Integrating Population Health Analytics and the EHR Environment Session 87, March 6, 2018

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1 Integrating Population Health Analytics and the EHR Environment Session 87, March 6, 2018 Nina M. Taggart, MD, Senior Medical Director, Population Health and Payer Relations, Lehigh Valley Health Network Sameera Ahmed, Manager, Clinical and Business Analytics, Populytics 1

2 Conflict of Interest Nina M. Taggart, MD and Sameera Ahmed have no real or apparent conflicts of interest to report. 2

3 Agenda Value Based Reimbursement Integrating Data Sources Integrating Analytics in the EHR Integrating Analytics into Organizational Culture and Population Health Strategy Outcomes and Metrics Keys to Success 3

4 Learning Objectives Describe the connection between analytics and success under riskbased contracts Explain the benefits of organizations helping physicians engage with data and analytics through the EHR environment Discuss how physicians can be engaged with actionable data to improve outcomes 4

5 A Complete Health Network 5

Lehigh Valley Health Network Overview 8 Campuses 1 Children s Hospital 160+ Physician Practices 17 Community Clinics 16 Health Centers 12 ExpressCARE Locations 81 Testing

6 Lehigh Valley Health Network Overview 8 Campuses 1 Children s Hospital 160+ Physician Practices 17 Community Clinics 16 Health Centers 12 ExpressCARE Locations 81 Testing and Imaging Locations 18,000+ Employees 2,005 Physicians 834 Advanced Practice Clinicians 4,208 Registered Nurses 57,272 Admissions 212,897 ED Visits 1,838 Acute Care Beds 6

7 Cardiology and Heart Surgery Gastroenterology and GI Surgery Geriatrics Orthopedics Pulmonology 21 st Consecutive Year #4 Lehigh Valley Hospital 7

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9 Value Based Reimbursement 9

Transition of the Healthcare Industry to Value Based Reimbursement Present Near-Term Future Fee-for-Service Providers paid for treating an individual s health problem QUALITY

10 Transition of the Healthcare Industry to Value Based Reimbursement Present Near-Term Future Fee-for-Service Providers paid for treating an individual s health problem QUALITY INCENTIVES FEE-FOR-SERVICE SHARED SAVINGS FEE-FOR-SERVICE GLOBAL RISK CONTRACTING FEE-FOR-SERVICE SERVICE Fee-for-Value Providers paid for proactively keeping populations healthy 10

Alternative Payment Model In 2015, HHS announced that

transition to value based reimbursement by the end of

encourage innovation and increasingly emphasize

Fee-forservice (FFS) FFS link to Quality and Value

11 Alternative Payment Model In 2015, HHS announced that it would like to see 50% of all Medicare payments transition to value based reimbursement by the end of MACRA drives clinicians there through MIPS APMs encourage innovation and increasingly emphasize delivery system through the progressive categories Fee-forservice (FFS) FFS link to Quality and Value Alternative Payment Models (FFS Architecture) Population Based Payment 11

12 Lehigh Valley Physician Hospital Organization (LVPHO) 1180 physicians 800 employed/aligned Independent total 380 Supports physician engagement and quality improvement Provides effective, efficient and uniform measures to support accountable care and population health 12

13 Experience Managing Populations Observations: The National Forecast is based upon the forecast of the yearly medical care cost trend by national authorities including Milliman, PWC, Kaiser and Mercer The LVHN Health Plan outperformed both it s budget and the National Forecast of medical care cost trend in each of the fiscal years subsequent to the analytics launch There were cumulative savings of $55M when comparing actual medical care costs to what the medical care costs would have been based upon the National Forecast absent any data driven initiatives 13

Value Based Contracts at LVHN/LVPHO By the beginning of FY 2018, over $1 billion in insurance-based claims (spend) is projected to be in value based contract arrangements with LVHN Evaluating MA &

14 Value Based Contracts at LVHN/LVPHO By the beginning of FY 2018, over $1 billion in insurance-based claims (spend) is projected to be in value based contract arrangements with LVHN Evaluating MA & Medical Assistance Payer Attributed Lives Accountable Spend Type of Arrangement Total at Risk LVHN Health Plan (live) 24,000 $130M Full Risk Total Risk MSSP (live) 40,000 $400M Commercial Insurer 1 (live effective 7/1/2016) Commercial Insurer 2 (go-live 1/1/2018) 50,000 $250M 45,000 $350M Shared Savings Limited Shared Risk Moving to Full Risk 50% of savings above target 50% savings above target, loss capped at $3M 100% savings or risk around target Commercial Insurer 3 (live) 10,000 $45M Shared Savings 50% savings above target TOTAL 163,000 $1,175M 14

15 Foundations for Success: Managing Population Risk CLINICAL INTUITION AND SUPPORT Leverage the experience of our clinical experts for the benefit of your strategic goals FINANCIAL MANAGEMENT Strategy to monitor performance under accountable care arrangements DATA MANAGEMENT Acquisition, integration & maintenance of data critical to the management of populations Successful population health management to thrive in value-based care models CLINICAL & PHYSICIAN ANALYTICS Data-driven review of populations to identify and stratify risk to reveal opportunities and inform providers 15

16 Integrating Population Health Analytics Integration must occur in three areas for successful Population Health Management: Data sources (claims, EHR, socio-economic) Analytics in EHR Analytics as a part of the organizational culture and population health strategy 16

17 Integrating Data Sources 17

18 Data Sources for Population Health Analytics Success in VBR requires population health management across the care continuum Population health management requires data that gives a complete picture of the patients health Disparate data sources in health care EHR systems Claims Socio-Economic Self reported 18

19 Data Source Challenges EHR Provides clinical and social data, but no information on actual cost of care Missing anything that happened outside of the health system Adjudicated Claims Provides financial information, diagnoses, prescriptions but not timely Matching the right information to the right patient Valuable insights come from both, yet both are traditionally not accessible in one system 19

20 Population Health Analytics Clinical Data Clinical & Social Analytics Population Management Analytics Insurance Analytics Claims Data Care Coordination Organizational Strategy 20

21 Supporting Care Coordination Process Clinical data from EMR Claims data from Payer Risk Scores & Predictive Analytics Registries Practice Clinical Contact High Risk Care Management/ PHO Liaison Referral to interdisciplinary team members Linkage to community Resources Continued education/care coordination/gap closure 21

22 Integrating Analytics in the EHR 22

23 Integrate Analytics into the EHR Clinicians work in clinical workflow systems, but actionable data may come from other systems or elsewhere in the record Data retrieval may be cumbersome, inefficient, or missed entirely Analysts need operational and outcomes metrics to monitor performance with value-based contracts 23

24 Challenges Sources of integrated predictive analytics and clinical workflow systems are separate EHR is used as care management workflow tool Registries created in BI tool outside of the EHR Process to access registries was inefficient and cumbersome 24

25 Registry Integration Application Programming Interface (API) Secure, web-based interface Enter code to request item, get the item back Result set is raw data that can be used by other applications Process is automated, removing manual effort involved with simple exports 25

26 Enterprise Analytics 26

27 Integration into Workflow Data driven work processes Directing resources to patients most at risk Registry development incorporating multiple data sources 27

28 Integrating Analytics into Organizational Culture & Population Health Strategy 28

29 Data Driven Culture 29

30 Challenges Defining patient populations Attribution vs Empanelment Clinical teams wanted all or none All None o Wanted to understand everything about patients o Analysis Paralysis o Distrust of claims data o Wrong metrics o Not timely 30

31 Right Data, Right Use Case, Right Audience Clinical Analytics that use EHR data to identify Gaps in Care, High Risk Patients, etc. Risk Analytics that use Claims Data to track prospective costs and stratify risk Registries with patient level profiles Predictive Analytics Easy to use Dashboards 31

Analytic Dashboards 11 drillable analytic dashboards to identify achievable opportunities to improve overall population health Create customized data segments

32 Analytic Dashboards 11 drillable analytic dashboards to identify achievable opportunities to improve overall population health Create customized data segments around demographic, financial and health information to support targeted initiatives including: Clinical pathways dashboards for COPD, oncology, CHF & AFIB 32

33 Clinical & Physician Analytics: Incentive Programs Semi-Annual Practice-Based Group Incentive Plan: Designed to provide physicians with incentives to meet the Triple Aim Measurement Categories Better Care: CG CAHPs participation, Meaningful Use standards Better Cost: Risk Adjusted ALOS, Risk Adjusted Episode Cost, Admissions and Readmissions, ED visits, and generic Rx Utilization Better Health: Evidence-based Quality Measures, QI Projects Funding Sources: Include employer, payers & shared savings distribution CME Opportunities/Online Modules Achieving Clinical Excellence (ACE) 33

34 Clinical & Physician Analytics: Provider Portal Achieving Clinical Excellence (ACE) Provider Portal Provider portal represents an opportunity to share results & opportunities with providers in a secure environment Physician progress to incentive goals are reported quarterly Utilization and quality goals are highlighted for each practice Member-specific care gaps are reported to drive compliance 34

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Engaging Our Workforce and Our Partners In Health Created a Population Health Academy Educational Programs for front-line clinicians and administrators to provide education on topics including:

37 Engaging Our Workforce and Our Partners In Health Created a Population Health Academy Educational Programs for front-line clinicians and administrators to provide education on topics including: Vision and Value of Population Health Quality Payer and Insurance innovations, metrics, and accountable care arrangements Population health analytics Pay-for-value reimbursement We are on a journey to engage more partners in this work 37

38 Outcomes and Metrics 38

39 Measure everything Operational efficiency Pathway compliance Population Health interventions Access Outcomes Quarterly review of financial performance under each accountable care arrangement Dashboard review of ACA clinical trends Performance on quality incentives by ACA ROI on specific program performance 39

40 Outcomes: LVHN Health Plan Observations: The National Forecast is based upon the forecast of the yearly medical care cost trend by national authorities including Mill iman, PWC, Kaiser and Mercer The LVHN Health Plan outperformed both it s budget and the National Forecast of medical care cost trend in each of the fiscal years subsequent to the analytics launch There were cumulative savings of $55M when comparing actual medical care costs to what the medical care costs would have been based upon the National Forecast absent any data driven initiatives 40

41 Quality Moves with Measurement & Alignment Measure 7/15 6/16 7/16 6/17 Aligns with ACE Adult BMI Assessment 44.10% 79.45% Yes Appropriate Testing for Children with Pharyngitis 88.15% 89.04% Yes Breast Cancer Screening 78.42% 78.55% Yes Colorectal Cancer Screening 62.41% 66.10% Yes Comprehensive Diabetes Care HbA1c (<8%) 42.57% 56.91% Yes Statin Therapy for Diabetic Patients-Received 54.94% 58.47% No Statin Therapy for Diabetic Patients-Adherence 80% 71.98% 71.25% No Cervical Cancer Screening 74.48% 73.76% No Use of Imaging Studies for Low Back Pain 75.32% 75.19% Yes 75 th percentile or at least 6% improvement 41

42 Outcomes: Medicare Shared Savings Program CY K Attributed Lives Program Structure CY K Attributed Lives Program Results CY 2015 Total claims cost $340M Final shared savings $11.2M Performance payment $5.5M Quality reported CY 2016 Total claims cost $378M Final savings $4.8M Performance payment $0* Quality 97.87% achieved * Did not exceed MSR saved CMS $$ but not enough to gain shared savings 42

43 Outcomes: Commercial Accountable Care Arrangement Program Structure Commercial Payer 7/1/2016 6/30/ K Attributed Lives 50% Gain Share 30% Risk Program Results Final Year End Trend Comparison (risk adjusted) LVHN Medical Trend 2.24% Peer Trend 5.74% Final Shared Savings At mid-year ($4,085,540) At program year end $7,431,949 43

Keys to Success Integrate Data Claims & clinical data are necessary to measure success in value-based contracts Select concepts that are most relevant and meaningful for population health management

44 Keys to Success Integrate Data Claims & clinical data are necessary to measure success in value-based contracts Select concepts that are most relevant and meaningful for population health management Integrate Analytics into EHR Workflow Get analytics at the point of care Make processes easier for care managers and clinicians Integrate Analytics into Organizational Culture and Population Health Strategy Report to all levels of the organization Provide incentives Provide education 44

Questions Nina M. Taggart, MD Nina_M.Taggart@lvhn.org Sameera Ahmed Sameera.

45 Questions Nina M. Taggart, MD Sameera Ahmed Please complete the online evaluation of our presentation! 45

A Practical Discussion of Value and Quality Based Payments What Do I Do Now?

Emerging Challenges in Primary Care: 2016 A Practical Discussion of Value and Quality Based Payments What Do I Do Now? Modified from AHLA Physicians and Hospitals Law Institute 2016 Faculty Ellie Bane