Presentation to the California Improvement Network
Harnessing the Power of Data to Treat the
January 25 2012
Individual: Archimedes IndiGO
Patrick Herson MDMS FAAFP
January 25, 2012
Peter Alperin MDPatrick Herson, MD MS FAAFP
Ex. Medical Director, South Region
Fairview Medical Group
Peter Alperin, MD
Vice President, Medicine and Products
Archimedes, Inc.p ,
IndiGO: A Tool to Improve Healthcare IndiGO: A Tool to Improve Healthcare Quality and Reduce CostsQuality and Reduce Costs
... a KAISER PERMANENTE Innovation Confidential
Archimedes: The CompanyArchimedes: The Company
l h d l• Healthcare modeling company
• HQ in San Francisco
• Core technology ‐ Archimedes ModelCore technology Archimedes Model– Carefully validated, mathematical model of
human physiology,diseases interventions and healthcarediseases, interventions, and healthcare systems
– In development since 1993
• Owned by Kaiser Permanente– Spun out as independent organization
20062006
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A word about the Archimedes ModelA word about the Archimedes Model• Is a simulation model of physiology, diseases, and p y gy, ,healthcare systems
• Includes a full range of risk factors and variables grelating to diabetes, CVD, and other conditions
• Uses equations to represent physiological pathwaysq p p y g p y• Represents variables as continuous functions of time• Represents multiple conditions in a single modelRepresents multiple conditions in a single model
– CAD, DM and its complications, stroke, HTN, obesity, cancer (breast, colon, lung), asthma,
• Spans a broad range of interventions• Is validated against many clinical trialsg y
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Trials and Studies in Automated Validation Suite
Clinical Trials Epidemiological Studies• ARIC Cohort• ALLHAT
• CPS‐II Nutritional Cohort• Framingham Original Cohort
• ATBC• CARDS• DPP
• Lieberman: Colonoscopy Screening
M di C h t
DPP• Flechtner‐Mors: Diet• HPS
L k AHEAD • Medicare Cohort
• SEATTLE
• WESDR
• Look‐AHEAD• SHEP • TNT • WESDR• UKPDS45• WHI‐DMT
The Model is validated against this set ofThe Model is validated against this set of trials every time it is upgraded/modified. New validations continually being added
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Improving the content of careImproving the content of care
• If we want to improve the quality and reduce the cost of healthcare, we need p q y ,to look at the content of care
• The content of care is determined largely by physicians following guidelines• Current guidelines have inherent limitations because they were designed for• Current guidelines have inherent limitations because they were designed for
use without computers:• Focus on one variable at a time (e.g., BP)
• Ignore other risk factors• Ignore other risk factors
• Use sharp thresholds (e.g., SBP > 140)• Ignore the continuous nature of risk factor
• Example: National guideline for hypertension• Example: National guideline for hypertension• “Treat if SBP > 140, of if have diabetes, treat if SBP > 130
• It is now possible to design more effective guidelines that will simultaneously improve quality and lower costsimprove quality and lower costs
Oversimplification impacts qualityOversimplification impacts quality
Mrs Smith Mr Jones• Age• Height• Weight
Mrs. Smith425’6”244
Mr. Jones455’11”345Weight
• Smoker• Diabetes• History of MI or stroke
244nonono
345nonono
• SBP• DBP• LDL
HDL
1428811661
1388017835• HDL
• FPG• Currently on hypertension meds
6189no
35116no
• Risk of MI or stroke in 5 years 1 2% 7 1%
Who would JNC‐7 treat for hypertension?
• Risk of MI or stroke in 5 years• Absolute risk reduction if lower BP
1.2%0.4%
7.1%2.1%
What can IndiGO do to help?( di id li d id li d )(Individualized Guidelines and Outcomes)
• How IndiGO works• How IndiGO works• Takes into account all pertinent individual health information• Calculates risks of outcomes using the Archimedes Model• Calculates effect of potential treatments on those risks• Calculate side effects and harms• Combines multiple outcome effects into a single benefit score for each• Combines multiple outcome effects into a single benefit score for each
treatment
• How IndiGO can be used• How IndiGO can be used• Identify patients who will benefit but do not qualify for standard
guidelines• Rank interventions for a single patient according to benefit• Prioritize panel of patients according to their total potential benefit• Educate patient on the benefits of treatmentEducate patient on the benefits of treatment
Copyright 2010 Archimedes
Integration with other systemsIntegration with other systems
• Easily integrated with EHR or chronic disease• Easily integrated with EHR or chronic disease registry systems
• Currently integrated into EPIC• Currently integrated into EPIC• Conversations ongoing with Cerner, Allscripts
l f d• Examples of current and past integrations:• At the point of care in EPIC with Fairview Clinics• At the point of care in a chronic disease registry tool with KPWith ti t t l t KP ( d t ti )• With patient portal at KP (under construction)
Inputs of current IndiGO
• Demographics (Age, gender, etc.)• Biomarkers (labs, vitals, etc.)• Behaviors (smoking, etc.)Behaviors (smoking, etc.)• Medical history (h/o MI, stroke, etc.)• Medications: current and previous• Medications: current and previous• Allergies and contraindications
Outputs of current IndiGOOutputs of current IndiGO
Risk of Outcomes Benefit of Interventions• Cardiovascular Disease (CVD)
– MI– Strokeb
• Statins• Anti‐hypertensives
– ACE Inhibitors• Diabetes Onset• Diabetes Complications
– Foot ulcers– Retinopathy
ACE Inhibitors– Beta Blockers– Thiazide Diuretics
Calcium Channel Blockers– Retinopathy• Renal Disease• Cancers
– Breast
– Calcium Channel Blockers– Combinations
• AspirinNi i– Colon
– Lung
• Niacin• HbA1c Reduction• Weight Loss• Smoking Cessation• Exercise• Fish Oil• Cancer Screening
Copyright 2010 Archimedes
Comparison of IndiGO and ATPIII statin id li h i dguidelines: who is treated
ATPIII IndiGO
k k
• ATPIII recommends statins to people with high LDL (blue dots)
Risk
Risk
• IndiGO recommends statins to people based on risk (red dots)
LDL LDL
on risk (red dots)
Copyright 2010 Archimedes
Ways IndiGO can improve careWays IndiGO can improve care
f h• Before the visit– Set priorities for outreach programs
• During the visit– Find high‐risk patients not identified by guidelinesFind high risk patients not identified by guidelines– Prioritize interventions for each patient
• After the visit• After the visit– Members more engaged– Better compliance– More likely to return
Copyright 2010 Archimedes
How IndiGO is being deployedHow IndiGO is being deployed
• In the exam room for use by providers at the point of carep– IndiGO integrated into EPIC
• Being used by care managers to prioritize care• Being used by care managers to prioritize care for populations
• On the web for direct patient access (under construction)construction)
Independent evaluation done by KP Care Management Institute
I d li• Increased compliance– Patients who had a care gap for statins under standard guidelines were 6
times more likely to close the gap after a PCP visit that included IndiGOF hi h i k i id ifi d b I diGO h 7 i i– For high risk patients identified by IndiGO, there was a 7 times improvement in prescription dispenses as compared to EHR and panel support tool alone
• Improved outcomes– A 13% reduction in 5‐year CVD more than EHR and panel support tool alone– For every 1 million members, we estimate 1400 heart and strokes averted
annually
• Significant physician acceptance—all physicians found IndiGO easy to use• High patient engagement• Reduced costsReduced costs
– An estimated $98M saved annually– An ROI in excess of 3 to 1
Copyright 2010 Archimedes
Why did medication uptake improve six‐fold?y p p
Based on anecdotal information we believe there appear to be aBased on anecdotal information we believe there appear to be a number of possible factors
• “Conversation with patient was entirely different”• Conversation with patient was entirely different
• Personalized information is powerful
• Choice and engagement• Choice and engagement
• Positive focus
• Doctors more likely to have conversation because it was more• Doctors more likely to have conversation because it was more likely to be successful
Copyright 2010 Archimedes
IndiGO Demo
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
Copyright 2010 Archimedes
California Improvement Network pPresentation
Engaging Patients: Leveraging care d h l
Patrick Herson MD MS FAAFP
teams and technologyPatrick Herson MD MS FAAFP
Executive Medical Director, South Region
Fairview Medical GroupFairview Medical GroupJanuary 25, 2012
Fairview Medical Group
Located in Minneapolis/St. Paul 7 county area
Multi specialty group practiceMulti-specialty group practice
40+ primary care clinicsp y
500+ total providers (~300 primary care)
1.5M patient visits in 2011
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External Market pressures
Minnesota has a publicly reported quality score• Minnesota has a publicly reported quality score program—Minnesota Community Measurement (MNCM)
• Business Health Care Action Group (BHCAG) has very active major employers pushing for more accountabilityactive major employers pushing for more accountability from payers and provider systems for outcomes, quality and satisfaction
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Internal pressures
Pressure from providers feeling cheated when they do• Pressure from providers feeling cheated when they do not get ‘credit’ for making considerable improvement in patient care but it doesn’t meet guideline cut-off—p ghandling continuous physiological variables with dichotomous end points (pass/fail)
• 40% of primary care pay now based on quality results—has led to ‘quality triage’ behaviorsD i t b i t iti t l ti• Desire to be savvier as we transition to a population based care model.
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Future Requires a New Value ChainImprove quality improve experience reduce costImprove quality, improve experience, reduce cost
Change Care
Creating Value and Outcomes
Consumer Provider
RealizingPatient
Activation and Value
Change Ch Realizing
Economic Return for New
Value
Employer / Plan
Consumer Engagement
Experience
Change Payment
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Value
Change Care: Keeping Patients Healthy with Team-Based Care
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Change payment
F i i h• Fairview has −Shared savings contracts with 4 local payers g p y−Agreement to participate in CMMI Pioneer
ACO program starting January 2012ACO program starting January 2012−Engaged state of Minnesota in dialogue to
t ACO lik i t fcreate an ACO like environment for Medicaid benificiaries
Change the experience
It is critical to engage our patients/members differently to succeed in a world of shareddifferently to succeed in a world of shared savings and capitation
• Archimedes IndiGO pilot in flight• Archimedes IndiGO pilot in flight• Video visits• PAM scores• Team based care modelTeam based care model• Zipnosis
Ideas being contemplated• Gaming technology—for condition specific
education and management• Social Media• Technology to speed check in processgy p p• Tools for patients to enter a lot of clinical
information prior to their visitp• “Watson”-like decision support—this is where
IndiGO fits
IndiGO at Fairview• 2 clinics (NorthEast and Oxboro), and two control clinics
for performance comparison• Total of 18 providers (MD, NP, PA) in the target clinics• More clinics will be added as we complete pilot (3-6
months approximately)• Using tool at the point of care• Clinics have high quality scores for Minnesota
Community Measurement on Diabetes and Vascular Disease with Oxboro being one of the top clinics in theDisease, with Oxboro being one of the top clinics in the State of MN for quality in these areas
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Evaluation of IndiGO at FMG
• How many patients received IndiGO and statistics for those patients: (overall, by clinic and by provider)(overall, by clinic and by provider)
• Summary stats (e.g. avg risk and benefit) • Changes in prescription usage from baseline• Changes in predicted risk from baseline• Estimate of averted events like MI's, strokes, diabetes complications,
etc • Patient satisfaction tested at point of care with questions related to
likelihood to follow through on care plan• Provider and staff satisfaction • Ease of incorporating the Archimedes output as another input for
C3PO conferences.
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