COMMUNICATING WITH ANALYSTS

2

Sought-for information in a useable format is rarely close at hand

Analysts are a valuable resource to find it

So, accurate communication with analysts regarding information needs is key

WHY ARE WE TALKING ABOUT THIS?

3

TMA/WISDOM

Recognize this Scenario?

You ask your analyst: “Would you please pull some data on how much care we provide to active-duty personnel?”

He or she says, “Sure,” writes a Business Objects query to extract M2 data, and provides the results to you.

You note that the results don’t include outpatient care, which you wanted.

So the analyst modifies the query to include outpatient care, reruns it, and delivers the updated results.

4

TMA/WISDOM

Recognize this Scenario? (2)

You look at the updated results and ask: “How much of this care was for the Navy afloat population?”

The analyst says, “I didn’t know you wanted the afloat population; I’ll run it again.” It’s Friday afternoon.

What happens Monday morning?

What’s going on here?

5

TMA/WISDOM

Problem Identification/Definition

Einstein is quoted to the effect that, if he had an hour to save the world, he would spend 55 minutes defining the problem and only 5 minutes solving it.

The point, …

The quality of our solution is dependent upon how well we define the problem we are trying to solve. Often, sufficient time spent defining the problem leads directly to its solution.

OBJECTIVES

1. Coordinate and communicate using clear and feasible questions.

2. Understand how M2 can help and also what it can’t do.

3. Provide the clinical, technical, or other “meat” needed to define the problem and interpret results.

4. Foster free and open dialogue with the analysts.

5. Balance rigor, need, and cost of gathering needed information

6

CLEAR AND FEASIBLE QUESTIONS

7

In the absence of guidance, the likely default for an analyst is to provide results in counts with no restrictions on data.

But, management may have made other assumptions about the desired information.

To be clear, the data request should include specific outcomes desired and restrictions or boundaries on applicable dimensions of the problem.

CLEAR AND FEASIBLE QUESTIONS

8

TO BE FEASIBLE. . .

•Data must be available

•The analyst must have enough time to construct the query

•M2 architecture must allow for addressing the issue. (more later)

HOW ABOUT THESE QUESTIONS?

9

• How many Active Duty beneficiaries live near our base?

• What are we spending on enrollees in our area?

• Where do beneficiaries around here go for outpatient care?

• What types of care are most often provided in the civilian network?

Dimensions for Clarifying Questions

10

Level of Aggregation

Encounter types

Type of carePayment categories

Care setting

Beneficiaries

Geography

Timeframe

Perspective

Costs

Workload measures

11

Perspective

Should I be looking at such questions from the:

• Beneficiary Perspective (where the beneficiaries reside)?

• Plan Perspective (to what plan and where beneficiaries are enrolled)?

• Provider Perspective (where the care is delivered)?

“What are we spending on enrollees in our area?”

12

Perspective (Plan/Provider)

1. Care I provide for my Enrollees.

2. Care other MTFs provide for my Enrollees

3. Care the Contractor provides for my Enrollees

4. Care I provide for other Enrollees• Other MTF Enrollees• Contractor Enrollees

5. Care I provide for unenrolled beneficiaries• MERHCF• Other

Martin ACH Other MTF MCSC TOTALPRIME

Benning 1,556.2 111.8 2,188.8 3,856.8Other MTF 100.4

MCSC 58.3NON-PRIME

Non-MERHCF 620.3Reliant 357.5Other 262.8

MERHCF 173.4PLUS 140.9Other 32.5

TOTAL 2,508.6

ENROLLMENTTREATED

13

FY11 RWPsMartin ACH, Fort Benning, GA

Row: Martin ACH Plan Perspective

Col: Martin ACH Provider

Perspective

14

Timeframe

Annual or monthly data? (check for completeness)

Would CY work better than FY?What do you mean by “recent?”

Most recent month?Most recent complete year?

For time trends:How far back should we go?Seasonality?Programmatic or data changes during the period of

interest? (e.g., CY07 E&M, CY11 PE RVU changes)

“Pull me recent data for _____.”

15

Geography

Geographical constructs:PRISMCatchment AreaMTF Service AreaMarket AreaMulti-Service Market Area (MSMA)

MTF parent-child relationships (local versus remote)

OCONUS included?Level of aggregation for results?

“Where do beneficiaries around here go for outpatient care?” “Report workload for the NCR.”

Caution on changing

parent/child relationships over

time!

16

Impact of Geographical Constructs

“Please get script counts for the BAMC area.”

"Geographical" Construct Direct Care Retail TotalProvider Catchment 0109 (BAMC) 1,380,507 686,694 2,067,201PRISM 0109 750,730 307,304 1,058,034Beneficiary Catchmemt 0109 1,303,532 659,382 1,962,914Market Area 109 2,412,377 1,288,799 3,701,176MTF Service Area 0109 807,974 377,004 1,184,978Treatment DMIS 0109 1,125,731 1,125,731Enrollment Site Parent 0109 794,841 119,010 913,851

FY11 PDTS Script Counts (Source System D or M)

17

Impact of Geographical Constructs

“What is the ambulatory case-mix (RVUs per Encounter) for Evans ACH?”

18

Beneficiary Designations

Do we want eligibles or enrollees?

Which beneficiary categories should we include?

Do we want all age groups?

For “Active Duty”:Is Guard/Reserve included?

What about the non-DoD Uniformed Services?

How should the results be summarized?

“What are we spending for care of our beneficiaries? Report Active Duty separately.”

19

Beneficiary Designations

Do you mean all Enrollees or “our” Enrollees?If “our” Enrollees, do you mean:

… to our hospital?… including those at our child clinics (local; remote)?

Do you want to include our costs for Enrollees to other MTFs or the Contractor?

Should we include Plus as well as Prime?I heard some always include Reliants in with

Prime, should we do that in this case?Should we include Navy afloat?

“What are we spending on Enrollee care”

20

Beneficiary Designations

21

Care Setting

Direct care:Include Army, Air Force and Navy sites only (e.g., exclude Coast Guard clinics)?Include DHP sites only (e.g., exclude line units, VA, civilian settings)?

Purchased care:Distinguish “network” from “non-network”?Exclude internal resource sharing (POS=26)?Exclude external resource sharing (partnerships)?For ambulatory, do we include/exclude Offices, Outpatient Hospitals, ERs, ASCs, etc.?

“How many visits & dispositions were there in FY11 for all MTFs?” “What was spent last year on inpatient care

in the network?”

22

Payment Categories

Should MERHCF be included?

What about claims with OHI payments?

Do we include supplemental care?

What about those SIDRs, CAPERs or TEDs that we find for USFHP enrollees?

“What are we spending on retiree healthcare?” “What is the cost per RVU downtown?”

ACV Group MS-RWPsPaid per

RWP MS-RWPsPaid per

RWP MS-RWPsPaid per

RWP MS-RWPsPaid per

RWP MS-RWPsPaid per

RWP

Prime 110,818 $7,211.53 104,497 $6,258.47 6 $739.44 14,196 $672.35 229,518 $6,372.97

Plus 46 $4,531.05 535 $5,482.93 28,411 $695.18 93 $2,265.89 29,084 $794.23

Reliant 7,940 $7,242.43 45 $6,014.31 7,985 $7,235.49

Other 46,265 $6,860.70 83,823 $4,678.85 472,783 $698.19 25,369 $784.92 628,239 $1,686.64

Grand Total 165,068 $7,113.95 188,900 $5,555.27 501,199 $698.02 39,658 $748.08 894,825 $2,909.17

Grand Total

MERHCF Flag

(A) AD/ADFM(N) Other Non-

MERHCF (T) TFL (U) Under 65 MC

23

Payment Categories

FY11 TRICARE Paid per MS-RWP: Acute Care Institutions (TED-I)

24

Type of Care

Should we include Inpatient Professional with Institutional in purchased care?

Should PC data be restricted to Acute Care facilities only?

Should mental health be included?How do we define an ER encounter?

Visits, services, line items?ER identified by E&M/Critical Care codes or place of

service or both?Should Drugs (PIC=D) and ancillary from TED-N

be included?

“What are we spending for Inpatient Care in the MTF vs. purchased care?” “How many civilian ER encounters were there for our Enrollees

in 2010?” “What procedures are we doing for OB/GYN?”

25

Type of Care

What do you mean by “procedure”?CPT codes?

E&M included?Surgical only?

ICD-9 procedure codes

How should we define a specialty area such as OB/GYN?Major Diagnostic Category?Range of DRGs?Diagnosis or Diagnosis Group?Product LineFor Direct Care, MEPRS code?Provider Specialty?

26

Direct Care Professional Encounters

Discourage concept of visit or count visit, suggesting encounters or appropriate RVUs instead

Consider MEPRS-B only? What about FBI/FBN?

Report by Compliance Status? Include Inferred?

Should Telephone Consults be included?

Should analysis be restricted to selected provider types? (e.g. what about encounters for General Duty Nurses and Corpsmen?)

“Please pull monthly visits in Primary Care for the past two years”

27

Workload

What inpatient measures do you want?Admissions/Dispositions?

Bed Days (for claims, if no admissions – home health, hospice, etc. – exclude bed days from ALOS calculations or restrict analysis to acute care only)

RWPs or MS-RWPs

Exclude DRGs 469/470, MS-DRGs 998/999?

“Is our workload increasing or decreasing” “How does ALOS compare for direct & purchased care?” “What’s

happening to market share?”

HINT: If asked to pull RWPs, pull dispositions and bed days also. Why?

28

Caution on TED-I Institution Type

29

Workload

Which outpatient measures do you want?Visits or Count Visits? (hopefully not)

Encounters?

RVUs – which ones (Work, Practice, Enhanced measures)?

APG or APC weighted workload for institution portion?

For Direct Care should we include telephone consults or report separately?

What about pharmacy workload (script/refill counts, days of supply)?

30

Impact of T-Cons on Workload

31

Costs*

What costs are relevant to the discussion?Direct Care Costs

Should we use Full or Variable costs?Should I use Pharmacy costs from my CAPER data or estimate

from PDTS and report separately?

Purchased CareNote that for purchased care our cost is what we pay.Should only TRICARE Paid Amounts be considered or would

Allowed Amounts make a better comparison?Should we include claims with OHI?Should we consider the amounts paid by patients?

“What is the cost of OB care in our MTF compared to purchased care?”

32

Level of Aggregation

AdviceWhen in doubt, err on the side of lesser levels of aggregation than needed to allow for follow-on investigation.

ExamplesIf you want RWPs, ask for dispositions and bed days

also, so case mix and ALOS can be examinedFor questions where Ben Cat Common (aggregated

counts) might suffice, ask for Beneficiary Category also, so Active Duty vs Guard/Reserve or Other vs Dependents of Retired/Survivors can be separated

If you want worldwide, pull by HSSC Region so OCONUS can be dropped or studied separately

If you want encounter counts, pull by Compliance Status so Inferred can be identified

OPERATIONALIZING DATA REQUESTS IN M2

33

(Typical analyst process)

1. Pick the right data type to answer the question.

2. List conditions for what to include/exclude

3. Pick the data fields necessary to get the right answer

4. Run (execute) the program (query)

5. Manipulate the extracted data to get the right information

6. Prepare data for presentation

OPERATIONALIZING IN M2

34

(WORKS FOR MOST THINGS. . .)

1. DOUBLE-PASS TYPE QUESTIONS

2. DATE ARITHMETIC (WHEN EXTRACTING DATA)

3. DATE WINDOWS CENTERED ON EVENTS

4. “KEEP LAST” TYPE QUESTIONS

5. DATA SET SUBTRACTION IN THE EXTRACTION

6. ANY ANSWER THAT REQUIRES MORE THAN 500K ROWS

M2 IS NOT GOOD FOR:

KNOWING THE DETAILS

• WHAT A RECORD REPRESENTS

• WHAT FIELDS ARE THERE? WHAT DO THEY MEAN?

• WHAT YEARS/MONTHS ARE AVAILABLE?

• WHAT IS MISSING?

• WHAT IS WRONG WITH THE DATA?

• WHAT DO THE CODE SETS MEAN?

35

THE M2 ANALYST MAY KNOW BETTER THAN THE MANAGER, FOR AN M2 DATA TYPE:

KNOWING THE DETAILS

• WHICH DIAGNOSIS CODES WORK BEST?• WHICH PROCEDURE CODES WORK BEST?• WHICH DRUGS OR THERAPEUTIC

CLASSES?• WHICH PROVIDER TYPES?• OTHER RELEVANT CONSTRAINTS OR

NEEDS.

36

THE MANAGER MAY KNOW BETTER THAN THE M2 ANALYST, FOR A GIVEN QUESTION:

COMMUNICATION CHANNELS

37

• IT IS NORMAL TO NEED MORE INFORMATION FOR A QUESTION.

• IT IS NORMAL FOR THE ANALYST TO ASK ABOUT AN UNHEARD OF AREA TO CLARIFY.

• BOTH MANAGER AND ANALYST NEED TO BE COMFORTABLE ASKING QUESTIONS OF EACH OTHER.

• BEWARE OF “HAND-OFF” QUESTIONS THAT CAN’T BE CLARIFIED!

COMMUNICATION CHANNELS

38

• HANDLING “HAND-OFF” QUESTIONS

• MANAGER SHOULD DO THE GUESSING BUT

• ANALYST CAN SUPPLY “EASIEST”

• BOTH MAY ADDRESS “FEASIBLE” AND “PROBABLY MEANT”

• DOCUMENT THE GUESSES; SUPPLY WITH THE ANSWER

THE INFORMATION-COST TRADE-OFF

39

ANALYST EFFORT

QC AND DOCUMENTINGPRECISION

40

ANALYST COST

• CLARIFYING THE QUESTION/ PLANNING THE ANALYSIS

• CAPTURING/EXTRACTING THE DATA

• MANIPULATING/ANALYZING THE DATA INTO INFORMATION

• (MAKING IT PRETTY)

• DOCUMENTING THE METHODOLOGY

• (QC OR PARALLEL PROCESSING FOR VALIDITY)

HOW VALUABLE IS THE INFORMATION?

41

Requestor \ Purpose

Significant Decision

Minor Decision

“Curiosity”

National or Worldwide Power

Very Important

Very Important

Important

Regional Power or Worldwide Player

Very Important

Important Benign*

Local Power or Regional Player

Important Benign Benign

THE MORE VALUABLE THE INFORMATION, THE GREATER THE INFORMATION COST THAT IS

JUSTIFIED.

* THIS COURSE BEGAN WITH A “BENIGN” CASE STUDY.

42

COMMUNICATING WITH ANALYSTS