Episode Treatment Groups - Tri-State Regional Extension Center
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Transcript Episode Treatment Groups - Tri-State Regional Extension Center
An Overview of
HealthBridge’s
Shared Data Analytics
Infrastructure
HealthBridge is one of the nation’s
largest and most successful health
information exchange organizations.
Randy Woodward
Director, Business Intelligence Systems
March 16, 2012
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“Best of Breed” Partners
Enterprise Master Patient Index (eMPI)
IBM’s Initiate™
Clinical & Claims Data Repository & Clinical Analytics
PluralSoft’s CareQuotient™
Semantic Data Normalization
Clinical Architecture’s Symedical™
Claims Data Grouping Engines
OPTUMInsight’s Symmetry™
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Initiate™
by
IBM
Overview
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IBM - Initiate
Proven Patient and Provider data models
Configurable identity matching algorithms and matching
thresholds, by data source
Efficient data stewardship, governance, and data quality
resolution tools
Enables collaborative data stewardship
Alerts for data quality issues
Custom business rules
Tools to locate and correct duplicates
Tools to identify and resolve potential duplicates and links
Tools to identify and resolve patient data quality issues via
pre-configured analytics
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IBM - Initiate
Proven standards-based integration
Integration toolkit for loading patient data
HL7 v2 and HL7 v3 support
Web Services in support of SOA environments
Support for Integrating the Healthcare Enterprise (IHE) HL7
v2 & v3 Profiles:
o Patient Identifier eXchange (PIX)
o Patient Demographic Query (PDQ)
o Audit Trail and Node Authentication (ATNA)
o Patient Admission Management (PAM)
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Symedical™
by
Clinical Architecture
Overview
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Clinical Architecture - Symedical
Free-standing semantic normalization tool
Critical capability to improve interoperability, and enable
aggregation of disparate data sources – operates across
all data structures
“Out-of-the-box” mapping includes LOINC, RxNORM,
CPT, ICD-9/10, NDC
Supports namespace and site specific terminologies
Maps in advance when terminologies are known
Maps terms dynamically at run-time when they're not
known
Monitors and manages multiple maps remotely with
powerful workflow tools
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Clinical Architecture - Symedical
Mapping algorithms that learn
Recognition of new and changed terms and workflow tools to
manage
Leverage configurable algorithms to fine tune results
Role / Site based user security
Fully audited environment
“Rosetta Stone” – Enables terms to be mapped to/from
standard and non-standard lexicons
Application: EPIC to EPIC translations (e.g., Hospital A lab
test catalogue to or from Hospital B lab test catalogue
utilizing LOINC coding as the common link)
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CareQuotient™
by
PluralSoft
Overview
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PluralSoft - CareQuotient
Highly flexible DIMENSIONAL model for storing
conformed/normalized data
Can store non-coded data and later transform that data
when translation maps are available
Optimized data structure for reporting and aggregation
Extensible data model, supports the addition of future data
requirements and related reporting
Platform for data marts & OLAP cubes
Data model supports clinical & claims data
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Information Domains
Encounters
People &
Organizations
Lab Orders & Results
Patient
Referrals & Authorizations
Appointments
Revenues (Charges, Grants ..)
Medications & Prescription Information
Provider
Expenses (Payroll, Supplies,
Infrastructure, …)
Immunization
Payer
Products
Radiology & Documents
Staff
Master Data (ICD, CPT, DRG, HCPCS,
CCS, CRG …), Geography
Facility
Medical Conditions (Allergies, Familysocial-medical history)
Clinical Observations & Vital Signs (EHR
Template/Flow Sheets )
Legend:
Provider
Member Enrollment
Medical & Rx Claims
Revenue (Ins. Billing)
Utilization
Payer
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PluralSoft - CareQuotient
14 chronic disease conditions and preventative care
measures:
Diabetes
Asthma
Hypertension
Ischemic Vascular Disease (IVD)
Coronary Artery Disease
Congestive Heart Failure
Chronic Pain
Depression
Tobacco Use Cessation Counseling and Advice
Breast Cancer Prevention
Cervical Cancer Prevention
Colon Cancer Prevention
Childhood Immunizations
Preventive Care and Screening
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PluralSoft - CareQuotient
264 clinical measures including HEDIS, NQF, and PQRI
Clinical measures can be customized
360 standard reports & dashboards
Standard reports & dashboards can be customized
Leverages existing investments in hardware and
software infrastructure
Built on the Microsoft Business Intelligence stack
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Diabetes Measures – Sample
Chronic Disease - Physical health
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Diabetes Measure Drill Through - Sample
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Patient Scorecard – Sample
Managing Comorbidity (physical & mental) + Preventive Care
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Provider Scorecard – Sample
Performance across physical & mental health, Chronic & Preventive Care
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Symmetry™
by
OPTUMInsight
(formerly Ingenix)
Overview
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Symmetry Suite
Universal language and business standard for health care analytics
in the marketplace
Only product suite in the market providing comprehensive health
care analytic solutions through “component” engines on an
integrated platform
Provider Measurement & Engagement
PCQ Connect
ETG
PEG
ERG
EBM
Connect
Clinical Resource
Measurement
Risk Assessment and
Predictive Modeling
Quality
Measurement
A complete toolkit for health care management and analytics
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Symmetry Suite
Episode Treatment Groups
Episode Risk Groups
Procedure Episode Groups
EBM Connect
PCQ Connect
Symmetry Suite – common
analytics platform for:
Care quality improvement
Care cost management
Physician performance
ratings
Minimized total cost of
ownership
Industry recognized common
methods and analytics
8 of top 10 health plans
20 of top 25 health plans
24 BCBS plans
Transparent, not a Black Box
Flexible for your needs
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Episode Treatment Groups (ETGs)
Claims data
• Diagnosis codes
• Drug codes
• Procedure codes
Episode Treatment Groups
Claims data,
grouped by
episode
Episode Treatment Groups
Foundation for clinical resource
use and efficiency analyses
analysis by episode to support:
Transparency
Health care measurement
Incentives for increased value and
high quality care
Organize health care data
(experience) into episodes of care
related to the treatment of a
medical condition for a given
patient
The market leading episode of
care grouper
Over 200 health plans and other
health care organizations
covering over 160 million
individuals
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Episode Risk Groups (ERGs)
Claims data
• Diagnosis codes
• Drug codes
• Procedure codes
Episode Treatment Groups
Claims data,
grouped by
episode
Episode Risk Groups
Population-based health risk
assessment
Predict current and future health
care usage for individuals and
groups
Predicts a member's current
(retrospective) and future
(prospective) need for health care
services and associated costs
Episode Risk Groups
Clinically-relevant – robustly
prioritize multiple conditions and
co-morbidities
Administrative
• Age, gender
Risk score for
each individual
Adoption
Over 100 health plans and other
health care organizations covering
over 115 million individuals
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Evidence Based Medicine (EBM Connect)
Claims data
• Diagnosis codes
• Drug codes
• Procedure codes
Administrative
• Enrollment records
• Laboratory results
• Disease registry
EBM Connect
EBM Connect
Foundation for quality measurement:
assesses compliance of delivered care with
evidence-based medicine and care
guidelines
Members who
qualify for EBM
conditions and
their compliance
Identifies gaps between clinical evidence and
health care practice
Unnecessary or potentially harmful
diagnostic tests or treatments
Patients with indications of poor disease
control
Potentially harmful drug-to-drug or drugto-disease interactions
Identifies both high-performing
physicians and areas to recommend
improved physician compliance with
prescribed care
Adoption
30 Health plans and other health care
organizations covering over 100 million
individuals
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Procedure Episode Groups (PEGs)
Claims data
• Diagnosis codes
• Drug codes
• Procedure codes
Procedure codes
• CPT
• HCPCS
• NUBC
Episode Treatment Groups
Claims data,
grouped by
episode
Procedure Episode Groups
Procedure Episode Groups
Industry-first foundation for
enhanced analysis by procedure
to support
Transparency
Provider measurement
Incentives for increased value
and high quality care
Analyze the cost and quality of
surgical providers, procedures,
and related services
Risk score for
each individual
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Provider Cost & Quality (PCQ Connect)
Claims data
• Diagnosis codes
• Drug codes
• Procedure codes
Episode Treatment Groups
Claims data,
grouped by
episode
PCQ Connect
Peer Groups
• Attributed episodes of care,
by severity group
• Attributed quality measures
– EBM conditions and
compliance
EBM Connect
Administrative
• Enrollment records
• Laboratory results
• Disease Registry
Members who
qualify for EBM
conditions and
their compliance
PCQ Connect
Foundation analysis for physician
measurement
Network management
Transparency
Tiering
P4P
Centers of excellence
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Advantages of PCQs
Adjust for Severity
Provides multiple methods to reflect underlying differences
in the types of cases addressed and the severity of a
patient’s condition
Manage outliers
Provides different methods to identify outliers, and the
ability to include, exclude, or set the cost to the threshold
value to account for and treat outlier episodes appropriately
Define peer groups
Provides standard methodology for creating peer groups
within the same region and specialty
Attribute properly
PCQ Connect correctly attributes the right cost and quality
measures to the right provide
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Symmetry Applications
Business
Application
ETG PEG ERG EBM
PCQ
Connect
Connect
Provider Performance
Measurement
Disease / Care
Management
Member / Population
Risk Assessment
Financial Performance
and Trends
Providers, Employer
Groups, and Consumer
Information Sharing
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Thank You!
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