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Presentation to 2014 Virginia Health Care ConferenceJune 5, 2014
©2014 The Advisory Board Company • advisory.com
2
Trusted Advisor to America’s Leading Health SystemsThree Decades of Experience Translating Policy into Practice
Source: The Advisory Board Company.
1) Includes urban and rural health systems; academic medical centers and community hospitals; safety net hospitals; non-profit and for-profit hospitals; and the VA.
Key Areas of Expertise
• Health care delivery system transformation targeted at higher quality and more efficient care, including development of ACOs and medical homes
• Improvements in clinical operations and health care cost reduction, such as strategies to decrease readmissions
• Development and effectiveness of health information technology and data analytics
• Health care financing and revenue management, including technologies to administer risk-based payments
• Health care workforce, leadership development, and staffing strategies
Broad Membership Yields Deep Insights
2,200 Advisory Board health care
professionals worldwide
3,600 Member institutions, including
health systems in all 50 states1
165,000Members among
the 100 largest US
health systems
10,000 Research interviews annually
with health care leaders
99 >1,000Health care leaders
participating in
memberships
Small-to-medium
community
hospital members
©2014 The Advisory Board Company • advisory.com
3
Our Firm in Numbers
RESEARCH AND INSIGHTS
• Dedicated to the most pressing issues and concerns in health care
• 300+ industry experts on call
• 200+ customizable forecasting and decision-support tools
Memberships Offering Strategic Guidance and Actionable Insights
PERFORMANCE TECHNOLOGIES
National Peer Collaboratives Powered by Web-Based Analytic Platforms• Leading provider:
Over 50% of inpatient admissions in the United States flow through our technology platforms
• Over 1.5 million user sessions annually
• Key challenges addressed: physician performance, population health, revenue cycle, referral growth, surgical profitability, and supply/ service cost
CONSULTING AND MANAGEMENT
Seasoned, Hands-On Support and Practice Management Services
• 2,500+ years of “operator” experience in hospital and physician practices
• Principal terrains: hospital-physician alignment/practice management, transition to value-based care, revenue cycle optimization, hospital margin improvement
• Range of engagements from strategy/diagnostic to best practice installation to interim management to fully managed services
TALENTDEVELOPMENT
Partnering to Drive Workforce Impactand Engagement
• Impacted the achievement of 76,000+ executives, physicians, clinical leaders, and managers
• 17,000+ outcomes-driven workshops tailored to partners’ specific needs
Survey Solutions
• Customized strategies for improving employee and physician engagement
• National health care-specific benchmarking database of 480,000 respondents
165,000+ health care leaders served globally
$500+ million in realizedvalue per year
1,300+ engagementscompleted
6,200+ employee-ledimprovement projects
3,600+ 2,200+ 1,500+Hospitals and health careorganizations in our membership
Health careprofessionals employed
Hospitals using ourperformance technologies
©2014 The Advisory Board Company • advisory.com
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Scaling “Best Practices” to Accelerate and Sustain Transformation
Advisory Board Approach to Innovation
Health Care’s Original
“Big Data” Asset• Field Intelligence
• Data Science
Proprietary Methodology
• Tomorrow’s problems today
• 80/20 process leverage points
• Scalable, sustainable BDPs
• Member activation model
Our Sustainable ROI Model
Directive Technologies
Action, Not Analysis
Performance Blueprints
Roadmaps to Rapid Results
Applied Expertise
Right Expert Against Right
Lever
Network-Driven Innovation
Iteratively Attacking Hard
Problems
Clinical Integration
Referral Management
Labor and Supply Cost
Care Variation
Driving Enterprise-Level Outcomes
Patient Engagement
Predictive Care Plans
Network Optimization
©2014 The Advisory Board Company • advisory.com
5
Offering Data and Analytics to Improve Cost, QualityPerformance Technologies Improving Value at Front Lines of Care
Source: The Advisory Board Company.
Advisory Board Technologies
360,000 Physician cost and quality profiles
1,500 Hospitals using Advisory Board technology
50% US admissions flowing through Advisory Board IT tools
Advisory Board Technology Suite
Improving Quality of Care• Population Risk Management• Preventive and Chronic Care• Cross-continuum Care Management• Patient Engagement and Experience• Patient Safety and Care Quality
Lowering Cost of Care• Supply and Labor Costs• Care Variation Reduction
Aligning Incentives• Value-based Contracting• ICD-10 Transition
Representative Results Achieved by ABC Members
Claims ($) Incurr...
Year 1 Year 2
$385K $354K
PMPM Claims (...
$25.38$17.61
©2014 The Advisory Board Company • advisory.com
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Gaps in awareness of all available information lead to sub-optimal outcomes
Opportunity to Personalize Care
Static
Unstandardized
Missing Data
Case Manager Assesses Risk of Readmission
Nurses Screen for Delirium Risk
Care Managers Assess Risk of Non-Compliance
ICU
M.D. Office
6th Floor Cardi
ac Care
Current Attempts to Improve Precision Fraught with Shortcomings
©2014 The Advisory Board Company • advisory.com
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Natural Language Processing to Detect Risk Factors Buried in Clinician Notes
Crimson Real-Time Clinical Analytics
Sample Findings of Text Analytics
©2014 The Advisory Board Company • advisory.com
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Algorithmic Early Warnings Enabling Proactive Risk-Reducing Interventions across Care Settings
Crimson Real-Time Clinical Analytics
Clinical Risk Surveillance
• Risk of DVT
• Core measure patient identification
• Sepsis early warning score
• Risk of mortality
Referral Flags
• Pain management consult
• Mental health consult, undetected depression
• Palliative care consult
• Social work consult
Clinical Utilization Risk
• Risk of readmission
• Risk of avoidable admission
• Risk of extended length of stay
• Risk of extended ICU LOS
Revenue Risk Management
• Ensure medical necessity is met
• Alert to present on admission
• Documentation opportunities
• Computer-Assisted Coding
Customized Surveillance Alerts
©2014 The Advisory Board Company • advisory.com
9
Precise Risk Stratification, Risk Factor Identification Drives Reduction
Enabling Readmission Reduction within the Medicare Population at Baylor Health
Change in HF and PN Readmissions Rates at Baylor Health System
2012:Q3 2012:Q4 2013:Q1 2013:Q2 2013:Q314
15
16
17
18
19
2019.6
17.9
17.3916.6 16.4
Quarterly Readmission Rates:Heart Failure
N = 343
2012:Q3 2012:Q4 2013:Q1 2013:Q2 2013:Q30
4
8
12
16
20
16.67
5.56 5.88 7.045
Quarterly Readmission Rates: Pneumonia
N = 243
Rea
dm
iss
ion
s R
ate
(%
)
Quarter (Time)
Rea
dm
iss
ion
s R
ate
(%
)
Quarter (Time)
16% relative reduction 70% relative
reduction
©2014 The Advisory Board Company • advisory.com
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1 in 4 Patients with Depression Conditions at High Risk for Readmission
Identifying Population Level Risk Factors Enables Efficient Resource Allocation
©2014 The Advisory Board Company • advisory.com
11
Complementary Changes Required to Create a Value-based System
Unlocking the Full Value of “Big Data”
Stages of Analytical Progression and Value Creation
Incentives Alignment
• Right rewards for clinical transformation
• Lowering costs (and perceived threats) of data sharing
Integration with Workflow
• Minimally-disruptive to native workflows
• Contextually-appropriate “answers”
IT Interoperability
• Lower the total cost of accessing data, systems
• Data unification across systems
Cultural Transformation
• Comfort with performance transparency
• Data “improvement”, not data “perfection”
Descriptive Predictive Prescriptive
How many of my diabetic patients are overdue for their a1C test?
Which of my diabetic patients is least likely to respond to my outreach to get a blood test?
Which outreach message should I send to each diabetic patient to maximize response rate?
©2014 The Advisory Board Company • advisory.com
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Policy Can Play Role in Fostering Interoperability
Lower Cost Connectivity Will Accelerate Innovation
Require standard APIs in Meaningful Use Stage 3
• Any API would need to be published, public, and open to use by any third-party
• Commonly required APIs should expand over time
Opportunities for Policymakers to Encourage Interoperability
Further specify standards for data transport
• Current standards make data transfer possible, but not financially viable
• Reducing financial barriers to data integration would spur rapid and broad innovation
Drive greater data sharing between providers and payers
• Would facilitate better population health management
• At a minimum, providers should have access to full claims data under risk-sharing arrangements
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