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© 2005 HHCF All rights reserved1
Transforming Data intoActionable Information
Executing a Data Integration StrategyExecuting a Data Integration Strategy
Neil Sullivan, M.P.H.May 21, 2008
© 2005 HHCF All rights reserved 2
What’s the Value Proposition of DataIntegration?What’s the Value Proposition of DataIntegration?
DATA ININFORMATION
OUTBUSINESS
SOLUTIONS
2
© 2005 HHCF All rights reserved 3
What can data integration do for you?What can data integration do for you?
What specific program evaluation needs do youhave?
What specific data storage needs do you have?
What specific strategic planning needs do youhave?
© 2005 HHCF All rights reserved 4
What types of data will you need tointegrate?What types of data will you need tointegrate?
1. Health Promotion and Wellness data2. Medical and Rx claims data3. Absence data4. Safety, Risk and Disability data5. Human Resource data (who, what, where, when and
how)6. Performance / Productivity data7. Compensation data8. Workforce Transition data (hire, fire, promote, demote)9. Management and Training
3
© 2005 HHCF All rights reserved 5
Why integrate data?Why integrate data?
Aggregate similar types of data into one placeMultiple medical carriers reporting standardized claims dataCompare business functions or locations
Build a more complete composite around an issueThe compounding costs of Medical + Rx + DisabilityThe compounding impacts of indirect costs
Building a person-centric modelLeveraging the complexities of the person vs. the disease
or programUtilizing the entire population when performing analytics
© 2005 HHCF All rights reserved 6
How to integrate dataHow to integrate data
Analytic Team – SpecializedAnalysts And
System Administrators
Interpretation andPresentation Team
Data Management Team –Data Technicians, Database Administrators
And System Administrators
PrimaryGroupsInvolved
DatabaseEngines
Toolsets BI &Analytic
Tools
•WebApplications
•Reports•Presentations
Security
Network, System and Database SecurityHIPAA and other Regulatory Laws
Separation of Roles/DutiesRestriction of Access
Change Management Processes
Systems
Database,Analytic andReportingServers
DatabaseServers
AnalyticServers
Web andApplicationServers
DataInvestigation
and DataCleansing
Data Collection(Log & Load)
DataProduction
Ready
Analysisof the Data
DataInterpretation
and InformationProduction
Outputand SupportProduction
Phase
Building of theServers,
Software andInfrastructure
DataRequirementsand Database
Design
4
© 2005 HHCF All rights reserved 7
HIPAAHIPAA
Health Insurance Portability and AccountabilityAct (HIPAA)Federal law enacted in 1996 to assist in the
healthcare reform initiative
Original Intent/Goals:Reduce costs of administrative overhead Improve efficiency and effectiveness of the
healthcare systemProtect privacy and security of patient health
informationProtect patient rights Improve the quality of careEnhance information availability for decision making
© 2005 HHCF All rights reserved 8
Protected Health Information (PHI)Protected Health Information (PHI)
1. Name2. Geographic (less than 20,000 people)3. Dates except for year (birth date, admission date, etc.)4. Phone Number5. Fax Number6. Email Address7. Social Security Number8. Medical Record Number9. Health Plan Beneficiary Numbers10. Account Numbers11. Certificate/license numbers12. Vehicle identifiers & serial numbers, including license plate numbers13. Device identifiers & serial numbers14. URLs15. IP Address16. Biometric identifiers, finger & voice17. Full face photos or other images18. Any other unique identifier
5
© 2005 HHCF All rights reserved 9
HIPAA DefinitionsHIPAA Definitions
Covered EntityHealth Plans, Healthcare Clearinghouses, and to any healthcare
provider who transmits health information in electronic form
Business Associate A person or organization, other than a member of a covered entity’s
workforce, that performs certain functions or activities on behalf of, orprovides certain services to, a covered entity that involve the use ordisclosure of individually identifiable health information.
Services are limited to legal, actuarial, accounting, consulting, dataaggregation, management, administrative, accreditation, or financialservices.
© 2005 HHCF All rights reserved 10
HIPAA Privacy and Security of DataHIPAA Privacy and Security of Data
Privacy is WHAT IS PROTECTEDSecurity is HOW INFORMATION IS PROTECTED
The Final Rule on Privacy Prohibits a covered entity from using or disclosing an
individual’s protected health information (PHI), unlessotherwise permitted or required by the rule.
Protects PHI transmitted or maintained in any form ormedium and encompasses electronic medical records, papermedical records and oral communication
6
© 2005 HHCF All rights reserved 11
Data Elements of Human Capital
Big Picture Human Capital SolutionsBig Picture Human Capital Solutions
WorkforceTransitionCompensation
Performance andOutput
Big PictureInformation
Safety and RiskManagement
Medical Serviceand Insurance
Attendance
Managementand Training
Prevention andWellbeing
© 2005 HHCF All rights reserved 12
Data Elements of Human Capital
Big Picture Human Capital SolutionsBig Picture Human Capital Solutions
WorkforceTransitionCompensation
Performance andOutput
Big PictureInformation
Safety and RiskManagement
Medical Serviceand Insurance
Attendance
Managementand Training
Prevention andWellbeing
7
© 2005 HHCF All rights reserved 13
Scenario #1: Disability and WorkersCompensationScenario #1: Disability and WorkersCompensation
Workers Compensation and Disability rates for Musculoskeletal & Injury claimsare 65% higher at one of your manufacturing locations.
020406080
100120
A B C D
Accidents and Injury Daysby location
Disability
WC
Statistically controlled for: Gender, age, job type, and tenure.
What’s causing the differences in claims rates across locations?
© 2005 HHCF All rights reserved 14
Scenario #1: Assumptions & fixesScenario #1: Assumptions & fixes
1. Assumption: All of these claims at Location C are truemedical injuriesFix: Fix the injuries with prevention and treatment
2. Assumption: The workers at Location C are older and less fitFix: Alternative duty, Back strengthening, pre-employmentphysical assessments
3. Assumption: Location C has more physically demandingjobsFix: Facility assessment and organizational redesign
8
© 2005 HHCF All rights reserved 15
Scenario #1: DiscoveryScenario #1: Discovery
0
50
100
150
A B C D
Accidents and Injury Daysby location
DisabilityWC
Location Discovery
A Partial salary reimbursement and WC charge back
B Incongruence between STD and WC
C 100% salary reimbursement for 6 weeks
D Incongruence between STD and WC
© 2005 HHCF All rights reserved 16
Scenario #2: Bariatric SurgeryScenario #2: Bariatric Surgery
0
10
20
30
40
50
60
2004 2005 2006 2007
Surg
ery
Cou
ntp
er10
00
Year
Bariatric Surgery
Bariatric surgery rates are on a dramatic rise at this organization
9
© 2005 HHCF All rights reserved 17
Scenario #2: Assumptions & fixesScenario #2: Assumptions & fixes
1. Assumption: Rates of obesity are increasing at this organizationand thus leading to a higher demand for bariatric surgeryFix: Reduce / prevent obesity in this population and thus reducethe need for bariatric surgery
2. Assumption: Employees are more motivated to loose weight evenif it means undergoing surgeryFix: Conduct additional BMI screening and diagnoses of obesity
3. Assumption: Bariatric surgery reduces obesity related illnessesand related absence and costFix: Promote bariatric surgery
© 2005 HHCF All rights reserved 18
Scenario #2: DiscoveryScenario #2: Discovery
Findings:• Post surgery medical and disability costs were higher than a non-surgical obese group• More than 30% of those undergoing the surgery left the company within 12 months post surgery
Decision:•Benefit Plan design changes including new eligibility criteria and increased cost share
10
© 2005 HHCF All rights reserved 19
Scenario #3: DiabetesScenario #3: Diabetes
$0
$4,000
$8,000
$12,000
$16,000
$20,000
Department A Department B Company Avg.
Integrated Costs of Diabetes
Medical Rx STD WC Presenteeism
Ann
ualI
nteg
rate
dco
sts
per
Em
ploy
ee
Statistically controlled for: Gender, age, #of risk factors, and tenure.
What’s different between Department A and Department B diabetics?
Diabetes costs differ dramatically from one department within your organization
© 2005 HHCF All rights reserved 20
Scenario #3: Assumptions & fixesScenario #3: Assumptions & fixes
1. Assumption: Department B diabetics are sicker, older and lessadherent to medicationsFix: Implement a diabetes management / prevention program
2. Assumption: Department A diabetics participate in DM/CMprograms and Department B diabetics don’tFix: Increase incentive or disincentive for participation inDM/CM for Department B diabetics
11
© 2005 HHCF All rights reserved 21
Scenario #3: DiscoveryScenario #3: Discovery
$0
$4,000
$8,000
$12,000
$16,000
$20,000
Department A Department B Company Avg.
Integrated Costs of Diabetes
Medical Rx STD WC Presenteeism
Ann
ualI
nteg
rate
dco
sts
perE
mpl
oyee
Location Discovery
A Bonus Compensation policy
B No bonus comp and 100% salary reimbursement for STD
© 2005 HHCF All rights reserved 22
Research Finding: Likelihood of STD byPercent of Variable Pay For Which Employee is EligibleResearch Finding: Likelihood of STD byPercent of Variable Pay For Which Employee is Eligible
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
0% 10% 20% 30% 40% 50% 60%
Relative Variable Pay (Variable Pay/Total Compensation)
Likelih
ood
ofHav
ing
a(N
on-P
regn
ancy)
STD
Cla
im
Likelihood of having a (Non-Pregnancy) STD Claim, controllingfor age and gender.
Likelihood of having a (non-pregnancy)STD claim, controlling for age and gender.
Source: Health as Human Capital Foundation, 2008
12
© 2005 HHCF All rights reserved 23
Various Ways of Helping Others See the“Big Picture”
© 2005 HHCF All rights reserved 24
Integrated Database Value Proposition:Data In → Information OutIntegrated Database Value Proposition:Data In → Information Out
People• Recruit/Retain
Jobs• Type & Performance• Mgmt/Training
Compensation• Wages/Deferred• Incentive Comp• PTOVacation/HolidaySick Leave/FML Disability/WCI
• InsuranceLifeHealth & DentalP&C/WC
Health & Safety• Prevention & Wellness• OSHA
Business Performance
HumanHumanCapitalCapital
ManagementManagementIDbIDb
HCMSHCMSRRDbRRDb
• HumanResource
• Comp & Benefits
• Health & Safety
• Risk, Finance &Legal
• Operations
• Contract Agents
Population BaselineRisk Analysis/DS
Periodic Reporting/DS(Longitudinal Trends)
Ad Hoc Analysis/DS(Query Investigations)
Online Reporting(Portals, Dashboards)
DataData DatabaseDatabase Information ProductionInformation Production& Decision Support& Decision Support
Human CapitalHuman CapitalManagersManagers
Benchmarking, Research, &Predictive Modeling Services
13
© 2005 HHCF All rights reserved 25
HCMS Group Research &Benchmark DatabaseHCMS Group Research &Benchmark Database
• Total People 1,570,000 People• Employees (Payroll and Demographics) 653,000 Employees• Insured Dependents 669,000 Dependents• Social Welfare and Wyo WC Claimants 247,000 People• Medical Insurance 74,975,000 Services• Prescription Drug 33,397,000 Prescriptions• Sick Leave/Other Absence 3,122,000 Episodes• STD Claims 111,400 Claims• LTD Claims 6,900 Claims• Workers’ Compensation Claims 673,400 Claims• Productivity Data 18,100,000 Total Records• Duration 2 to 7 Years
© 2005 HHCF All rights reserved 26
Longitudinal Integrated Health TrendAnalysesLongitudinal Integrated Health TrendAnalyses
$0
$250
$500
$750
$1,000
$1,250
$1,500
$1,750
$2,000
$2,250
1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th
2004 2005 2006 2007
Av
era
ge
Co
st
pe
rE
mp
loy
ee
Employee Medical Employee Preventive Employee DrugDependent Medical Dependent Drug WC
STD LTD Health Account
14
© 2005 HHCF All rights reserved 27
Pareto & Quintile AnalysesPareto & Quintile Analyses
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile
Av
erag
eC
ost
per
Em
ploy
ee
Employee Medical Employee Drug Dependent MedicalDependent Drug W C Med W C IndemSTD LTD
High Risk Group588 Employees
Moderate Risk Group2,987 Employees
Low Risk Group21,425 Employees
N = 25,000Average Cost per Employee: $2,780Aggregate Cost: $69,493,604
Quintile PopulationAvg. Employee
CostAvg. Employee &Dependent Cost
Employee CostRange
1 21,425 (85.7%) $646 $2,276 $0-$3,4732 2,083 (8.3%) $5,994 $9,540 $3,473-$9,3653 904 (3.6%) $14,755 $18,126 $9,367-$18,9764 444 (1.8%) $35,541 $41,919 $19,008-$41,0055 144 (0.6%) $97,690 $100,237 $41,029-$453,662
Based on 12 calendar months
Average cost = $2,780
© 2005 HHCF All rights reserved 28
Pareto Risk Group TrendsPareto Risk Group Trends
Adjusted for Inflation
40% Increase
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd
2001 2002 2003 2004 2005
Ave
rag
eC
ost
perE
mpl
oyee
Low Risk Moderate Risk High Risk
15
© 2005 HHCF All rights reserved 29
$0
$5,000
$10,000
$15,000
$20,000
$25,000
4 Q uartersPre
Q ua rter O fHigh C os tEp isode
4 Q uartersPost
4 Q uartersPre
Q ua rter O fCM Start
4 Q ua rtersPost
No Cas e M anagem ent Case M anagem ent
Av
era
ge
Co
stp
er
Qu
arte
rp
er
Em
plo
yee
M ed ical D rug ST D W C LT D
Statistical Matching for ProgramEvaluationStatistical Matching for ProgramEvaluation
© 2005 HHCF All rights reserved 30
Predictive ModelingPredictive Modeling
0.0%
12.5%
25.0%
37.5%
50.0%
Age
Tenu re
SF-
8O
vera
ll
Cas
eTy
p e2
or4
Prio
rMed
icat
ions
Med
ical
Exa m
inat
ion /E
valu
atio
n
HRA
Parti
cipa
nt
Cas
eTy
pe3
or5
Patho
logy
Lab
orat
ory
Prior
Co st
s
Rad
iolo
gy
Ess
entia
l Hyp
erte
nsio
n
Re
lati
ve
Wei
gh
t
● Blu e bars represent variables that con tr ibute to increased risk.● Red bars rep resent variab les associated with decreased risk.
16
© 2005 HHCF All rights reserved 31
Questions for you to answer:Questions for you to answer:
1. Internal vs. External solution?
2. What’s the investment?
3. What’s the return?
4. Who should be my Integrated Database Partner?
5. Who in my organization should pay for this?
6. Who in my organization should own this?
7. How do I get started?
© 2005 HHCF All rights reserved32
Questions for me to answer?
17
© 2005 HHCF All rights reserved 33
HCMS Group HHCF ActivitiesHCMS Group HHCF Activities
501(c)(3) Research and Education Arm of HCMS Group
Health as Human Capital Research Approach- People- Incentives- Prevention
Education Activities Include:- Presentations- Seminars and Conferences (Continuing Education)- Blog and Publications
© 2005 HHCF All rights reserved 34
HHCF Blog and Blog BookHHCF Blog and Blog Book
www.hhcfoundation.org
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© 2005 HHCF All rights reserved35
Thank you!
nsullivan@hhcfoundation.org
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