Reclaiming HealthcareThrough Data

Tony Hermann

“Medicine used to be simple, ineffective and

relatively safe. Now it is complex, effective and potentially dangerous.”

Sir Cyril ChantlerFormer Dean Guy’s, King and St. Thomas’

Medical and Dental School,Lancet, 1999

Addressing questions

Healthcare Informatics

• Vision: To provide reliable healthcare-related data, reports and tools to theWEA Trust and other stakeholders at the right time and right place.

• Team– Lori, Brenda, Jared, Tony, and Jeff

– Outside consulting: Data scientists, vendors

• Tools– MedInsight, Data Warehouse, Business Objects,

WHIO, InfoTool, R

Employer Group Report

Defining wellness

• Diabetics getting eye exams, Hgb A1c, foot exam

• All chronic conditions compliant with taking their chronic medications

• Members getting annual checkups

• Incorporating clinical data with claim data for evaluation

Asthma

Diabetes

Examining chronic conditions

What is variation?

• MRI for technical component vary from a billed price of $975 to $3,128 per service

• Why are chest X-ray single view only used 0.9 per 1,000 whereas a two view chest is used 56.8 per 1,000? Which is safer?

• What is your story?

What is appropriate care?

• From Nov. 2013 until June 2014, a patient had 128 Chest X-rays done

• A patient recently had more than 30 heart catheterizations done

• Is it appropriate to only do therapy or wait for an MRI with a stable knee injury?

What are we doing now?

• Reviewing data and acting on it within Provider Network Management and Member Health Services

o Providers

o Procedures

o Populations

o Diagnoses

• Creating new metrics

Anticipatory care: Predictive modeling

How well will our members with diabetes be next year?

What can we do to help them not be hospitalized?

Is there an asthmatic going to the ER soon?

Can we prevent someone from having a heart attack?

Are there alternatives to surgery?

The future of reporting