This document discusses strategies for using data analytics to improve physician alignment with quality and value-based care goals. It notes the changing roles of providers and patients with new payment models focusing on quality and value over volume. Analytics can help prioritize measures, identify gaps in care, and target high-risk patients and providers. The document outlines several approaches including empowering office staff, personalized engagement, and automated outreach. It presents a case study showing a data-driven program successfully engaged providers and improved performance on several quality measures.

1. © 2016 Indegene. All rights reserved.
UNCOVER SUCCESSFUL
STRATEGIES FOR
ANALYTICS-DRIVEN
PHYSICIAN ALIGNMENT

2. 2
Evolution of the Provider
and Patient’s Role in
Accountable Healthcare
Need for
Data Analytics
Where
we are
Full Provider and
Member Autonomy
Need for
Alignment
Where we
were
Quality and Value
Based Care
Payment Models
Need for Data Analytics
based Interventions
Where are
we going
Changing Times = Evolving Needs

3. 3
Changing Times = Evolving Dynamics
Providers
ACO &
Integrated
Networks
• Right Focus: Given various and varied measures, how to focus energy on right measures?
• Redefined Relationships: With new value based provider relationships, how to drive desired
patient and provider behavior?
• Busy Providers : Given time and resource constraint, how to meet increasing compliance
requirements?
• Information Overload : How to avoid information overload and have right information at
point of care?
Overburdened StaffResource and Time Crunch
Patients
• Generic Communication : What information applies to me? Can I have that when needed?
• What to Trust : Given various requests (mostly generic), are these visits/test really required?
Lack of Appropriate Tools

4. 4
Reboot Interventions and Engagement Strategies
Increasing
Measure
Complexity
Evolving
Stakeholders
Role
Macro
Changes
Changing
Behavior
Relook at Engagement Strategies
New
Challenges

5. 5
Predicted Compliance
Low High
ImpactonCompliance(RiskFactor)
LowHigh
“High-value” gaps
Integrated Analytics Driving Interventions
Evolving Times Call for Efficient and Targeted Engagement
Analytics
To Action
Quality Targets
Cost Targets
Identify ‘High
value’ Measures
Identify ‘High
Value’ Providers
Identify
Gaps In Care
Identify ‘High
Risk’ Patients
EMR & Lab
Data
Medical and
Pharmacy
Claims
Patient
Reported
Outcomes
Data
Other Data
Sources

6. 6
Data-Driven Analytics Insights to Optimize the Interventions:
Measure Prioritization Through Measure Difficulty Analysis
Provider performance scores vary across different outcome
measures
Patient satisfaction measures vs. Provider performance measures
Current quality performance percentile score varies for different
measures
SCORE
43%
Determined for each measure
to rationalize further member
prioritization
Measure
Prioritization Score
Difficulty
Factor
Analysis
Patient Driven Gap-Closure Provider Driven Gap-Closure
SCORE
67%
SCORE
38%

7. 7
Data-Driven Analytics Insights to Optimize the Interventions:
Patients vary in gap-numbers and gap-complexity
Patient compliance likelihood affects outcomes of
interventions
Patient-Provider interaction history impacts outcomes
Integrated
Multi-
Dimensional
Analytics
Identify the High Risk Patients for Gap Closure and
integrate with Patient Engagement Program.
Provider and Patient Prioritization through Multi-Dimensional Analysis

8. 8
Integrated Multi-Dimensional Analytics
Measure-level Factors
• Measure Difficulty Factor
• Measure’s Industry Performance
• Measure Weight
• Patient or Provider Driven Gap
Closure
Integrated Multi-Dimensional Analytics Encompassing Factors Across Patient, Measures and Patient-Provider Interactions
Patient-level Factors
• Number of Gaps per Patient
• Patient Risk Score
• Patient Demographics
Patient-Provider Interaction Factors
• Patient-Provider Visit Frequency
• Patient past utilization of services
• Auto-Compliance probability
• Composite Compliance Score
• Gap Closure Complexity
Analyzing impact of various interventions
through multiple Simulators for ROI Optimization
Integrated Multi-Dimensional Analytics

9. 9
Just Sharing Data Is Not Sufficient
Approach 1
Right
Data
• Easily accessible
• Actionable data at point of care
Current Intervention Approach
• Complex and too much Information
• No slicing and dicing possible
Gap reports which are easily
accessible by providers at
point of care will drive higher
gap closure
Right
Format
Right
Time
Suggested Intervention Approach

10. 10
Unsung Heroes: Office Managers/Billing Managers
Various gaps can be
prevented/closed by
provider offices with
suitable support
Approach 2
• Empower office staff with easy to
read content on Quality Measures
• Provide right tools and resources
to streamline various activities
Current Intervention
Approach
• Deploying same content for office
staff as physicians
Suggested Intervention
Approach

11. 11
Have Data Driven Personalized Engagement
Effective Engagement
Receptive Providers
Higher Gap Closure
Individualized 1-1 Sessions
Practice Data Highlighted
Share Best Practices
Approach 3

12. 12
Don’t Miss Critical Piece of Member Engagement:
Providers
Provider Driven Outreach is More Effective
Than Any Other Source
Higher Response Rate | Higher Trust | Timely Action
But Providers are busy and have resource crunch .
Need a Solution/Platform which is:
Low Management
Overhead
Simple to
use
Works
With
Workflow
Automated Reach with
minimal staff involvement
Approach 4

13. 13
Support Members in Managing Complex and Multiple Condition
Personalized Medication Instruction Timely Medication and Preventive
Screening Reminders
Print Automated
Voice
Email Text
Messages
Medication Adherence Is A Key Challenge In Managing Multiple Conditions.
One Key Reason –Understanding Medication Instructions Itself
Approach 5
1 in 3 Americans struggle to
understand medication instruction
Over 30 million have
limited English proficiency

14. 14
Large Blues Plan– Quality Improvement Program
Multiple Provider Initiatives Under Way – However Gap Closure Rate And Scale Not Satisfactory
Low Utilization Of
Provided Gap
Information
No Empowerment / Involvement
Of Office Staff Who Are Critical
To Gap Closure
Need Help In Certain
Measures Where
Needle is Not Moving
Challenges
Faced
Solution
Data Analytics and Platform
Deployment – Effective
Targeted Data Sharing
One-to-One
Clinician Sessions
Self Service Educational
Interventions
Tools/Resources for
Member Outreach/Coding
Rating for “Engaged” groups increased
compared to start of program
B Clinic
3.83
4.20
B Medical Associates
2.72
3.00
G Coast
Physician Management
3.39
3.67
O Health Primary Care
3.48
3.65
S Multispecialty
Associates*
2.85
3.22
* Name Modified
Outcomes 53 Provider Groups
“Engaged Group”
282 providers across 19
groups
“Non-Engaged Group”
Providers across remaining
31 groups
Successfully engaged 19 groups and
their physicians in 12 weeks

15. 15
Indegene Performance Impact
Group Start End Change
B Clinic 3.83 4.20 0.37
Bet Medical Associates 2.72 3.00 0.28
G Coast HMA Physician
Management 3.39 3.67 0.28
Internal Medicine Associates 3.27 3.52 0.25
Mars Medical Group Pa 3.36 3.46 0.10
Group Start End Change
South Multispecialty Associates 2.85 3.02 0.17
O Health Primary Care 3.48 3.67 0.19
G Clinic 2.96 3.14 0.18
B Water 3.46 3.59 0.13
North Hospital District 3.82 3.92 0.10
Engaged group’s performance increased more than median change
• ‘Engaged Group’ did better than ‘Non-Engaged’ in majority of measures
• Performance improved in 14 out of 17 measures
• In most measures of higher focus, % improvement was much higher than other
measures
Engaged Group
Measure
Performance
Measure Group Change
Diabetes Care, DRE
Engaged 24.9%
Non Engaged 18.7%
Diabetes Care, LDL
Screening
Engaged 9.4%
Non Engaged 3.9%
Rheumatoid Arthritis
Management
Engaged 6.1%
Non Engaged -
Adult BMI Assessment,
18-74 years
Engaged 30.6%
Non Engaged 21.7%
Colorectal Cancer
Screening
Engaged 19.6%
Non Engaged 12.8%
Measure Group Change
Diabetes Care, Monitoring
for Nephropathy
Engaged 12.8%
Non Engaged 3.5%
Adherence with Cholesterol
Medication (Statin)
Engaged -7.5%
Non Engaged -11.5%
Adherence with Oral
Diabetic Medications
Engaged -6.9%
Non Engaged -11.4%
Diabetes Treatment
(ACE/ARB)
Engaged 3.8%
Non Engaged 4.3%
High Risk Meds, 1
Medication
Engaged 1.1%
Non Engaged 1.3%
Measure Group Change
Cholesterol Mgmt, LDL-C
Screening
Engaged 8.7%
Non Engaged 10.4%
Breast Cancer Screening
Engaged 9.5%
Non Engaged 2.7%
Diabetes Care, LDL < 100
Engaged 11.2%
Non Engaged -2.5%
Diabetes Care, A1c Good
Control
Engaged 9.3%
Non Engaged 3.1%
Osteoporosis Mgmt.. for
Women
Engaged 4.3%
Non Engaged 17.1%

16. 16
Risk & Gaps Data
Quality Data
Performance Data
Provider –Gap
Attribution and
Patient Consult
Creation
Provider Prioritization
Provider 1-1 Session
Provider
Intervention
Plan
Provider DashboardPoint of Care
CRM, TRAINING,
E-LEARNING
CLINICAL
OPERATIONS
PROGRAM
MANAGEMENT
DATA & ANALYTICS
OPERATIONS
Patient Outreach & Campaigns
Build Patient Groups Automatically Send MessagesAttach Patients To Campaigns
• Share actionable Gap Data at the
point-of-care
• Seamless data exchange
• Scale provider outreach through
multi-channel engagement
• Facilitate better care coordination
1
2
3
Putting It All Together

17. 17
ABOUT INDEGENE HEALTHCARE
Indegene Healthcare is a leader in end-to-end Risk Adjustment, HEDIS/STARS improvement and Provider Engagement solutions. Indegene
leverages its legacy of rich clinical expertise, proprietary analytics models and multi channel engagement platforms to help payers and providers
drive better health and business outcomes.
Indegene has a strong focus on IP and innovation, with a full portfolio of next generation platforms including STARMAX and HEDISPro for Quality
Improvement, RiskOptimizer, ProspectiveEnhance and EncounterPlus for Risk Adjustment, CareMax and iClinEngager for Care Management and
Provider Engagement and UNITY, an integrated enterprise data platform for payers.
Corporate Office: 485B Route 1 South, Suite 300, Iselin, NJ 08830
+1 732 750 2901
+1 732 750 7990
healthcare@indegene.com
www.indegenehealthcare.com
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