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Succeeding in the Reform Era. Jeff Moser, Vice President Sg2 August 2, 2012. Agenda. What is this all about? How the industry is responding. 2012 Outlook: May You Live in Interesting Times. Market share is redefined and with it, intensified battles. - PowerPoint PPT Presentation
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www.sg2.com
Succeeding in the Reform Era
Jeff Moser, Vice President Sg2
August 2, 2012
What is this all about?How the industry is responding
Agenda
Confidential and Proprietary © 2011 Sg2 3
2012 Outlook: May You Live in Interesting Times
Market share is redefined and with it, intensified battles. Tiered/narrowed networks move markets overnight. Redesigned benefits = more bad debt Cost cutting yields to margin management. Patients expect Apple at Dollar General prices. IT implementation breaks the bank and drives
alliances. New market entrants and technology enablement
threaten incumbent dominance. Policy, politics, budgets keep the C-suite up at night.
IT = information technology.
Confidential and Proprietary © 2011 Sg2 4
At the Heart of Health Care Reform…
Waste30%
“Estimates suggest that as much as $700 billion a year in health care costs do not improve health outcomes.”
–Peter Orszag, Former Director of the Congressional Budget Office
Quality and SafetyProvider Error
Unnecessary Care
Readmissions
Avoidable Conditions
Lack of Care Coordination
Value70%
Source: Inskeep S. Budget chief: for health care, more is not better. National Public Radio. www.npr.org/templates/transcript/transcript.php?storyId=103153156. Published April 2009 on Morning Edition. Accessed June 2011.
EfficiencyWell-Defined Care Paths
Less Costly Sites of Care
Coordinated Care
Increased Access
Predictive Care Paths
Confidential and Proprietary © 2011 Sg2 5
Health Care Reform Accelerates the Need for Proving Performance
Medicare readmission penalties
HAC = hospital-acquired condition; VBP = value-based purchasing; PPACA = Patient Protection and Affordable Care Act.
Medicare Shared Savings Program
Hospital VBP Program
Payment adjustment for HACs
2008 2010 2012 2014 2016
Payment pilot programs
Health care reform highlights tension between increased access and cost control. Payers are piloting new models that reward coordination, quality and efficiency. Evidence-based multidisciplinary care that spans the care continuum is a required
competency for programs. Clinical practice research continues to uncover opportunities to improve care. Focus on decreasing inpatient costs continues as hospitals try to control staffing,
length of stay (LOS) and device costs.
PPACA passes
The Middle Game
Confidential and Proprietary © 2011 Sg2 6
While Growth Across the IP Business Is Flat, OP Opportunities Abound
Adult Outpatient ForecastUS Market, 2012−2022
Billions
20000000
25000000
30000000
35000000
40000000
Adult Inpatient ForecastUS Market, 2012−2022
2022 2022
+18%+9%
–4%–1%
Note: Forecast excludes ages 0–17, psychiatry and obstetrics service lines and the not assigned category. Sources: Impact of Change® v12.0; NIS; Pharmetrics; CMS; Sg2 Analysis, 2012.
2012
2013
2014
2015
2016
2017
2,500,000,0...
3,000,000,0...
3,500,000,0...
4,000,000,0...
4,500,000,0...
+28%+20%
+15%+7%
Millions 5 Year 10 Year 5 Year 10 Year
Sg2 IP Forecast Population-Based Forecast Sg2 OP Forecast
Confidential and Proprietary © 2011 Sg2 7
What Does This Mean for a Typical Health System?
Focused on inpatient business Strong physician referral channel ED as the “front door” for majority
of admissions Excels at revenue cycle, LOS
management Few System of CARE linkages Lots of inappropriate utilization and
readmissions CFO pushed 5% cost reduction
over the past 3 years
ED = emergency department; LOS = length of stay; CARE = Clinical Alignment and Resource Effectiveness.
Confidential and Proprietary © 2011 Sg2 8
Fast Forward 5 Years
CMS = Centers for Medicare & Medicaid Services; PCP = primary care physician; PAA = potentially avoidable admission.
Hospital is a success! Hospital is growing and
profitable. Physicians are happy. System wins best
employer award. Weaker aspects of
performance do not affect market or financial results.
2011 2016 CMS docks hospital
5% of revenues for PAAs, readmissions.
Hospital is excluded from private payers’ preferred tier networks.
Patients shop to manage their out-of-pocket liability.
PCPs redirect cases away to maximize their incentives/reduce penalty exposure.
Profitability and market share erode.
Confidential and Proprietary © 2011 Sg2 9
Start By Asking New Questions
Any volume is good.
Standard Thinking
MD? Has a pulse? Buy!
Grab share at all costs.
Readmits are revenue.
Worry later.
The economy is getting better. Volumes will
rebound
Value-Driven Thinking
How do I drive sustainable margin?
How do I optimize payer rates?
Who are my real competitors?
How can I backfill as readmissions drop?
How do we survive new payment models?
What is our product?
What is market share?
What is our value proposition?
What is appropriate future
demand?
How do we capture the System of CARE?
How do we perform?
What MDs do we want?
Confidential and Proprietary © 2011 Sg2 10
Future Payment Models Seek to Reward Coordinated, Quality Care
Objectives Decrease premiums and
slow spending growth Reduce spending variation Improve quality Find efficiency Improve care coordination
CM
MI I
nitia
tives
Med
ical
Hom
e M
odel
Bun
dled
Pay
men
t
AC
Os
Emerging Payment and Care Delivery Models
Out
-of-P
ocke
t
Confidential and Proprietary © 2011 Sg2 11
What New Economic Structures Will Enable Us to Redesign the Work?
Deg
ree
of C
ompl
exity
High
HighLow
Scope of Risk
Fee for service
Inpatient case rates (DRGs)
Bundled episodes (inpatient only)
Clinical integration program
ACO
Bundled episodes (pre- and post-care included)
Global capitation
P4P/Value-based purchasing
Disease-specific capitation
Confidential and Proprietary © 2011 Sg2 12
Actuarial Risk
Providers Will Be Asked to Be More Accountable and Take on More “Risk”…
Performance Risk
Cost = # Conditions × # Episodes × # Services × Cost Person Person Condition Episode Service
How many people have back pain?
How many acute
episodes do they have?
Conservative management vs. surgical intervention
Expensive implant or less-costly
implant
Source: Network for Regional Healthcare Improvement. From Volume to Value: Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs. November 17, 2008. Available at Robert Wood Johnson Foundation Web site. www.rwjf.org/newsroom/product.jsp?id=36217. Accessed October 2010.
What is the cost per patient to manage back pain?
Confidential and Proprietary © 2011 Sg2 13
The Private Market Will Lead Innovation
CalPERS Pilot, Northern CA: 40,000 members, well-managed IPA
Carilion Clinic, Roanoke, VA: 17,000 employees beginning July 1, leading to cobranded insurance product
Piedmont Physicians Group, Atlanta, GA: 100 physicians, about 10,000 CIGNA members
Tucson Medical Center, Tucson, AZ: 50 to 60 PCPs
CalPERS = California Public Employees’ Retirement System; BCBS = Blue Cross and Blue Shield; IPA = independent practice association; CI = clinical integration; PCP = primary care physician. Source: Sg2 Interviews, 2011.
Advocate Health Care, BCBS, Chicago, IL:CI program evolved into ACO.
Norton, Louisville, KY:Partnership with Humana
Confidential and Proprietary © 2011 Sg2 14
Case Example: CalPERS ACO Pilot in Sacramento
Catholic Healthcare West, Hill Physicians, Blue Shield (CA)
42,000 lives “Virtual cooperation” model
Source: Sg2 Interview With CalPERS Pilot, July 2010.
Initial Critical
Success Factors
Experienced physician participants 3-way risk sharing and ongoing collaboration Upside for all participants “Teach back” program and daily rounds Public validation from payer
CalPERS Pilot (Northern CA)
http://www.worldatlas.com/webimage/countrys/namerica/usstates/counties/ca.htm
Confidential and Proprietary © 2011 Sg2 15
Year 1: Significant Savings…Mostly Due to Reduced Hospital Utilization
Exceeded target of $15.5 M in savings for the 42,000 member pilot 15% reduction in inpatient readmissions 15% reduction in average length of stay for inpatient admissions 14% reduction in inpatient days per thousand 50% reduction in inpatient stays per thousand of 20 or more days
Source: “A Community Model Case Study”, presented by Juan Davila and Rosaleen Derington at the America’s Health Insurance Plans Summit on Shared Accountability, Washington DC, October 2011.
“2010 was the easiest year that we’re going to have. After that, it will require real hardcore process re-engineering to be successful.”
- Rosaleen Derington, Chief Medical Services Officer, Hill Physicians Medical Group
Confidential and Proprietary © 2011 Sg2 16
Considerations in Defining the Right Timing for Your Strategy Evolution
SlowerOrganizational Issues
ED-driven inpatient strategy . . . . . . . . . . . . . . . . . . . . . . . . . . .
Limited IT infrastructure . . . . . . . . . . . . . . . . . . . . .
Market Issues
Highly fragmented splitter market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dominant, conservative payers . . . . . . . . . . . . . . . . . . . . . . . .
Regulatory Issues
Game-changer 2012 election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Restrictive insurance exchange . . . . . . . . . . . . . . . . . . . . . . . .
System of CARE IssuesConstrained, fragmented sub-acute capacity . . . . . . . . . . . . . . . .
Poor integration, effectiveness . . . . . . . . . . . . . . . . . . . . . . . . .
Faster
Diversified System of CARE strategy
Well-integrated and pervasive EMR
Regionally consolidated
Competitive and/or innovative payers
Stay-the-course election
Flexible state regulatory environment
Robust System of CARE capacity
Strong integration and relationships
What is this all about?How the industry is responding
Agenda
Confidential and Proprietary © 2011 Sg2 18
In the Short-term, Focus on Protocols, Coordination, PreventionTop Strategies to Improve Quality, According to Health Plan Leaders
Employing PhysiciansTransparency/Public Reporting
ACOsRemote Patient Monitoring
Medical HomeComparative Effectiveness
Pay for PerformanceDecision Support Tools
Preventive Care and Patient EducationCommunication Among Physicians and Hospital
Care Coordination TeamsEHR and e-prescribing
Better Treatment Guidelines and Protocols
3 3.2 3.4 3.6 3.8 4 4.2 4.4
Score (Scale of 1–5)
EHR = electronic health record. Sources: HealthLeaders Media Intelligence. Industry Survey: Health Plan Leaders. HealthLeaders Media, 2011; Sg2 Analysis, 2011.
Confidential and Proprietary © 2011 Sg2 19
Care Redesign Will Offer a Framework to Help Execute on Value-Driven Strategy
Valu
e (Q
ualit
y/C
ost)
Execution Risk
Variance and Cost Reduction
UnnecessaryCare Reduction
ClinicalRestructuring
System Optimization
Elements of Care Redesign
Confidential and Proprietary © 2011 Sg2 20
The Tried and True: Variance and Cost Reduction
Variance and Cost Reduction: Improving operational efficiencies
ED = emergency department.
Sample Analytics Potential Hurdles Margin mix Labor effectiveness Supply cost analysis
Physician resistance Inadequate data capabilities Existing vendor relationships
Examples Minimizing orthopedics supply chain costs Decreasing turnaround time for chemotherapy chairs Standardizing clinical pathways for asthma patients in the ED Uncovering staffing and productivity opportunities
Valu
e
Risk
Confidential and Proprietary © 2011 Sg2 21
0 5 10 15 20 25 30 $-
$1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000
Duration (Weeks)
Reduce Variation in Rehabilitation Across Post-Acute Care Sites
SNF
Home Health
OP PTHH & OP PT
Note: Postdischarge claims were filed after the date of discharge. Excludes episodes with cost >$46,000. TJR = total joint replacement; HH = home health; OP = outpatient; PT = physical therapy. Source: Sg2 Analysis, 2011.
Sample Hospital TJR Rehab Cost per Patient, 2007–2009
Confidential and Proprietary © 2011 Sg2 22
Improve Access and Productivity Through Centralized Scheduling
WellSpan Health System, York, PA Centralized call center was
implemented to address patient and staff satisfaction.
40 employees, 3 supervisors work shifts 7 am–8 pm weekdays and 8 am–4 pm Saturdays.
Goal is to answer 80% of calls within20 seconds.
One practice increased the number of visits from 1.9 to 2.1 per hour.
Noise reduction in practices also is increasing employee efficiency.
Source: Sg2 Interview, 2011.
Confidential and Proprietary © 2011 Sg2 23
Prepare for Penalties and Tiered Networks by Reducing Unnecessary Care
Unnecessary Care Reduction: Decreasing avoidable, unproductive and
duplicative services
SNF = skilled nursing facility.
Sample Analytics Potential Hurdles Evidence-based clinical
criteria Readmission analysis
Lack of care coordination between providers Weak relationships with post-acute providers Slow development and diffusion of clinical
effectiveness research
Examples Daily blood draws on inpatients Readmissions for CHF patients discharged to SNFs Excessive or duplicative imaging studies between sites of care Prostate cancer screenings for elderly patients
Valu
e
Risk
Confidential and Proprietary © 2011 Sg2 24
Standardize Radiology Ordering Process to Improve Diagnostic UtilityInstitute for Clinical Systems Improvement, Bloomington, MN
ACR = American College of Radiology; ACC = American College of Cardiology; ACP = American College of Physicians; M = million. Sources: Institute for Clinical Systems Improvement (ICSI). ICSI News November 3, 2010. Accessed June 2011; Sg2 Expert Insight: Transforming How Radiology Studies Are Ordered in Minnesota, February 2, 2011.
Innovation: Standardized Orders Designed a clinical decision support system that grades
the tests being ordered based on information and purpose Decision support system approved by ACR, ACC and ACP. System offers evidence-based alternatives. Piloted by 5 medical groups completing more than 1 million
imaging tests per year between 2007 and 2010
Results Shorter radiology ordering and approval times 10% improvement in diagnostic utility Estimated savings of $84M No increase in claims for imaging
Confidential and Proprietary © 2011 Sg2 25
Accelerate Access for Unscheduled Visits
Sutter Medical Foundation—Sutter Health, Sacramento, CA Operates 3 urgent care centers; 4 more are planned. Integrated with retail care, occupational health and diagnostic centers Future plans to collaborate with FQHCs to manage new Medicaid enrollees Fast-track access for 10 diagnoses.
ED = emergency department; UTI = urinary tract infection; IV = intravenous; FQHC = Federally Qualified Health Center.Source: Sg2 Analysis, 2011.
Confidential and Proprietary © 2011 Sg2 26
Encourage level of Care Optimization Through Clinical Restructuring
Clinical Restructuring: Ensuring treatment occurs in the optimal
setting with the most appropriate provider level
Sample Analytics Potential Hurdles Site/level of care cost Capacity and access
modeling
Current regulations and benefit coverage limits Lack of human capital planning Physician resistance Poor access to primary care providers (PCPs)
Examples Early transfer from an IP to SNF bed Pharmacists managing all medications for patients with chronic diseases Partnerships with a local retail clinic to offer nonurgent, convenient care Palliative care/end of life in ICU/ED
Valu
e
Risk
IP = inpatient; ICU = intensive care unit.
Confidential and Proprietary © 2011 Sg2 27
Improve Quality of Care While Managing Costs
Source: California HealthCare Foundation, February 2010.
California Pacific Medical Center, San Francisco, CA
University of California, San Francisco
$2.2 million in annual savings and improved clinical outcomes: 33% decrease in mean daily
costs 30% decrease in mean LOS 14.5% lower costs when
compared to usual care patients 86% decrease in pain scores 64% decrease in dyspnea
scores 87% decrease in secretion
scores
$2,179 savings for patients who received palliative care (PC) services
CostsWithout
PCWith PC Savings
Pharmacy $793 $31 $762
Laboratory $138 $7 $131
Radiology $57 $2 $55
Room $837 $412 $425
Services $616 $16 $600
Supplies $230 $24 $206
Total Costs $2,671 $492 $2,179
Confidential and Proprietary © 2011 Sg2 28
Use OP Palliative Care to Reduce Utilization While Improving Outcomes
Selection criteria based on this question posed to physicians: “Would you be surprised if this patient died in the next 1 to 2 years?”
Background Multispecialty practice with 11 locations
Challenge High use of hospital services for end-of-life patients
Solution: Outpatient Palliative Care Program Patients are referred to palliative program by physicians. Program is run by nurses and assistants. Nurse provides ongoing
care management and filters appointments and medications. Nurses proactively call all 250 patients once per month.
Results 47% vs 62% hospital admit rate for patients who received palliative care vs those who did not Palliative care patients’ ALOS was 0.5 days fewer than nonpalliative patients. Reduced ED care and inpatient care utilization
Everett Clinic, Everett, WA
ALOS = average length of stay. Source: Szabo J. High-quality palliative care programs bring comfort to terminally ill patients. AHA News September 6, 2010. American Hospital Association.
Confidential and Proprietary © 2011 Sg2 29
Use Telehealth and Home Health to Redesign Acute Care Delivery Sentara Healthcare, Northern Virginia
Goals Improve compliance, bed capacity and patient satisfaction Reduce readmission, LOS and HAC
Innovation: Telehealth and Home Health Pilot project to identify and evaluate acute care patients appropriate for early discharge with
enhanced home health and telehealth services HF, pneumonia, COPD, SOB, respiratory failure, atrial fibrillation and MI patients qualify. Admission criteria meet Medicare homebound criteria: cognitively intact, home electrical and
telephone services. Patients are referred by nurse and hospital case manager; discussed with patient and hospitalist. Patients seen by home care on day of discharge; telehealth monitoring begins on admission visit. PCP notified of patient’s admission to home care for follow-up orders and plan of care.
Results Treated 83 patients under pilot project Decreased LOS by 0.49 days at one hospital and 1.14 days at a second hospital Decreased readmission rates for same diagnoses to 3.6%
SOB = shortness of breath. Source: Sg2 Interviews, 2011.
Confidential and Proprietary © 2011 Sg2 30
Manage Population Risk Through Integration and Prevention Strategies
System Optimization: Shifting focus to upstream, preventive care through clinical
integration and population health management
Sample Analytics Potential Hurdles Population health
analytics Lagging incentives for preventive care and care
coordination Significant capital investment for a coordinated
shared savings infrastructure Poor relationships with PCP networks
Examples Disease-based medical homes Patient engagement strategies using telehealth Disease registries
Valu
e
Risk
Confidential and Proprietary © 2011 Sg2 31
Patients Are Coming From Mars, Physicians Are Leaving for Venus
Dr Jones, I’m having knee pain. I can’t keep up with my child anymore.
Your blood pressure is high, and I am worried that you cannot walk up
a flight of stairs. Let’s have you come back
next week to talk about your knee.
The Complicated Universe of Ambulatory Care
I should schedule him for a treadmill in case he has silent ischemia with his diabetes.
How could they schedule this man for a
15-minute visit?
I hope she doesn’t tell me I am fat.
My wife is really unhappy that I
lost my job.
Confidential and Proprietary © 2011 Sg2 32
MDs Challenged With Aligning Patients’ Clinical Needs While Lowering Costs
MLP = midlevel provider.
Simple Visit Ambulatory ICU
Care Customization
Social ICU
Priority Delivery
Team MLPPhysician
PhysicianMLP
MLPSocial WorkerNurse Physician
Nurse Social WorkerMLPPhysicianBehavioralists
Setting Office Office Multispecialty practice
Multispecialty practice
Example Sprained ankle
Multiple issues, pick 1
Serious chronic condition(s)
Overweight smoker, uninsured
Confidential and Proprietary © 2011 Sg2 33
Preliminary Results From Boeing Ambulatory ICU Pilot Boeing Intensive Outpatient Care Program (IOCP), Puget Sound, WA Partnered with 3 clinics, incentivized through per-patient-per-month fee Focused on employees contributing to highest health care costs Care teams included RN care manager, IOCP physician, current PCP
Patient involved in development of personalized care plan Care team proactive outreach Education in disease self-management Team huddles to assess patient status, discuss follow-up plan
Source: Milstein A and Kothari P. Are higher-value care models replicable? Health Affairs Blog. http://healthaffairs.org/blog/2009/10/20/are-higher-value-care-models-replicable. Accessed October 2011.
Improved functional status, depression scores, patient and provider satisfaction
Met clinical quality metrics for diabetes care, high blood pressure, high cholesterol
Reduced per capita spending by 20%
Confidential and Proprietary © 2011 Sg2 34
Utilization and Behavioral Patterns Help Identify Social ICU Patients
Used medical billing data to explore health trends: 1% of Camden’s patients accounted for 30% of
costs Identified 2 most expensive blocks: a large
nursing home and a low-income housing tower Camden Coalition of Healthcare Providers
formed to provide a medical home for “super-utilizers” Rely on home visits, phone calls, urgent call
number to reach patients
Jeffrey Brenner, MD, Camden, NJ
ED = emergency department. Source: Gawande A. The hot spotters. The New Yorker January 24, 2011. www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande. Accessed June 2011.
“The people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care.”
Results 40% reduction in ED
visits 56% reduction in
hospital bills
Confidential and Proprietary © 2011 Sg2 35
Background 12-hospital system, including 2 children’s hospitals and a medical group
Care Coordination: AdvocateCare Program Focused on 5 Aspects to Improve Care Enterprise care management
Enhance ED case management and OP care coordination Improved access
Expand PCP/clinic hours Build retail clinic relationship
Market share Target splitter docs and unassigned
patients in the ED Data analytics
OP care management system Prospective risk analysis
Post-acute care providers Preferred networks of providers Transition coaches SNF management with “SNFists”
Increase Retention and Improve Patient Outcomes With Care Coordination
Advocate…“could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs and be held accountable for the results.”
–Health Affairs January 2011
Advocate Health Care, Oak Brook, IL
Source: Shields MC et al. Health Aff (Millwood) 2011;30:161–172.
Confidential and Proprietary © 2011 Sg2 36
Extend Outreach to Capture Downstream Revenue
Direct Mail Phone Calls Web Presence
ThedaCare, Appleton, WIResults During 2.5-Month Campaign 10% of targeted patients scheduled and completed a colonoscopy. 28% increase in the average number of colonoscopies performed. ThedaCare is preparing to roll program out to other clinics and service areas.
Overall Increase in Screening Rate 21% increase to 73% between 2005 and 2010 (also due to disease management efforts)
Printed with permission of ThedaCare.
Printed with permission of ThedaCare.
Source: Sg2 Interview, 2011.
Confidential and Proprietary © 2011 Sg2 37
Where is the Venture Capital Going CareHubs (Beaverton, OR) is a healthcare enterprise social platform that offers
dynamic, innovative tools to help patients and healthcare providers better connect, coordinate and engage.
CareWire (Minneapolis, MN) is a patient engagement solution that utilizes automated patient text messaging to increase billable appointment yield, visualize patient satisfaction in near-real-time and improve provider performance.
DermLink (Atherton, CA) is a cloud-based, HIPAA compliant application that enables remote diagnosis of dermatology cases, dramatically reducing wait times for patients while driving increased revenue and flexibility for providers.
Iconic Data (Norcross, GA) delivers a cloud-based patient list manager solution that provides physicians access to near-real-time snapshots of clinical care episodes across disparate, non-integrated facilities, resulting in increased charge capture and reduced inefficiencies.
UnitedPreference (Princeton, NJ) offers a Tailored Spend™ payments network that improves member participation in preventative health initiatives via nationally accepted prepaid cards that can only be used to purchase goods and services pre-determined by health plans and employers.
Sample Of HealthBox 2012 Class
Confidential and Proprietary © 2011 Sg2 38
Successful Strategy Requires Management and Engagement
CARE = Clinical Alignment and Resource Effectiveness; IP = inpatient; OP = outpatient; SNF = skilled nursing facility.
Retail Pharmacy
Wellness and Fitness Center
Diagnostic/ Imaging Center
Urgent Care Center
HospitalAcuity
Community-Based Care
Acute Care
Post-Acute Care
Physician Clinics
Ambulatory Procedure Center
OP Rehab
IP Rehab
SNF
Preventive Care
Home
Home Care
Pt. ProfilingCare Managers
InformationSystems
Data Analytics
Disease MgmtTechnology
Confidential and Proprietary © 2011 Sg2 39
Sg2 provides business analytics for health care.
Our data-driven systems, business intelligence and educational programs deliver growth and performance
improvement solutions across the care continuum.
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