healthbridge is one of the nation’s largest and most successful health information exchange...
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HealthBridge is one of the nation’s largest and most successful health
information exchange organizations.
An Overview of HealthBridge’s
Shared Data AnalyticsInfrastructure
Randy Woodward
Director, Business Intelligence Systems
March 16, 2012
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“Best of Breed” Partners
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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
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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IBM - Initiate
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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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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
PluralSoft - CareQuotient
Information Domains
People & Organizations
Lab Orders & Results
Medications & Prescription Information
Patient
Provider
Payer
Staff
Facility
Immunization
Radiology & Documents
Referrals & Authorizations
Medical Conditions (Allergies, Family-social-medical history)
Encounters
Appointments
Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography
Revenues (Charges, Grants ..)
Products
Member Enrollment
Medical & Rx Claims
Revenue (Ins. Billing)
Utilization
Provider PayerLegend:
Clinical Observations & Vital Signs (EHR Template/Flow Sheets )
Expenses (Payroll, Supplies, Infrastructure, …)
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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
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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
Diabetes Measures – Sample Chronic Disease - Physical health
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Diabetes Measure Drill Through - Sample
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Patient Scorecard – SampleManaging Comorbidity (physical & mental) + Preventive Care
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Provider Scorecard – SamplePerformance across physical & mental health, Chronic & Preventive Care
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Symmetry™ by
OPTUMInsight(formerly Ingenix)
Overview
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
A complete toolkit for health care management and analytics
Clinical ResourceMeasurement
Risk Assessment andPredictive Modeling
QualityMeasurement
ERG EBMConnect
ETGPEG
PCQ Connect
Provider Measurement & Engagement
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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
Symmetry Suite
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Episode Treatment Groups (ETGs)
Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes 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)
Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes 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
Clinically-relevant – robustly prioritize multiple conditions and co-morbidities
Adoption Over 100 health plans and other
health care organizations covering over 115 million individuals
Episode Risk Groups
Risk score for each individual
Administrative• Age, gender
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Evidence Based Medicine (EBM Connect)
EBM Connect
Claims data• Diagnosis codes• Drug codes• Procedure codes
Administrative• Enrollment records• Laboratory results• Disease registry
Members who qualify for EBM conditions and their compliance
EBM Connect Foundation for quality measurement:
assesses compliance of delivered care with evidence-based medicine and care guidelines
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 drug-to-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)
Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes Claims data,
grouped by episode
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
Procedure Episode Groups
Risk score for each individual
Procedure codes• CPT• HCPCS• NUBC
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Provider Cost & Quality (PCQ Connect)
Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes
Claims data, grouped by episode
EBM Connect
Members who qualify for EBM conditions and their compliance
PCQ ConnectPeer Groups• Attributed episodes of care,
by severity group• Attributed quality measures
– EBM conditions and compliance
Administrative• Enrollment
records• Laboratory results• Disease Registry PCQ Connect
Foundation analysis for physician measurement
Network management Transparency Tiering P4P Centers of excellence
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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
Advantages of PCQs
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Symmetry Applications
Business Application
ETG PEG ERG EBMConnect
PCQ 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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