Advancing Data & Analytics Collaboration Between Provider ... › content › dam › optum3 › optum › en › ...Leveraging data to deliver more efficient, higher quality care

Advancing Data & Analytics Collaboration Between Provider and Life Sciences Organizations

Robert Musslewhite, CEO, Optum Analytics

Spotlight: provider viewpoint on life sciences

Implications for data and analytics

Trends in the provider landscape

©2018 Optum, Inc. All rights reserved. 2

Provider landscape going through a series of changes

Push towards Value Based Care

New provider payment models focused on

quality and cost outcomes.

Need commitment to quality and efficiency

goals along with investment in infrastructure to

facilitate performance improvement.

Price and cost pressures

squeezing margins

Long-anticipated challenges to revenue and

cost driving declining margins.

Need to contain it, realize full value of IT

investments and harness innovation to fuel

future growth.

Rise of “Consumerism”

Increasing patient awareness, financial

accountability and active engagement in their

health demands improved choice,

engagement and experience.

Need to rethink approach to growth strategy.

Ongoing political and legislative

uncertainty

Healthcare players, including lawmakers,

industry groups and patient advocates, will

continue to clash; likely result in additional

policy changes.

Need to build enterprise resilience on a

baseline of continued uncertainty.


Key themes as providers adapt to this transitioning phase

Growth of population

health management

Leveraging data to deliver more efficient, higher quality care

Creation of mega-systems Vertical integration

76% organizations employed

population health programs1

115 provider-provider transactions

announced in 2017 in their quest

for scale, improving bargaining

power and efficient care delivery

through facility specialization

Expanding beyond automation to digitization, analytics allows health systems to improve the

consistent, high quality delivery of care, avoid unwarranted utilization of services, and better

support their patients and care delivery processes

Large players cross historical

industry lines to combine

assets, reduce spending

+ +

1.http://www.himssanalytics.org/sites/himssanalytics/files/HIMS

S17%20Population%20Health%20Final%20Presentation.pdf

2.https://www.kaufmanhall.com/sites/default/files/2017-in-

Review_The-Year-that-Shook-Healthcare.pdf


All other trademarks, product names, service names, trade names, and logos used within these pages are the property of their respective holders. Use of other company

trademarks, product names, service names, trade names, and logos or images of the same does not necessarily constitute (a) an endorsement by such company or

Optum or Advisory Board and its products and services, or (b) an endorsement of the company or its products or services by Optum or Advisory Board.





Data analytics gaining significant momentum driven by external and internal forces

Digital health funding continues at a record pace1 ($, Bn)

153

2314

2013 2020

Massive growth in patient health data volume2 (in Exabytes – 1 Exabyte = 1 million Tb)

External Internal

>95% Hospitals adopted EMR3

82% Hiring the right IT talent4

Dr. Michael Blum, Director, Center

for Digital Health Innovation, UCSF

Providers have overcome historical barriers

Analytics is a top of mind issue, with high potential

>90% Provider IT executives view analytics

as big source of tech investments5

We have the data in usable, annotated forms, and the

ability to validate apps that [has a promise to] make a

difference in the system.”

$47-60B Healthcare analytics and solutions

market size in 20176

1. http://www.startuphealth.com/marketing/insights/51630

2. https://www.healthdataarchiver.com/health-data-volumes-skyrocket-legacy-data-archives-rise-hie/

3. https://www.advisory.com/daily-briefing/2016/06/02/ehr-adoption-rates-rising-barriers-to-interoperability

4. https://www.ca.com/content/dam/rewrite/files/White-Papers/healthcare-reaping-the-benefits-of-digital-transformation.pdf

5. https://www.healthcatalyst.com/the-changing-role-of-healthcare-data-analysts/

6. Optum research

$2.9

$11.5

2013 2014 2015 2016 2017


Predictive modelling for

staffing optimization

Significant opportunity for providers to tackle new areas with data and analytics

Procedural profitability

analysis

Episodic cross-continuum

care management

Clinical decision support

Remote patient monitoring

Personalized care delivery

Post-acute network

management

Targeted service-line

marketing

Population health risk

management

Tracking physician referral

patterns

Post-acute discharge

disposition

Surgery room efficiency

improvement

Outcomes-based contracting

Medication management Improved patient recruitment

for clinical trials

Product evaluation,

purchasing and contracting

EHR enabled care pathways In-house comparative

effectiveness studies

Product utilization and

compliance

Capacity management and

operational benchmarking


Major roadblocks limiting realization of true value of analytics

Status

Quo

Digital

Enterprise

DATA

Fragmented system leading to

limited view of patient information

IT INFRASTRUCTURE

Processes don’t bridge system

boundaries, leading to inconsistent

execution

LEADERSHIP FOCUS

Multiple stakeholders with varying

priorities, lacking common vision

IT GOVERNANCE

Disconnect between IT governance and

corporate planning; success measured only

by “on-time”, “on-budget”, not by outcomes

Providers struggling to address key roadblocks

Of the data needed for

precision medicine and

population health resides in

today’s EMRs

<8%

“We’ve done the same test three times,

because there was no easy way of

knowing if it had already been done.”

CIO, large health system

If the CEO doesn’t own digitization, it will

die—it’s not even a fair fight.”

Aaron Martin, Chief Digital Officer,

Providence St. Joseph Health

Challenge for CIOs focused on

business intelligence

implementations #1






Highlighting takeaways from Optum & Advisory Board provider market research

WHO did we speak with?

• Chief Pharmacy Officers, VPs of Supply

Chain, Chief Medical Officers, VPs of

Quality, VPs of Population, Service Line

Leaders (Oncology, Cardio) etc.

• Product evaluation

• Purchasing and contracting

• Appropriate use

WHAT did we discuss?

Insights derived from 200+ providers through interviews, surveys, and polls across the past 3 years

Common Provider Themes

Focus on a pop.

health, holistic view

to capture total cost

of care

1 2 3

Increase in number

of stakeholders

interested in and

accountable to data

4

Appetite to continue

experimentation with

different-in-kind life

sciences partnerships

Emphasis to expand

beyond traditional

clinical trials data for

decision-making




Focus on a pop.



of care

1 2 3

Increase in number

of stakeholders

interested in and

accountable to data

4





Emphasis to expand

beyond traditional


decision-making


Pharmacy execs note growing need to include multiple metrics for drug evaluations

Focus on a population health, holistic view to capture total cost of care 1

Today’s focus on readmission rate is not enough in the population health focused world

• >84% of pharmacy executives are

accountable for managing the budget in a

value-based world across the continuum

• They want to know how does your drug:

Reduce utilization of emergency

department services

Minimize adverse events that require

intervention

Reduce adherence challenges

Help reduce per member per month

spend (PMPM)

Improve disease-specific metrics

Chief Pharmacy Officer, health system in the southwest

“It’s ironic that manufacturers come to the ACO

totally focused on readmission data. They don’t

realize that only a small percentage of patients will

be hospitalized and an even smaller percentage will

be readmitted. The larger portion of the

population is the PMPM group. That’s where I’m

focused on: ‘How much am I spending to keep

everybody well?’ and ‘if I use drug X how does

that impact my PMPM spend?’”

Example: Providers with Capitated Contracts

Patients

hospitalized

Patients

readmitted

Total Patients Under Capitated Contract


Some health systems already using additional metrics to drive selection Case: Pine Health


Pine Health’s1 Process For Letting “Patient Adherence Profiles” Guide Drug Selection

High compliance Generics; even those that

need to be taken multiple

times per day

Moderate compliance

Low compliance

Branded agents that offer

sustained or extended

release

Branded long-acting agents

that reduce number of doses

and administrations

Patient Adherence

Profile:

First-Line Medications to

Consider:

Before PCP visit, ACO-dedicated

pharmacist calls patient to complete

assessment

• Are you taking medications currently or have

you taken medications in the past?

• Have you ever missed a dose?

• How many doses have you missed in the

last six months?

• Have you had any troubling side effects?

• Have you ever reached out to a doctor with

concerns about your medications?

• Do you have a regular primary care

physician?

• Have you ever participated in a medication

compliance program?

? Hypothetical Adherence Assessment

1. Pseudonym.


Implications for life sciences: success hinges on presentation of product milestones


Requirement to think about medications through a new lens

Provider questions yesterday

• Is this drug clinically effective?

• Is this medication safe for my patient?

• Has this drug worked well for my patients in the past?

• Do I have reason to use one of the newer drugs in class?

• Is this drug covered by the patient’s insurance?

ADDITIONAL provider questions today

• Are the patient’s out-of-pocket costs likely to inhibit

adherence?

• Is this drug easy for my patient to take properly?

• Do the common side effects cause many patients to

stop taking the drug?

• Are there less expensive, similarly effective options?

• Is there evidence this drug can help reduce

downstream utilization better than other options?

• Is there a care pathway I need to follow?

• Should I contact other members of my care team to

review my Rx selection (e.g., pharmacist, nurse)?

Broadening product criteria from…

Cost Safety Efficacy

…to include

Access Appropriate

Use Adherence +




Focus on a pop.



of care

1 2 3

Increase in number

of stakeholders

interested in and

accountable to data

4





Emphasis to expand

beyond traditional


decision-making


A Working Definition

Providers relying less on clinical trials data as source of truth for appropriate use Although providers largely fall in level 3, appetite is high to move towards level 1

Emphasis to expand beyond traditional clinical trials data for decision-making 2

Appropriate Use is a broad term that refers to using and prescribing

medications in a manner consistent with a care standard.

Levels of Appropriate Use

Utilization based on

evaluation of population-

specific real world data

Utilization matches care

standard based on empirical

or consensus-based practice

(e.g., non-randomized trials,

case studies, usual practice)

Utilization matches

restrictions based on

clinically proven evidence

(e.g., randomized controlled

trials)

Level 2 Level 1

(Aspirational)

Level 3

(Most Prevalent)


Implications for life sciences: deeper collaboration and data sharing will be required

Adherence data –

that show patients’

likelihood to

comply with

regimens in

different scenarios

Results on

multiple

population health

metrics– that

prove a

treatment’s overall

impact

More effective

cost savings

analyses – that

incorporate

provider

reimbursement

realities

Clinical trials

data – providing

initial safety and

efficacy data

Head-to-head

product

comparisons –

against current

standards of care

Real-world data –

for a specific

organization’s

patient population

Emphasis to expand beyond traditional clinical trials data for decision-making 2

Level 3

Level 2

Level 1

Standard data today

Not standard data today

Source: Advisory Board research and analysis.

“Data pharmaceutical firms are bringing

to us is just basically whatever external

consultants have told them they need to

do. They haven’t spent enough time

really listening to customers to

understand the data we truly need.”

VP of Pharmacy, health

system in the Midwest

“Where manufacturers could be

helpful is supporting the appropriate

use of these drugs. We’re still shot-

gunning in that world as opposed to

figuring out which specific drug to use.”

Director of Ambulatory Pharmacy,

health system in the Southwest

“If pharma continues to have the old

paradigm of just prescribe the drug and

see that as their value, that doesn’t

resonate with the care team. Focus is

not on getting the physician to order a

medication but instead on getting the

patient to take that medication.”

VP of Pop Health, health

system in the South

Health impact

analyses– for a

specific

organization’s

patient population




Focus on a pop.



of care

1 2 3

Increase in number

of stakeholders

interested in and

accountable to data

4





Emphasis to expand

beyond traditional


decision-making


New individuals are influencing treatment and prescribing decisions

CMOs playing a unique behind the scenes role

Increase in number of stakeholders interested in and accountable to data 3

n=138 Pharmacy leaders

93%

78%

28% 32%

16%

10% 10% 9% 8%

Traditional Influencers Emerging Influencers

Pharmacists Physician

peers

Service line

leaders

CMO Quality

dept. staff

Care

managers

Patients IT dept.

staff

CMIO


CMOs taking new lead as the adherence enforcer


• Drive system-wide clinical

standardization

• Promote system-wide

physician engagement

• Integrate costs into clinical

decisions

• Increase adherence to

care standards

• Ability to secure broad

medical staff buy-in

• Improve performance on

value-based payment

programs

Snapshot of the CMO Role

Responsibilities Metrics

The CMO’s Day-to-Day Impact on Pharmacy

• Analyze clinical practice variation

data (including drug use)

• Conduct one-on-one discussions

with outlier physicians to increase

adherence to care standards

• Attend P&T1 committee meetings

Manage Outliers

Clinical and cost

effectiveness data to support

a change in care standard to

physicians

Outcomes data that drugs

improve performance on

readmissions, adverse events,

adherence

Validation and attribution

studies to defend data and

convince resisting

physicians

What Do CMOs Care About – It’s All About The Data

1. Pharmacy & therapeutics committees


Pharmacy executives gaining more influence on drug selection, use, and evaluation


1. Pharmacy & therapeutics committees

Select Measures of Success

The Pharmacy Executive

Select Responsibilities

• Manage pharmacy budget/staff

• Oversee drug ordering/dispensing

• Serve on P&T1 committees

• Perform outcomes research

• Coordinate care across sites, care settings

• Perform direct patient care activities

• Monitor physician prescribing variation

• Manage overall pharmacy costs

• Lower drug cost by category

• Improve formulary adherence

• Minimize adverse drug events

• Reduce drug-related readmissions

• Improve medication adherence

What Pharmacy Leaders Care About

Costs Outcomes data Appropriate use; minimizing

prescribing variation

Clinical efficacy and

safety


Implications for life sciences: deploy a targeted approach to identify provider leads


Proliferating Potential Points of Engagement Onus on Pharma to Identify Provider Contacts

Who Own Pop. Health-Based Pharmacy Strategy

Chief

Executive

Officer of

Pharmacy

Ambulatory

Pharmacy

Director

Chief

Transformation

Officer

Chief

Pharmacy

Officer

VP of

Population

Health

Chief

Medical

Officer of

the ACO

VP of

Clinical

Innovation

and Quality

How integrated is your ambulatory setting

(including the ACO, PCMH1) with the

health system’s pharmacy department?

Which members of your team “own”

pharmacy strategy for your ACO or

population health efforts?

Which members of your leadership team

are addressing pharmacy costs and spend

in the ambulatory arena?

Which team members are directly held

financially accountable for lowering the

cost of care?

1

2

3

4

? Questions to Identify the Right Call Points

1. Patient-centered medical home.




Focus on a pop.



of care

1 2 3

Increase in number

of stakeholders

interested in and

accountable to data

4





Emphasis to expand

beyond traditional


decision-making


In early stages Met with limited success Met with limited success

Providers interested in exploring partnerships despite mixed results in past efforts

• Contracts where portion of

manufacturer payment is tied to

measurable outcomes

Outcomes-Based Contracting

Appetite to continue experimentation with different-in-kind life sciences partnerships 4

• Engagements to study questions of

mutual interest in a product-

agnostic fashion

• Questions may target medications,

investments, or services

Research Collaborations

Research collaborations in

the past 5 years 10+ 30+ Performance-based risk

sharing agreements in the

past 5 years

• Patient education resources

• Medication adherence solutions

Beyond The Pill Solutions

Solutions created as

supplementary product

offerings 50+

Used for strategic positioning in TAs1 Used for market access and adoption

1. Therapeutic Areas



Challenges in the past have inhibited the widespread success of OBCs1

Identifying And Maintaining

Partnership

1

• Accessing information and

targeting appropriate fit

Disconnect between health

system strategic focus and

manufacturer product suite

• Overcoming administrative

burden

Time and resource intensive

negotiation and contracting

process

Measuring Outcomes

2

• Determining outcome metrics

Challenge in selecting clinically

appropriate and measurable

metrics

• Tracking and analyzing

outcomes

Copious amounts of information to

collect and review

Aligning Stakeholders

3

• Dealing with mistrust

Involved parties often perceive

competing objectives in partnership

• Promoting buy-in and proving

program efficacy

Lack of publically reported

schemes question feasibility

Ch

allen

ges

1. Outcomes-based contracting


However, market advancements indicate promise for future partnerships


Identifying And Maintaining

Partnership

1

• Accessing information and

targeting appropriate fit

• Overcoming administrative

burden

Measuring Outcomes

2

• Determining outcome metrics

• Tracking and analyzing

outcomes

Aligning Stakeholders

3

• Dealing with mistrust

• Promoting buy-in and proving

program efficacy

Ch

allen

ges

• Emergence of 3rd party non-

biased ‘matchmakers’

• Rise of dedicated provider

roles focused on contracting

to handle tactical

administrative functions

• Meaningful and ongoing

advancements in provider

IT to handle data

electronically and track

patients across multiple

settings

• Enhanced patient

segmentation

• Progressing towards

unsustainable spend rates

(for both stakeholders)

• Providers continuing to

migrate to payment risk,

even if at slower pace


Implications for life sciences: explore opportunities without ‘one size fits all’ mentality


Value-driven Contracting May Be In It’s

Preliminary Stages But It’s Not Going Away

We’re in the very early days, so for anyone

to say the approach won’t work, when the

entire medical community is moving in the

value-based direction, is premature.

-Pharmaceutical Reimbursement Expert

Value-based deals are a component and

not the silver bullet. On its own, it’s not

really enough to address the pricing issue.

But I don’t see it fading away, either,

because the pressure to demonstrate value

for a medicine is too great.

-Pharmaceutical Reimbursement Partner

‘Win Themes’ And Considerations For Crafting

Successful Partnerships With Providers

1. Target health systems with baseline level of

readiness – Not everyone is ready

• Large-risk bearing organizations

• Sophisticated IT infrastructure

• Org structure reflects investments in robust

procurement/supply chain team

2. Understand what agreements are best

suited for YOUR product – Not every

product is a good candidate

• Traditional outcomes-based contracts:

medical devices, high-cost rare disease

treatments, etc.

• Beyond the pill solutions: treatments for

chronic conditions, co-morbid conditions,

etc.


Learn more about how Optum Analytics can drive collaboration

Brandi Greenberg

[[email protected]]

Expert on Market

Dynamics Affecting

Patient Care

CEO/COO

Relationships 8,800+

Years of researching

provider issues 35+ National provider

meetings hosted annually 90+

Life Sciences companies

engaged on a range of

issues 200+

Generator of Broad,

Deep & Enriched

Patient Data

Claims lives 188M+

Clinical lives 100M+

Data and analytics

professionals 26,000+

Convener of

Healthcare

Delivery Issues

We are well-positioned to drive collaboration


29

Documents

Advancing Data & Analytics Collaboration Between Provider ... › content › dam › optum3 › optum › en › ...Leveraging data to deliver more efficient, higher quality care