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Using advanced analytics to evaluate cost and utilization metrics

Angie Massey, Director, MHMD Strategic Analytics

Gene Moeller, Sr. Architect, ISD Enterprise Analytics

November 15, 2016

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Objectives

• Discuss value of bringing together disparate data, inclusive of payer and claims data

• Detail role of interactive analytic visualization tools in identifying trends and patterns

• Describe benefits of gaining transparency to cost and utilization metrics

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Memorial Hermann Health System

• Total hospitals: 12 (9 acute, 2 rehab, 1 children’s)

• Heart & Vascular Institutes: 3

• Managed acute care hospitals: 3

• Imaging Centers: 29

• Sports Medicine & Rehab Centers: 33

• Diagnostic laboratories: 25

• Ambulatory surgery centers: 17

• Cancer centers: 7

• Retirement/nursing center: 1

• Home Health agency: 1

• Hospital-Based Clinics - 5

• Employed Physician Practices – 70

• Primary Teaching Hospital for UT Health

Houston

• Annual admissions: 138,351

• Annual emergency visits: 450,000

• Annual ambulatory visits: 650,000

• Annual Life Flight missions: 2,960

• Annual deliveries: 26,731

• Employees: 20,840

• Beds (acute licensed): 3,723

• Medical staff members: 9,830

• Physicians in training: 1,821

• Annual payroll: $1.19 billion

Woodlands Sugar Land

TMC

Katy Memorial City Southeast

Northwest Northeast TIRR PaRC Children’s

Southwest

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Memorial Hermann Health System

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MHHS strategic initiatives

• Promote integration across Memorial Hermann

• Supports new vision to advance health

• Develop competencies for post healthcare reform success

• Population segment actuarial analysis

• Risk management and compliance

• Chronic disease management

• Governance and physician leadership

• Meaningful incentives

• Medical home infrastructure

• Quality and cost control incentives

• Focus across entire service continuum

• Support service line efficiencies and Medicare profitability

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Accountable careOur market-facing operating model

Clinically Integrated IPAPrivate, Employed & Faculty IntegrationExclusive Contracting DOJ/FTC Protections

PCMH 410

CI 3,300

ACO* 3,000

MHMD 4,000

Gr Houston >11,000

PrivateEmployment Faculty

3 distinct practice models

13 independent medical staffs

Health

System

*ACO number Includes UT MDs

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Growth in covered lives

Gain share

Full risk

Aetna Whole Health

37,310

Aetna Commercial

58,487

Humana Commercial

4,602

Health Solutions Medicare Advantage

5,609

United Healthcare Medicare Advantage

6,273

CMS MSSP

47,508

Humana Medicare Advantage

8,516

Aetna Medicare Advantage

10,287

BCBS Commercial

94,932

United Healthcare Commercial

87,452

Health Solutions Commercial

73,634 (>50% employees)

Value

MH – we own the plan, full premium

Aetna Whole Health – downside risk

Significant upside

No risk, new partnerships

429,420

covered lives

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Top 50 ACO year 1, 2, & 3 aggregate MSSP savings

$0 $50 $100 $150 $200

MH ACOPalm Beach ACO

Advocate Physician Partners ACOMillennium ACO

Atlantic ACOCleveland Clinic Medicare ACO

Hackensack Alliance ACOUT Southwestern ACO

Orange ACO of South FloridaRGV ACO Health Providers

West Florida ACONorthern Maryland Collaborative Care

Methodist Alliance for Patients and PhysiciansKentuckyOne Health Partners

POM ACOMyHealth First Network

ACC of SE WisconsinIntegral Healthcare

Allcare OptionsPhysicians ACO

AnewCare CollaborativeCommonwealth Primary Care ACO

Baroma Healthcare InternationalAccountable Care Options

Oakwood ACOUSMM ACCOUNTABLE CARE PARTNERS

Rio Grande Valley Health AllianceRevere Health

NATURE COAST ACOProHEALTH AC Medical Group

HHC ACO IncSouthern Kentucky Health Care Alliance

Privia Quality NetworkPremier Patient Healthcare

University Hospitals Coordinated Care OrgMercy Health Select

WellStar Health NetworkBayCare Physician Partners ACO

Collaborative Health ACOLehigh Valley Health Network ACO

Broward GuardianLifeBridge Health ACO

Physicians Accountable Care SolutionsQualuable Medical Professionals

CCACOAccountable Care Coalition of Texas

Scottsdale Health PartnersLahey Clinical Performance ACO

Optimus Healthcare PartnersCoastal Medical, Inc.

Millions

Generated Savings Yr 3

Generated Savings Yr 2

Generated Savings Yr 1

Millions

MH ACO

$200M

savings

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The road so far…

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“You know what I mean, Vern?”

Advanced analytics is the autonomous or semi-autonomous examination of data or content using sophisticated techniques and tools, typically beyond those of traditional business intelligence (BI), to discover deeper insights, make predictions, or generate recommendations.

Advanced analytic techniques include those such as data/text mining, machine learning, pattern matching, forecasting, visualization, semantic analysis, sentiment analysis, network and cluster analysis, multivariate statistics, graph analysis, simulation, complex event processing, neural networks.

Source: Gartner

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“You can't handle the truth!”

Descriptive analytics Predictive analytics Prescriptive analytics

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“You're gonna need a bigger boat”

Estimate versus reality

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“I live my life a quarter mile at a time.”

Advanced analytics is no longer a market advantage. It is a

business essential.

Memorial Hermann timeline

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“By the way, is there anyone on board who knows how to fly a plane?”

MHMD strategic analytics

Information systems

Cerner

Managed care contracting

Health plan

Consulting actuaries

Care management

Pictured: (l to r) Pete, Kendra, Vincent, Dennis, Blake, Brandon,

Sean, Raman, Nayan

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“Where’s the beef?”

• You need as much data as possible to produce advanced reports

• Reports are only as good as the data used to produce them

• Value achieved by connecting data across sources is getting that full longitudinal view which allows your clinicians to provide proper, timely care

NOTE: Don’t underestimate the effort required to get this data into one unified system.

[1st objective: discuss value of bringing

together disparate data, inclusive of payer

and claims data.]

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“Let it go.”

• Who doesn’t love a good pivot table? Or MS Access report?

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“Show me the money!”

• Claims categorization

• Moving to national standards

• Milliman based risk scoring

• Episode – event based

• Cohort – large disease groups

• Replacing existing systems

[2nd Objective: Detail role of interactive

analytic visualization tools in identifying

trends and patterns]

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“I’m the king of the world!”

• MSSP attribution & summary reports with standard KPIs

• Now tying EMR data to claims enhancing registries metrics

• Post-acute visibility

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“Badges? We don't need no stinkin' badges!”

• Direct access to SmartAnalytics where reports and dashboard are exposed in project groups to specified users• Examples: ACO Admin,

Clinical Operations, and My Reports Provider

• Allow us to get claim level detail directly out to the report audience.

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“Game over, man! Game over!”

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“We got one!”

• Received additional money back because of closed gaps when working with payer

• In October, we were able to evaluate a bundled RFP using data versus piecing fee schedules together or guessing

• Visualization of network utilization by providers is providing insights into how we can better serve the community

• Productivity• Previous analysis method consisted of pulling data and reporting each

time something was needed

• Time spent on requests is converting from creating the analysis to evaluating the analysis. We can tell the story instead of spending all our time putting the story together

• Care management• We are providing the patient’s longitudinal record to care managers

allowing for more meaningful interactions

[3rd objective: Describe benefits of gaining transparency to

cost and utilization metrics]

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“Just keep swimming.”

• Episode groupers, including diagnosis and cohort

• Wider self-service audience for dashboards and reports

• Further enhancing value to the care management team.

• Moving metrics and using data to set performance standards

• Unified definitions• Data governance

• Allows for benchmarking to national standards

• MACRA/MIPS/etc. • As government regulations and reporting continue to evolve, so do the

payer’s

• Coordination with registries

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Objectives

• Discuss value of bringing together disparate data, inclusive of payer and claims data

• Detail role of interactive analytic visualization tools in identifying trends and patterns

• Describe benefits of gaining transparency to cost and utilization metrics

“It’s a dangerous business, Frodo, going out your door.

You step onto the road, and if you don’t keep your feet,

there’s no knowing where you might be swept off to.”

-Gandalf the Grey, The Lord of the Rings, J.R.R. Tolkien

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Questions?