Accountable Care Transformation Framework

© 2013 Health Catalyst
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Accountable Care
Transformation Framework
1
Webinar – June 4, 2014

Population Health Management
Developing the asset
Provider Network
1
Population
2
Cost Outcomes
4
Quality Outcomes
3
Four Building Blocks of
developing
the asset

PHM and Accountable Care (AC)
Accountable Care
Financing and
Administration
Population Health
Management developing
the asset
packaging and
marketing the asset

Accountable Care Transformation
Retail Marketing
Access, Satisfaction:
Optimize: 1) coverage
of the service area by
the AC network; and 2)
member/patient
satisfaction
Quality, Safety:
Improve clinical and
patient safety
outcomes
Cost:
Provide care at the
lowest necessary
cost
Pricing:
Negotiate “price”
based on clinical
registry assessment
of disease density
and severity

• Population Health Advanced Applications
• Permanent Clinical Team Structures
• Repeatable Deployment Methodology
• Ordering Waste Reduction Explorer
• Workflow Waste Reduction Explorer
• Defect Waste Reduction Explorer
• Disease Density Explorer
• Risk (Severity Level) Explorer
• Cohort Driven “Underwriting”
• Network Composition Analyzer
• Service Area Explorer
• Wholesale Contracting
• Network Access Agreement*
Health Catalyst Products/Services
• Deployable
• Under development
• On Road Map
• Client, Third-party Payer
and/or Health Catalyst
• Patient Injury Prevention Applications
• Patient Registries
• Activity-based Costing
• Predictive models for clinical staffing
• Financial Risk Allocation - Reinsurance
• Patient-Provider Attribution Modeler
• Retail Marketing Vehicle(s)
• Care Management Resources • Care Management Resources
• Patient Analytics and Communication • Patient Analytics and Communication
• Payer Market Analyzer
• Key Process Analyses
• Participating Provider Service Agreements*
* Outline of concepts to be included in agreements
• Accountable Care Organizational Plan*
• Risk/Reward Allocation Plan*
• Member/Patient Satisfaction Explorer
• Patient Leakage
• AC Executive Dashboard

Access, Satisfaction
6

Provider network
analysis (geoanalytics)
7

Service Area Explorer
Potential “layer” inputs under evaluation
Hospital Service Areas from the Dartmouth Atlas of Health Care
Medical care regions, medical trade areas and hospital service areas
defined using central place theory (Margot W. Smith)
Census data from the U.S. Census Bureau of the U.S. Department of
Commerce
Health Benefit Program filings with state health insurance
departments, including definition of geographic coverage areas
Patient origin analyses based on client data
CMS service area definition (Hospital Compare)

Service Area Explorer
Dartmouth Atlas of
Health Care
(Healthcare Regions)

Network Composition Analyzer
10
Medicare FFS payments by venue – 2008-2012
OutpatientClinic Care Inpatient SNF Home Hlth Hospice
$ 152 Billion
11.8%
372 Billion
28.7%
447 Billion
34.5%
$ 133 Billion
10.3%
$ 90 Billion
6.9%
$ 48 Billion
3.7%
LTCH/IRF
$ 53 Billion
4.1%
Clinic Care Outpatient Inpatient SNF LTCH/IRF Home Health Hospice

Current network

?
?
Network access
Current state (integrated layers)

Poll question
• How well do you feel your current network of
physicians and facilities covers the geographic service
area of the third-party payers with whom you want to
establish a shared-accountability contract? (five-point
scale)
• 5 - Full coverage – 10%
• 4 – 33%
• 3 – 37%
• 2 – 16%
• 1 - Little or no coverage – 4%

Patient Registries,
Key Process Analyses
14

Patient Registries
15

Registries – “the Intel chip”
Patient registries are the “Intel” chip inside
PHM/AC; they form the basis of:
• Essentials layer applications.
• Population evaluation.
• Quality outcomes. Advanced applications
and Patient Injury Prevention Processes
• Cost outcomes. Ordering waste, workflow
waste and defect waste

Heart
Rhythm
Disorders
Vascular
Disorders
Ischemic
Heart
Disease
Heart
Failure
CARDIOVASCULAR
Care Process
Families
Clinical
Program
ICD9 Volumes I-II
17,674
Diagnosis Codes
ICD-9 Volume III
3,903
Procedure Codes
2013 CPT®
Code Set
9706 Codes
CPT-4
Code Groupings
ICD9 Procedure
Code Groupings
ICD9 Diagnosis
Code Groupings
Care
Processes
Valve
Disorders
CHF
Cardio-
myopathy
Pulmonary
Heart
Disease

Mapping ICD9 Dx to clinical hierarchyPrimaryIC
DDiagnosi ICDDiagnosisDSC ClinicalProgram CareProcessFamily CareProcess TotVarCostAMT
648.91 OTH CURR COND-DELIVERED Women and Newborns Pregnancy Management of high-risk pregnancy 1,380,256.84$
644.21 EARLY ONSET DELIVERY-DEL Women and Newborns Pregnancy Management of high-risk pregnancy 1,177,045.05$
659.61 ELDERLY MULTIGRAVIDA-DEL Women and Newborns Pregnancy Management of high-risk pregnancy 1,168,355.92$
642.32 TRANS HYPERTEN-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 1,020,221.38$
642.41 MILD/NOS PREECLAMP-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 908,276.75$
642.51 SEVERE PREECLAMP-DELIVER Women and Newborns Pregnancy Management of high-risk pregnancy 906,969.56$
648.81 ABN GLUCOSE TOLER-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 837,075.90$
658.11 PREM RUPT MEMBRAN-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 808,349.85$
658.23 PROLONG RUP MEMB-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 596,809.84$
648.93 OTH CURR COND-ANTEPARTUM Women and Newborns Pregnancy Management of high-risk pregnancy 590,661.91$
656.53 POOR FETAL GRTH-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 544,525.63$
649.03 TOBACCO USE DIS-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 510,959.65$
648.21 ANEMIA-DELIVERED Women and Newborns Pregnancy Management of high-risk pregnancy 395,594.30$
646.83 PREG COMPL NEC-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 363,172.67$
642.71 TOX W OLD HYPERTEN-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 352,317.40$
642.02 ESSEN HYPERTEN-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 345,091.13$
V23.89 SUPRV HIGH-RISK PREG NEC Women and Newborns Pregnancy Management of high-risk pregnancy 332,141.48$
658.03 OLIGOHYDRAMNIOS-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 307,153.00$
656.61 EXCESS FETAL GRTH-DELIV Women and Newborns Pregnancy Management of high-risk pregnancy 303,155.43$
648.02 DIABETES-DELIVERED W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 259,335.69$
655.83 FETAL ABNORM NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 246,455.47$
659.53 ELDER PRIMIGRAVID-ANTEPA Women and Newborns Pregnancy Management of high-risk pregnancy 244,258.48$
644.03 THRT PREM LABOR-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 241,969.46$
648.42 MENTAL DIS-DELIV W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 198,240.68$
644.13 THREAT LABOR NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 180,973.69$
678.03 FETAL HEMATOLOGIC-ANTE Women and Newborns Pregnancy Management of high-risk pregnancy 179,887.38$
652.63 MULT GES MALPRES-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 172,157.76$
644.03 THRT PREM LABOR-ANTEPART Women and Newborns Pregnancy Management of high-risk pregnancy 168,240.11$
764.96 FET GRWTH RET 1500-1749G Women and Newborns Pregnancy Management of high-risk pregnancy 167,934.27$
655.83 FETAL ABNORM NEC-ANTEPAR Women and Newborns Pregnancy Management of high-risk pregnancy 167,045.46$
649.32 COAGULATN DEF-DEL W P/P Women and Newborns Pregnancy Management of high-risk pregnancy 164,740.85$

19
Clinical Programs
Relative size (455 care processes)
Hem-
Onc GI CV
Gen
Med
W&NMusc RespNeuroSurg Comm
Peds
Spec
Beh
Inpatient
Outpatient
Series

ICD Patient Registries
Foundational and discovery apps
CLINICAL INTEGRATION HIERARCHY
Care
Process
Families
Care
Processes Total Variable Cost
CARDIOVASCULAR
Ischemic heart disease 1
Coronary artery disease 1 20,354,043.06$
Acute myocardial infarction 1 16,271,150.87$
Chronic ischemic heart disease 1 2,603,804.78$
Totals 1 3 39,228,998.71$
Vascular disorders 1
Aortic aneurysm and dissection 1 9,975,878.61$
Vascular insufficiency - extremities 1 9,680,024.62$
Venous phlebitis, thrombosis, embolism 1 6,861,044.17$
Complication of vascular device, implant or graft 1 3,922,582.89$
Other vascular or lymphatic disorders 1 3,392,116.22$
Vascular insufficiency - intestines 1 2,748,775.13$
Arterial embolism and thrombosis 1 1,425,285.88$
Aneurysm and dissection except aorta 1 941,468.22$
Totals 1 8 38,947,175.74$
Heart failure 1
Congestive heart failure 1 18,591,198.70$
Cardiac valve disorders 1 9,232,012.97$
Cardiomyopathy and myocarditis 1 2,512,491.38$
Pulmonary heart disease 1 1,393,951.25$
Totals 1 4 31,729,654.30$
Heart rhythm disorders 1
Atrial fibrillation and flutter 1 7,943,076.82$
Cardiac rhythm device insertion, revision, replacement or removal1 2,872,634.31$
Conduction disorders 1 2,764,910.95$
Other dysrhythmias 1 4,340,898.91$
Ventricular tachyarrhythmias 1 2,866,885.63$
Totals 1 5 20,788,406.62$
Other cardiovascular diorders 1
Complication of cardiovascular device, implant or graft 1 3,809,826.99$
Disorders of the endocardium 1 1,036,527.10$
Disorders of the pericardium 1 1,260,923.96$
Hypotension 1 1,623,867.20$
Other cardiovascular findings and anomalies 1 457,535.73$
Totals 1 5 8,188,680.98$
Heart and lung transplants 1
Heart transplant 1 1,345,601.35$
Lung transplant 1 1,418,317.86$
Totals 1 2 2,763,919.21$
Cardiovascular diagnostic testing and pre-operative assessment1
Pre-procedural CV exam 1 1,691,636.46$
Abnormal CV diagnostic study 1 379,488.76$
1 2 2,071,125.22$
GRAND TOTALS 5 19 143,717,960.78$

Operational ContentPopulation Management Content Patient Injury Prevention Content
Shared
FrameworksAvailable
Newly Released
or Enhanced
2014
Roadmap
Platform
Components
Comorbidity Analyzer & Content
Readmission Explorer
Source Mart Mapping Content
Ambulatory EMR, Professional
Billing, Time Card, Human
Resources, Accounts
Receivable, Supply Chain,
Claims
Atlas
IDEA
Security and Auditing
Metadata Core
Additional
Source Marts
as necessary
Source Mart Designer & Patterns
SAM Designer & Patterns
Product
Components
EMR, Patient
Billing, Costing,
General Ledger,
Patient SatisfactionHosting Infrastructure & Services
CAFÉ De-identification Infrastructure
EDW Console
Common Linkable Identifiers
EDIT—Executive Dashboard Integration Tool
Clinical Content Framework
Severity Risk Models
*CAFE—Comparative Analytics Framework and Exchange
Essentials Layer Mapping Content
Patient-Provider Attribution ModelerClinical Hierarchies
Visualization & Architectural Frameworks
Essentials Layer Definitions Statistical Framework-Metric Correlation Framework
Workflow Content Framework
Patient Injury Prevention Content
Framework
FinancialAccountable
Care
GL Explorer
Financial Management Explorer
Key Process Analysis CORUS: Real Time Location Services Integration CORUS: Predictive Staffing Models
CORUS: Activity Based Terminology Mapping CORUS: Clinically Driven Activity Based Costing
Revenue Cycle Explorer CORUS: Clinically Driven Revenue Cycle
Cohort Builder
Accountable Care Organizational Plan Participating Provider Srv Agr Templates Payer Market Analyzer Patient Analytics & Communication
Wholesale Contract Network Access
Agreement
Disease Density Explorer Risk Allocation (Reinsurance) Modeler
Service Area Explorer ACED Accountable Care Executive Dashboard Risk (Severity Level) Explorer Cohort Driven “Underwriting” Modeler
Member Satisfaction Explorer Risk/Reward Allocation Modeler Patient Leakage Care Management Planner
Essentials
Application
Population Explorer Admin Patient Registries
Precise Patient RegistriesReadmission Predictor
Mental HealthDeployment Templates
Pediatrics SpecialtyRespiratory
OncologyGI
SurgeryWomen & Children
MusculoskeletalCardiovascular
NeurosciencePrimary Care
Application
Suite Patient Flow Explorer Patient Satisfaction
Labor Management Exp Supply Chain Explorer
A3/Value Stream MapsOhio C
External & Regulatory
PM: AppointmentsInvasive
PM: Prof BillingAcute Medical
PM: Patient AccessAmbulatory
PM: Orders and ReferralsTherapeutic (Rx, Resp)
Practice ManagementDiagnostic (Lab, Path)
Patient Safety Explorer
Pressure Injury Falls (S, A, C)
Patient/Procedure ControlGlucose Management
Venous ThromboembolismTransfusion
CLABSI
Parenteral Nutrition
TPN)
Surgical Site InfectionsRX: Electrolytes
CAUTIRX: Fluids
VAPRX: Medications
InfectionsSubstances
Patient Flight Plan Predictor
A3/Value Stream Maps
Specialty Clinics
US N&W

Key Process (Pareto)
Analyses
22

23
Top 10 Care Process
Families account for
34% of the opportunity
Top 40 Care Process
Families account for over
80% of the opportunity
X-Axis = Care Process Families by resources consumed (High to Low)
Y-Axis=Percentoftotalresourcesconsumed
Key Process Analysis (IP+OP)

Key Process Analysis (Pareto sort)
Care
Process
Families
Care
CARDIOVASCULAR
Totals 1 3 39,228,998.71$
Totals 1 8 38,947,175.74$
Heart failure 1
Totals 1 4 31,729,654.30$
Totals 1 5 20,788,406.62$
Totals 1 5 8,188,680.98$
Totals 1 2 2,763,919.21$
1 2 2,071,125.22$
GRAND TOTALS 5 19 143,717,960.78$
Pareto Care Processes
Pareto ICD
Registries
All ICD
Registries

Cardiovascular Clinical Program

Poll questions
How well prepared do you feel your organization is
to:
• Use patient registries and key process analysis as
important elements in prioritization of improvement
initiatives? (five-point scale)
• 5 – Very Prepared – 7%
• 4 – 18%
• 3 – 28%
• 2 – 33%
• 1 – Not Prepared – 13%

Pricing based on
disease density and
severity of illness
27

Disease Density and
Severity Level Explorer
28

Disease density analysis
• Use ICD patient registry groupings to analyze third-
party payer populations to determine the “density” of
disease by Clinical Program, Care Process Family and
Care Process
• Determine organizational readiness to address care
improvement opportunities highlighted by the patient
registry groupings analysis
• Use output from the disease density analysis of claims
data as the starting point for risk (severity level)
stratification

Risk (severity level) analysis
• Apply a risk stratification framework (e.g., Charlson-
Deyo comorbidity analysis, CMS-HCC) to the disease
registry populations highlighted in the claims-based
disease density analysis
• Compare a statistical sample of historical data from
delivery system data sets (inpatient facility, outpatient
facility, clinic care) to the claims-based disease registry
data (drill down) to project cost of care
• Determine whether to include or exclude statistical
outlier cases for each disease registry sub-population

Financial risk
allocation
31

Excellent Outcomes Poor Outcomes
# of
Cases
Mean
Excellent Outcomes
# of
Cases
Poor Outcomes
Bring cases above the mean down to the mean
• Strategy. Use content and analytics to develop value-based guidelines and
protocols to reduce inlier variation
• Implementation. Work with clinicians to use these value-based guidelines
and protocols to bring the cases above the mean down to the mean
Approach: “Tighten the Curve and Shift it to the Left”
Focus on “inlier” management

Financial risk allocation
Contract for coverage of outlier risk. Health systems
should consider contracting for some type of reinsurance
to cover stochastic events (outlier risk management)
• Alternative #1: Contract with each third-party payer to assume
risk for outliers as a part of the Network Access Agreement;
or
• Alternative #2: Contract with one reinsurer across all Network
Access Agreements to cover outlier risk
• As a new line of business within their captive medical malpractice
reinsurer (GPO?)
• With a third-party payer such as Aetna
• With a traditional reinsurer such as Employers Re

Network Access
Contracting
34

Network access agreements
Wholesale contracting. A Network Access Agreement
specifies the terms and conditions between a health care
financing sponsor and the AC provider network
• Leases the AC provider network to the payer
• Defines the nature of the payment relationship; e.g.,:
• Bundled per case
• Population-specific capitation (capitation by disease registry)
• Global capitation
• Specifies the nature of financial risk allocation (e.g.,
outlier trim points) and the reinsurance treaty (if any)

Network access agreements
Contracting strategy. Contracting negotiations could be
informed by data-driven criteria, such as:
• Volume. How much volume does the payer have to
drive to the AC provider network?
• Directability. How strong is the payer’s health benefit
program gradient (delta between plan payment for in-
network vs. out-of-network services)
• Alignment. What proportion of the network offered to
members of the payer’s plan does the AC provider
network represent? (i.e., How exclusive is the contract
with the AC provider network?)

Poll question
• How well prepared do you feel your organization is to
evaluate the risk of sharing financial responsibility for
managing defined populations of members/patients?
(five-point scale)
• 5 – Very prepared – 2%
• 4 – 15%
• 3 – 37%
• 2 – 33%
• 1 – Not prepared – 12%

Quality, Safety
38

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Home
(Patient Portal)
* To Invasive
Care Processes
Clinic Care
Non-recurrent
Clinic Care
Chronic
Acute Medical
IP Med-Surg
Acute Medical
IP ICU
Invasive
Medical
Invasive
Surgical
Diagnostic Work-up
Bedside care
Triage to Treatment Venue
Substance
Preparation
Invasive*
Subspecialist
Chronic
Disease
Subspecialist
Screening & Preventive Symptoms
The Anatomy of Healthcare Delivery
Procedure
Indications for Intervention
Diagnostic algorithms
Indications for Referral
Triage Criteria
Preventive, Diagnostic,
Triage and Clinic Care,
Algorithms; Referral &
Intervention Indications
Population
Utilization
Knowledge Assets
Treatment and
Monitoring
Algorithms
Treatment and Monitoring Algorithms
Health Maintenance and
Preventive Guidelines
Substance Selection
Substance Selection
Clinical Supply Chain Management
Admission Order SetsAdmission Order Sets
Supplementary Order Sets
Pre-Procedure Order Sets
Post-
procedure
Order Sets
Discharge
Bedside care practice guidelines, risk
assessment and patient injury prevention
protocols, bedside care procedures,
transfer and discharge protocols
Standardized
Follow-up
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Management of Acute
Medical, Invasive & Post-
Acute Care Modules
Per Case
Knowledge
Assets
Clinical ops procedure guidelines and
patient injury prevention
Post-procedure Care

Quality:
Population Health
Advanced Applications
40

Focus on the “Golden Few”
Care
Process
Families
Care
CARDIOVASCULAR
Totals 1 3 39,228,998.71$
Totals 1 8 38,947,175.74$
Heart failure 1
Totals 1 4 31,729,654.30$
Totals 1 5 20,788,406.62$
Totals 1 5 8,188,680.98$
Totals 1 2 2,763,919.21$
1 2 2,071,125.22$
GRAND TOTALS 5 19 143,717,960.78$
All ICD
Registries
Pareto ICD
Registries

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Population Health
Advanced Applications
Mapping admin
codes to clinical
hierarchy
ICD patient
registries
Key Process
Analysis
Precise patient
registries (add
clinical rules)
Care Process
Models for Pareto
Care Process
Families
AIM statement
starter sets
Improvement
initiative
knowledge
assets
Process and
outcome metrics
& visualizations

Heart Failure Care Process Model

Heart
Rhythm
Disorders
Vascular
Disorders
Ischemic
Heart
Disease
Heart
Failure
CARDIOVASCULAR
Care Process
Families
Clinical
Program
Valve
Disorders
CHF
Cardio-
myopathy
Pulmonary
Heart
Disease
Care
Processes
Systolic
Dysfunction
Diastolic
Dysfunction
Improvement
Initiatives
Anatomy of Healthcare
Delivery Goals
(e.g., Beta blocker Rx)
Regulatory and
Accreditation Goals
(e.g., HF readmits)
Aim
Statement
Packets

Heart Failure
Advanced Application

Safety:
Patient Injury
Prevention Applications
46

Hospital-Acquired
Condition (HAC)
cohorts
Analysis of
frequency, costs,
potential savings
Patient injury
Improvement initiative process
Criteria for PIPP
intervention
identified
Care units
identified to
which PIPPs
apply
PIPP surveillance
process,
outcome metrics
& visualizations
AIM statement
starter sets
PIPP intervention
protocol starter
sets
Patient Injury
Prevention
Process (PIPP)
starter set maps

Patient injury – CMS HAC registries
• Ventilator-associated pneumonia
(VAP)
• Adverse drug events (ADEs)

Condition Estimated cost
% of
Total Cum % Cases Cost/Case
Vascular Cath-Assoc Infection 405,299,703$ 51.9% 51.9% 2318 174,849$
Pressure Ulcers Stages III and IV 96,917,626$ 12.4% 64.3% 402 241,089$
Iatrogenic Pneumothorax 89,402,081$ 11.4% 75.8% 747 119,682$
Falls and Trauma 67,772,069$ 8.7% 84.4% 1134 59,764$
Cath-Assoc Urinary Tract Infection 59,991,394$ 7.7% 92.1% 720 83,321$
Surgical Site Infection 37,792,448$ 4.8% 97.0% 233 162,199$
Venous thromboembolism (VTE) 8,544,237$ 1.1% 98.1% 204 41,884$
Manifestions of Poor Glycemic Control 6,561,973$ 0.8% 98.9% 119 55,143$
Foreign Object Retained After Surgery 6,347,387$ 0.8% 99.7% 110 57,704$
Air Embolism 1,395,845$ 0.2% 99.9% 13 107,373$
Blood Incompatability 849,397$ 0.1% 100.0% 6 141,566$
780,874,160$ 6,006 130,016$
Cost estimated from gross charges based on cost to charge ratio = 0.254); Savings calculated from cost of DRG with HAC subtracted
from average cost of DRG (for MS-DRGs and HAC with at least 5 cases). Estimated cost per case for all cases in California =
$12,700 (3.7 million cases). Michael Dietzel analysis.
Estimated cost of defects
2011 OSHPD data

Approach to patient injury prevention
Approach and tools to reduce patient injury
Define for each type of defect a Patient Injury
Prevention Process (PIPP).
● Cohort of patients to be screened because they may be at risk
● Screening criteria/tool (e.g., Braden Scale) to define patients
who are at risk
● Clinical operations protocol to be implemented with at-risk
patients to prevent injury
● Tracking system to detect injuries and near misses
Regard patient injury as a “process failure” to
be subjected to root-cause analysis rather than
an “incident” to be reported

CLABSI prevention

CLABSI prevention
“A-3” for process redesign

CLABSI prevention – tracking

Poll question
• How well prepared do you feel your organization
is to demonstrate with dashboards and outcomes
reports your proficiency in quality and safety to
third-party payers? (five-point scale)
• 5 – Very prepared – 9%
• 4 – 23%
• 3 – 19%
• 2 – 36%
• 1 – Not prepared – 13%

Cost
(waste reduction)
55

56
PHM waste reduction construct
Population
Utilization
WastePer capita management
(population focus)
Sample Metrics
Admits/1000 members
IP days/1000 members
OP visits/1000 members
Procedures/1000 members
ED visits/1000 members
Readmissions/1000 members
Per Capita
Waste
Population
Utilization
Knowledge Assets
Per case management
(individual patient focus)
Per Case
Utilization
Waste
Sample Metrics
Cost/visit
Cost/case
OR minutes
L&D hours
LOS
# of comorbidities
Per Case
Waste
Acute Medical, Invasive &
Post-Acute Care Modules
Per Case
Knowledge
Assets

Ordering Waste Workflow Waste Defect Waste
Ordering tests, care,
substances and
supplies that do not add
value
Variation in efficiency of
delivering tests, care
and procedures ordered
Patient injuries incurred
in delivering tests, care
and procedures ordered
57
Three forms of waste

Population ordering
waste reduction
58

Home
(Patient Portal)
* To Invasive
Care Processes
Clinic Care
Non-recurrent
Clinic Care
Chronic
Acute Medical
IP Med-Surg
Acute Medical
IP ICU
Invasive
Medical
Invasive
Surgical
Diagnostic Work-up
Bedside care
Substance
Preparation
Invasive*
Subspecialist
Chronic
Disease
Subspecialist
Sources of population ordering waste
Triage Criteria
Population
Utilization
Knowledge Assets
Substance Selection
Substance Selection
Procedure
Treatment and
Monitoring
Algorithms
Post-
procedure
Order Sets
Discharge
Standardized
Follow-up
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Per Case
Knowledge
Assets
Post-procedure Care

Population ordering waste reduction
Community Care dashboard

Population ordering waste reduction
NTSV C-Section rate with no induction attempt

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Per case ordering
waste reduction
62

Home
(Patient Portal)
* To Invasive
Care Processes
Clinic Care
Non-recurrent
Clinic Care
Chronic
Acute Medical
IP Med-Surg
Acute Medical
IP ICU
Invasive
Medical
Invasive
Surgical
Diagnostic Work-up
Bedside care
Substance
Preparation
Invasive*
Subspecialist
Chronic
Disease
Subspecialist
Sources of per case ordering waste
Triage Criteria
Population
Utilization
Knowledge Assets
Substance Selection
Substance Selection
Procedure
Treatment and
Monitoring
Algorithms
Post-
procedure
Order Sets
Discharge
Standardized
Follow-up
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Per Case
Knowledge
Assets
Post-procedure Care

Per case ordering waste
Appendectomy

Per case workflow
waste reduction
65

Home
(Patient Portal)
* To Invasive
Care Processes
Clinic Care
Non-recurrent
Clinic Care
Chronic
Acute Medical
IP Med-Surg
Acute Medical
IP ICU
Invasive
Medical
Invasive
Surgical
Diagnostic Work-up
Bedside care
Substance
Preparation
Invasive*
Subspecialist
Chronic
Disease
Subspecialist
Sources of per case workflow waste
Triage Criteria
Population
Utilization
Knowledge Assets
Substance Selection
Substance Selection
Procedure
Treatment and
Monitoring
Algorithms
Post-
procedure
Order Sets
Discharge
Standardized
Follow-up
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Per Case
Knowledge
Assets
Post-procedure Care

Workflow waste - surgical services

Workflow waste – surgical services
reduce room turnover
time

IP per case waste reduction opportunity
Facility perspective Per case ordering waste
Per case workflow waste
Per case defect waste
69
$144 MM
~ 23%
Total IP per case waste
$57 MM*
~ 9 %
$87 MM*
~ 14 %
In Progress
< 1** %* Preliminary Findings (work in progress)
** Extrapolated from OSHPD and CMS data
DRAFT

Defect waste
reduction
70

Defect waste reduction
CMS’s establishment
of penalties weighted
by measurement
domain creates an
incentive to choose
CLABSI and CAUTI
improvement initiatives
(65% of total)
71

Focus on workflow/defect waste

Summary
73

Retail Marketing
Access, Satisfaction:
Optimize: 1) coverage
of the service area by
the AC network; and 2)
member/patient
satisfaction
Quality, Safety:
Improve clinical and
patient safety
outcomes
Cost:
Provide care at the
lowest necessary
cost
Pricing:
Negotiate “price”
based on clinical
registry assessment
of disease density
and severity

Questions and Answers
Building a Data Warehouse and Analytics Strategy
from the Ground Up
Date: June 11th 1-3 pm ET
Presenter: Eric Just and Mike Doyle, Health Catalyst
Register at http://healthcatalyst.com/
Healthcare Analytics Summit
Join top healthcare professionals for a high-powered analytics
summit using analytics to drive an engaging experience with
renowned leaders who are on the cutting edge of healthcare using
data-driven methods to improve care and reduce costs.
Date: September 24th-25th
Location: Salt Lake City, Utah
Save the Date: http://www.healthcatalyst.com/news/healthcare-
analytics-summit-2014
For Information Contact: david.burton@healthcatalyst.com

Follow Us on Twitter #TimeforAnalytics 76
Obtain unbiased, practical, educational advice on
proven analytics solutions that really work in healthcare.
The future of healthcare requires transformative thinking
by committed leadership willing to forge and adopt new
data-driven processes. If you count yourself among this
group, then HAS ’14 is for you.
OBJECTIVE
MOBILE APP
Access to a mobile app
that can be used for
audience response and
participation in real time.
Group-wide and individual
analytic insights will be
shared throughout the
summit, resulting in a more
substantive, engaging
experience while
demonstrating the power
of analytics.

Chronic condition management
Primary Care Physician
ChronicDisease
Sub-specialist
Medical Assistant
Generalist
CareManagers
(RN,Beh)
Specialist
CareManagers
(RN,Beh)
MD
and/or
APC
Clin Ops
Behavioral

78
PHM waste reduction construct
Population
Utilization
WastePer capita management
(population focus)
Sample Metrics
Admits/1000 members
IP days/1000 members
OP visits/1000 members
Procedures/1000 members
ED visits/1000 members
Readmissions/1000 members
Per Capita
Waste
Population
Utilization
Knowledge Assets
Per case management
(individual patient focus)
Per Case
Utilization
Waste
Sample Metrics
Cost/visit
Cost/case
OR minutes
L&D hours
LOS
# of comorbidities
Per Case
Waste
Per Case
Knowledge
Assets

Accountable Care Transformation Framework

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