shc intro slides rev 12.19.2016

SHC Capabilities

The National Minority Quality Forum and the Data Warehouse

• Founded in 1998, NMQF is a non-profit Washington-based, health care research and education organization.

• Seeks to eliminate the disproportionate burden of premature death and preventable illness in racial and ethnic minorities and other special populations through data-driven initiatives.

• Has developed a comprehensive database with over 2 billion patient records used to define disease prevalence, costs, and outcomes for demographic subpopulations at the zip code level.

Sustainable Healthy Communities, LLC

• For-profit extending NMQF outreach• Exclusive publishing rights for NMQF databases, including 15

years+ of analyzed Medicare and Medicaid studies• Mission is to translate data into tools for patients,

community leaders, policy-makers, clinicians, researchers, and innovators to achieve health equity and the triple aim—better care, outcomes, and value.

Health Indices: Map disease by prevalence, cost, outcomes, co-morbidities, socioeconomic status, Rx drug use, payer, environmental/social factors

Advisory Groups: Gain input of leading experts, policy-makers, innovators, and community representatives on data use

Research Support: Examine trends, correlates, and test hypotheses using health index data

Education: Help clinicians, community groups, and patients put health index data into use for better

outcomes – minority-serving clinician networks

Clinical Trial Support: Join nation’s top campaign to encourage diversity in clinical trials—I’M IN, plus trial recruitment services informed by health index data

SHC Products

Examples of Health Indices

Some of Our Partners

Our Leadership Team: Decades of Health Policy, Research, Education, and Quality Accomplishment

Gary Puckrein, PhD, SHC founder and CEO

May-Lynn Andresen, BSN-RN, SHC VP for Patient Engagement

Bernard M. Rosof, MD, MACP, SHC President

Laura Lee Hall, PhD, SHC COO

What Have We Learned? Health Care Market Has Predictable Structure to Guide Resource Management

• Geography Matters: Stable health care consumption patterns exist in specific geographic locales over time

• Predictable Forces Shape the Market: Consumption patterns reflect disease prevalence, patient response to those diseases, practice variation, and health care system structure and function

• Critical Intelligence: This knowledge is stable and predictable, and algorithms can be built that can anticipate consumption patterns.

• The Value Proposition: An understanding of these consumption patterns can improve management of health care resources.

Big Data: Challenges and Solutions

•Volume

•Rapidly changin

g

•Complex

technology

platforms

•Different data sets

•Expert

analysis

required

•Outputs not

always actionable

, understan

dable

CHALLENGES

A SOLUTION

•MAKE IT VISUAL

• Maps provide demographic intelligence about acute and chronic disorders at the zip code level – segmented by age, gender, race/ethnicity – to:

• Map any index disease by prevalence, cost, outcomes, comorbidities, socioeconomic status or other data type for any state, MSA, congressional and state legislative districts

• Define where the unmet needs exist• Forecast trends using predictive analytics• Produce customized reports to support

educational, advocacy and policy efforts

GIS-based Data Visualization

Confidential: For Advisory Board Use Only

Health Index Data in Action: Real-world Examples

Americans Live in 38,000 Zip CodesMost Minorities Live in 7,500

50%of Asian Live in 1,500 Zip Codes 70%of Hispanics Live in 2,500 Zip Codes

70%of Blacks Live in 2,500 Zip Codes 70%of Other Minorities Live in 1,000 Zip Codes

Adult Immunization Index

U.S. Diabetes Index

Zip code Level Identification of PatientsInvestigators, Points of Care, and Trial Sites

Targeting is key

Which Doctors Serve Patients with Diabetes? A Health Index-ACP Member Map

Understand Specific Physicians’ Patient Profile

2013229 Multiple Sclerosis Patients

Ruth Kellum Fredericks, M.D.Neurology971 Lakeland Dr.Suite 657 Jackson, Mississippi 39216-4643Telephone 601-200-2780Fax Number 601-200-5929

BENE_RACE # BENE % Bene All Cause Cost % All Cause Cost All Cause Bene Out of Pocket

% All Cause Bene Out of Pocket

Average Bene Out of Pocket

White 146 64% $1,559,361 64% $494,570 69% $3,387.47Black 81 35% $859,276 35% $220,891 31% $2,727.05Asian 2 1% $17,924 1% $4,122 1% $2,061.14 229 $2,436,562 $719,584

BENE_RACE # BeneMedicare Part B

Payments% Medicare Part B

PaymentsBeneficiary Part B Out of

Pocket% Beneficiary Part B Out

of PocketAverage Beneficiary Out of

PocketWhite 146 $166,947 61% $41,985 60% $1,143.48Black 81 $108,956 39% $27,645 40% $1,345.13Asian 2 $37 0% $10 0% $18.71  229 $275,941   $69,640   $1,204.98

BENE_RACETysabri

intravenous

Pro-C-Dure 5

injection

Solu-Medrol

(PF) injection

dexamethasone sodium phosphate injection

Celestone Soluspan injection

Depo-Medrol

injection

triamcinolone acetonide injection

80 mg IM

Methylprednisolone acetate

20 mg

# of Part B

Medications

# Bene % of Part B Medications

White 51 39 35 24 21 18 10 8 1 207 146 73%Black 36 1 15 5 3 1 11 72 81 26%Asian 3 3 2 1%Total 282 229

Part D Beneficiaries # %

Blacks with CHF On Insulin SMBG 50,902 67%

Blacks with CHF On Insulin No SMBG* 25,326 33%

Total Blacks with CHF On Insulin 76,228  * DME Reimbursements Under $200 per Year

The Power of Data, Research, and Advocacy: Are African Americans with Diabetes and HF Accessing Needed Care with Policy Change?

Beyond Claims Data: National Surveys

Environmental Factors

Advocacy and Resource Distribution

Narrow Your Focus… by the Individual

Patient Characteristics• Age• Gender• Race/ethnicity• Diagnosis• Comorbidity• Health insurance

Provider Characteristics• Demographics• Billing zip code• Patient profile• Rx• Reimbursement profile

Narrow Your Focus… Geographically

• National • State/county• MSA• Zip code• Legislative or school

districts• Individual clinic/provider

Narrow Your Focus… By Social Demographic Clusters

Narrow Your Focus… Key Statistics

• Incidence• Prevalence• Quality of care• Cost• Outcomes

Thank you.

For more information, contact Laura Lee Hall at lhall@shcllc.info