2
Jan
-13
Ma
r-1
3
Ma
y-1
3
Jul-
13
Colon Cancer Screening Optimal Care
Goal = 73%
Colon Cancer Screening Optimal Care
Supporting Wellness & Prevention Ambulatory Dashboard
MD Name
Ability to focus on
a specific provider
or patient
population
Shows performance on
optimal care and
component measures
with patient detail,
provider name and clinic
ACO Population Focus Northwest Metro Alliance
• HealthPartners and Allina Health care for nearly 300,000 people in the Northwest Metro together.
• Serves as a learning lab for Accountable Care to move forward the Triple Aim
– Data sharing critical across organizations
– Use of claims and clinical EMR data valuable
– Physician engagement and collaboration has been core to success
Critical shift in mindset from competition to cooperation
2014 Northwest Alliance TCOC Trend HealthPartners Commercial Population
Summary
Summary This is Only the Beginning…
• Have patience & prioritize: Utilize Pareto analysis of population data key for determining opportunity and focus
• Focus on waste: Consistent quality drives lower cost of care
• Use predictive modeling to focus care management resources
• Prepare to invest $$’s for tech & talent
• Engage physicians in data strategy development
• Integrate and analyze claims and clinical data
• Transparency and access are critical
• Use outcome improvement approach
• Keep the patient at the center of all decisions
http://www.himss.org/ValueSuite
Value
Easier to share information
& identify opportunities
Evidenced based protocols
deployed
Data available right time,
right place
Individual and Population
Health planning backbone
Efficiency
Questions?