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Victoria Tiase, MS, RN, Director Informatics Strategy, NewYork-Presbyterian Hospital Kathleen McGrow, MS, RN, PMP, Director Customer Marketing, Caradigm April 23, 2014

Healthcare Analytics & Managing Population Health

Cost, Quality and Access to Appropriate Care

2

The US spent

$2.6 trillion on health in 20101

$432 billion on heart disease and stroke

$212 billion on diabetes2

1. Kaiser EDU.org. “U.S. Health Care Costs.” 2. 2011 National Diabetes Fact Sheet 3. GE Healthcare. “Clinical Decision Support Decision: Defining our Problem Statement.” 2011.. 4. NEMJ “Care in US Hospitals” July 2005 5. 2009 National Vital Statistics, CDC. Estimating HAIs and Deaths in US Hospitals, 2002, Klevens 2002

30% of the total annual US

expenditure on healthcare spent on

ineffective or redundant care.3

30% of care delivered is not evidence-based and is not in accordance with the best clinical knowledge.3

Healthcare-associated infections kill more people every year than breast cancer and prostate cancer combined. 5

Reimbursement to Improve Quality

The impact on Healthcare organizations

• Non-payment for never events and hospital-acquired conditions

• Meaningful Use incentives

• Value-based Purchasing

Management of at-risk patients enables organizations to realize 50% or more of shared savings Single payment for inpatient, outpatient,

and post-acute care services

$280 M in payment penalties based on readmission rates for AMI, HF and pneumonia—added conditions in 2015

Hospital Readmissions Reduction Program

Shifting Risk to Providers

The Impact on Healthcare Organizations

Challenges of Cost and

Quality

Government Regulations

and Initiatives

New Payment Methods

Provider Risk

Models

Need for Population

Health

The new demands of population health require solutions that

facilitate collaboration, deliver insights and enable care teams to achieve integrated, accountable

care.

The Advisory Board. “Survey results: Percentage of providers taking on risk doubled since 2011.” June 2013.

Population Health

Balancing risk and clinical programs

RIS

K/R

EWA

RD

LEV

EL

CARE MODEL

Low

Independent Integrated

Hig

h

Coordinated

FFS

U&C

DRG

VBP

Bundled payment

Shared savings

Capitation

Full risk

Readmission penalties

Population Health Framework

Four Capabilities for Success

Population Health

Data Control

Healthcare Analytics

Care Coordination and Management

Wellness and Patient Engagement

Promote healthier lifestyles for your patients.

Make information accessible where and when you need it.

Generate insights and drive better decisions.

Drive improved outcomes for patient populations.

Freeing your data from information silos

Caradigm Intelligence Platform

Data formats HL7 CCD CSV XML

Patient Encounter Lab Results Claims

HOSPITAL

OUTPATIENT PRACTICE

GOVERNMENT

LAB PHARMACY

PAYER

HOME

Amazing Things are Happening Here …

About NewYork-Presbyterian Hospital (NYP) • NYP is composed of six main facilities located in and around New York City

– Columbia University Medical Center

– Weill Cornell Medical Center

– 2,600 patient beds

– 2 million inpatient and outpatient visits

• US News & World Report Honor Roll - #1 in NYC

Use of EHR at NYP • Main EHR for clinical care: Allscripts Sunrise Clinical Manager

– Computerized provider order entry: 81,000 orders per day

– Nurse charting, ancillary clinical documentation: 98,000 notes per week

– Provider documentation: 49,600 notes per week

• Active user accounts: 26,300

– 1,300 resident physicians, 1,300 medical students

• NYP successfully attested to Stage 1 and well-poised for MU Stage 2

– Patient Engagement (myNYP.org)

– Clinical Analytics and Public Health reporting

1

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Aggregating Data from Multiple IT Systems

Lab Report

Discharge Medications

Stress Report

EKG Report & PDF of Tracing

Surgery Report

Echo Report

Nursing Discharge Instructions

Cath Report

Discharge Summary

Near real-time data repository

NYP Regional Health Collaborative

Population Health

Infrastructure /

Capabilities Patient Centered Medical Homes

Targeted Care Initiative (TCI)

Integration & Coordination of

Community-based Programs and Services

Health Information Exchange

Medical Village

Care Coordination Tools

Use of Patient Registry

• Disease Coordination

• Prevention of Readmissions

• Monitoring of DVT risk

Use of Quality Reporting Dashboards

• Prevent CAUTI

• Monitor Pain Assessment

• Assess care management of patients on care pathways

Clinic Visits with a Diabetes Diagnosis

Last H1AC was >9 and have not had a visit in 3 months or longer

CHF Readmission Prevention

DVT Risk Monitoring

CAUTI Reduction

ACTIVE FOLEY

NO = No active foley catheter order present in SCM

YES = Active foley catheter order present

APPROVED INDICATION

NO = Indication for foley catheter is a non-approved indication (i.e. “other:…”)

YES = Indication for foley catheter is approved indication

DAILY REVIEW

NO = Daily review for necessity not completed at some point in patient hospital stay

YES = Daily review completed or those patients w/o a foley catheter order

2

0

Pain Assessment Pilot

Care Pathway Status Draft

Lessons Learned as the Journey Continues

• New demands for data analytics - regulatory and quality initiatives

• Data quality management process is key

• Incremental process – care is complex and multi-faceted

• Priority, Patience, & the Patient

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Thank You