Presentation at AHIMA on Predictive Modeling given on September 24, 2018: Welcome to the age of data – the revolution has arrived made possible by new sources of data available in every industry and every walk of life. No area has been untouched and we see examples from baseball to the steady stream of customized adverts and content. Big data is improving the utilization of resources, efficiency, capacity, and ultimately access to healthcare. The next frontier is predicting futures. Can we identify the patients that are sickest and mitigate their disease progression? Traditional population health programs have focused on the high utilization patients predicting their progression and applying interventions to improve their health and decrease the costs associated with treating their disease progression. But the analysis of data has its perils risking false discoveries as our unconscious bias impacts our search of these huge troves of data in a modern-day version of “I know the facts, now let’s find ‘em” to “confirm” our facts. But the reality of healthcare and increasing insights into a precision-guided healthcare system it is increasingly clear that no membership population is “average”. The interplay between even a couple of input factors and comorbidities can be very non-linear.

1. @drnic1
Predictive Modeling is Here
Dance with the Dragon of Artificial Intelligence
Nick van Terheyden, MD
Founder & CEO of Incremental Healthcare

2. @drnic1
Conflict of Interest Statement
• The Presenter is Founder and CEO of Incremental Health
• Provides Strategic Guidance and Services to Healthcare
Companies in a Range of Areas including Data Analytics,
Population Health and Personalized Healthcare, Big Data,
Artificial Intelligence
• The Presenter is a Big Fan of the Fantasy Drama: Game of
Thrones

3. @drnic1
Nick van Terheyden, MD Founder & CEO, Incremental Healthcare
AboutMe http://about.me/obiwan
Twitter http://twitter.com/drnic1
LinkedIn http://www.linkedin.com/in/nickvt
Blog http://www.IncrementalHealthcare.com/
FaceBook http://www.facebook.com/drnic1
E-Mail DrNick@IncrementalHealthcare.com
Google Voice (301) 355-0877
Where you can find me

4. @drnic1
Agenda
• Introduction
• Health Declines in the Context of Life
• Undiagnosed Conditions in our Population
• Is Data Analytics in Use Elsewhere
• The Invisible Patient
• Population Targeting
• Questions

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Undiagnosed Silent Preventable Killers
• Uncontrolled hypertension leading cause of
heart disease and stroke
• 1 in 3 U.S. adults (70 Mil) have Hypertension
• 13 million U.S. adults aren’t even aware they
have Hypertension
• 84 million people suffer from cardiovascular
disease - causing about 2,200 deaths a day,
averaging one death every 40 seconds
• 8 million adults have undiagnosed diabetes and
87 million have pre-diabetes

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Your First Dragon
• Drogon - Named after Daenerys' late husband, Khal Drogo

7. @drnic1
Can We Predict the Future

8. @drnic1
But Analytics are Imperfect

9. @drnic1
A Word on Bias
• Reproduce the inherent biases present in the data
they are provided with
• Disproportionately creating a ‘feedback loop’ by
which the predicted outcome simply becomes a self-
fulfilling prophecy
• Models Created with the Bias of the Builders either
intentionally or unintentionally

10. @drnic1 2009 Continua Health Alliance Brigitte Piniewski, MD
0 70
Age
IllnessPre-IllnessWellness
Death
60-80% Lifestyle
Modifiable Health

11. @drnic1
Your Second Dragon
• Viserion - Named after Daenerys' brother, Viserys Targaryen

12. @drnic1
Finding the Invisible
Patient

13. @drnic1
Financial Risk within Populations
Known Risk
We all know this and are effectively managing it.
Members with a significant claims history; and a correspondingly high
risk classification, who will likely utilize significant healthcare resources.
Unknown Risk
We know little about this and are doing little to manage it.
Members with an insignificant claims history, with a correspondingly low
risk classification, who are likely to utilize significant healthcare resources

14. @drnic1
“Unknown” Risk is the Deal Breaker
By 2025, 49% of Americans
Will Have Chronic Diseases
Cost of treatment due to progression from risk to disease in a population of 1000 individuals
1000 individuals
Depression 75
Allergic Rhinitis 56
Hypertension 32
Heart Disease 12
Asthma 7
Type 2 Diabetes 6
Cancer 2
Annual Progression
Risk to Disease
Additional Annual
Cost due to Disease
$325,000
Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, 10/2000

15. @drnic1
Lurking “Unknown” Rising Risk within Populations

16. @drnic1
Lurking “Unknown” Rising Risk within Populations

17. @drnic1
Lurking “Unknown” Rising Risk within Populations

18. @drnic1
Lurking “Unknown” Rising Risk within Populations

19. @drnic1 18
Actionable Management “Unknown” Risk
Current high-acuity members are the most
expensive, with limited risk ROI

20. @drnic1
Turning Information into Knowledge

21. @drnic1
Validation Against Previous Year Experience
CAD HYPERTENSION STROKE
Prevalence
Actuary
prediction
Actual
occurrence
Prediction
2014-2015 Health Member Experience
DIABETES
Tested against national
standards and real
patient populations, and
further verified with
Banner’s own member
data

22. @drnic1
Your Third Dragon
Rhaegal- Named after Daenerys' otherbrother, RhaegarTargaryen

23. @drnic1
Interventional Population Health Management Overview
Targeted Intervention Population and Value
Target Population 2,243
Total Predicted Savings $13,259,153
PMPY Average Savings $5,911
Average ROI 1,078%
Population Description Size
Total 46,320
With usable data 41,068
With clinical intervention potential 28,310
High value T2D/CAD risk factor intervention potential 2,243
Medicare Advantage 2017

24. @drnic1
Interventional PHM: Representative Members

25. @drnic1
Right Patient, Right Time at the Point of Care

26. @drnic1
Massive Multiplayer Online Role Playing Games
(MMRPOG/MMO)
• $31 Billion Market
• League of Legends – 100 Million
• Heroes in World of Warcraft – 70 Million
• WoW $5 Million in Subscription Fees Every Day
• Steam Concurrent Player Peak – 13 Million
• Gaming is Voluntary and Does not Pay
• WoW Average Player 17-22 Hours per week
• WoW Total of 5.93 Million Years of Player Time
– Equivalent to the time taken for the Human species to evolve

27. @drnic1
Final Thoughts
• The BiggestRisk are the Patients We have Not Seen
• Supermarkets KnowMore Aboutour Nutrition than the Healthcare System Does
• Prioritization for the Application ofClinicalResources = Triage
• Innovationand Augmentation ≠ReplacingPeople
• Genomics and the Biome willrevolutionize our DiagnosisandTreatment of Disease –
This Includes Surgery
• We Don’t Go Online– We Live Online

28. @drnic1
Nick van Terheyden, MD Founder & CEO, Incremental Healthcare
AboutMe http://about.me/obiwan
Twitter http://twitter.com/drnic1
LinkedIn http://www.linkedin.com/in/nickvt
Blog http://www.IncrementalHealthcare.com/
FaceBook http://www.facebook.com/drnic1
E-Mail DrNick@IncrementalHealthcare.com
Google Voice (301) 355-0877
Questions

29. @drnic1
Predictive Modeling is Here
Dance with the Dragon of Artificial Intelligence
Nick van Terheyden, MD
Founder & CEO of Incremental Healthcare

30. @drnic1
List of References
• https://www.cdc.gov/features/undiagnosed-hypertension/index.html
• https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/cardiovascular_
disease_statistics_85,P00243
• http://www.espn.com/espnw/news-commentary/article/7577771/stats-created-moneyball
• https://dsapp.uchicago.edu/projects/education/
• https://dssg.uchicago.edu/project/identifying-high-school-students-who-may-not-graduate-on-time/
• http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.725.9316&rep=rep1&type=pdf
• https://www.bbc.co.uk/programmes/b08msdc2
• https://www.channel4.com/news/predictive-policing-tackling-crime-before-it-happens
• http://www.cxotoday.com/story/using-big-data-analytics-to-predict-crime-patterns/
• https://www.independent.co.uk/news/uk/home-news/police-big-data-technology-predict-crime-
hotspot-mapping-rusi-report-research-minority-report-a7963706.html
• https://en.wikipedia.org/wiki/Massively_multiplayer_online_role-playing_game
• https://en.wikipedia.org/wiki/List_of_massively_multiplayer_online_role-playing_games
• http://www.dailydot.stfi.re/debug/pokemon-go-workout-exercise-perk