U.S. Department of Health & Human Services Data: How to Use It презентация

it to the masses and let 1000 flowers bloom.

In other words, can these guys use it?

Let’s give it a shot

Liz Young

English major

Working with open health data at RowdMap, Inc.
for about a year

Skier

Born in 1991

now you don’t need a PhD to use this data in a meaningful way …

For mechanics of how to do this:
http://goo.gl/Y64Fa2
Have an Idea? Attend Bootcamp:
HealthCare Entrepreneurs’ BootCamp
Tomorrow , 4:15pm
Lincoln 2-3-4

as a Key Driver (psychographic) - measured by Index scores for:
- Domains (chronic, wellness, quality of care, customer satisfaction, customer service);
Brands (parent org and you individually)

Market Growth; Census; Healthy Food; County Health Rankings & Indicators; Behavioral Health Factors; etc.*

Dartmouth Atlas; STAR; Hospital Compare; Actual, Expected & Predicted Readmissions; Part B & D, etc.*

STAR; Price, Bid, Rebate;
Hospitals, Nursing Homes; Market, etc.*

* Dozens of Primary Data Sets, updated at various frequencies

When we say a lot…we mean a lot.

post acute centers)

Dartmouth Atlas for Unwarranted Variation
(Decades of research and data on unwarranted variation by condition and geography to keep things apples-to-apples for comparisons, hence “Unwarranted” in the name)

New Government
Released Performance Data (Individual providers, groups,
hospitals and post acute centers including the new part B&D)

Provider Pattern Intensity Profiles and Risk Readiness for every provider, hospital, post acute center in the US. All preloaded with no IT.

OPEN DATA –
Particularly powerful when pulled together

Affordable Care Act data to determine
Risk-Readiness of Providers / Networks

has changed- health plans, government payers, providers, and hospital systems need to develop Risk-Readiness SM strategies to excel as they transition from fee-for-service to pay-for value.

(CMS HHS, Gov, CDC)

Chronic prevalence & physician supply
Population Health Report
Population Report Card

Match practice patterns to the right
risk arrangements – PFV Readiness
Group Risk-Readiness SM Report
Physician Risk-Readiness SM Report
Hospital Risk-Readiness SM Report
Post Acute Center Risk-Readiness SM Report
Risk-Readiness SM Arrangement Match-Maker

Manage clinical care and costs –
Remove No Value Care
Group Unnecessary Cost Report
Physician Unnecessary Cost Report
Hospital Unnecessary Cost Report
Post Acute Center Unnecessary Cost Report
Unnecessary Cost Referral and Value Chain Report

(CMS HHS, Gov, CDC)

Chronic Prevalence &
Physician Supply

Match Practice Patterns to the right
Risk Arrangements – PFV Readiness

Manage Clinical Care and Costs –
Remove No Value Care

care management resources around condition-specific population needs by zip. Locate clinics, health fairs, etc. based on chronic needs.

Income

Obesity

Depression

Health Opportunity Index

Demand and Supply

Lots of diabetics but few PCPs

Lots of diabetics and lots of PCPs

What type of populations?

Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE
CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT
Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk

PCP Density –
Westchester

calibrate expectations for profitability by incorporating population health and provider performance into product strategy. Use excess to subsidize operations in counties with fewer high-performing resources

Risk Scores

Total Cost

PMPM Reimbursement

Overall Star

Chronic Star

Health Rank

MA Profit Opportunity - MA

Profit Opportunity - Exchange

MA Eligibles

MA Enrolled

Exchange Subsidized

Exchange
Enrolled

Compare to National and Regional Benchmarks

Medicare FFS Geo. Variation: http://go.cms.gov/1D8j7LE
CDC Behavioral Risk Factor Surveillance: http://1.usa.gov/1PzcisT
Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk

(CMS HHS, Gov, CDC)

Chronic Prevalence &
Physician Supply

Match Practice Patterns to the right
Risk Arrangements – PFV Readiness

Manage Clinical Care and Costs –
Remove No Value Care

Dartmouth Atlas for Unwarranted Variation methodologies to data on Medicare Parts B & D. This research has been repeatedly validated over the last 30 years and we now have a national data set to apply the methodologies at a large scale.

The estimated 30% of medical expense that goes to unnecessary care. This unnecessary spend drives billing in a fee-for-serve economic model, but success in pay-for-value comes from managing and mitigating these pockets
of variation.

Every provider has a unique practice pattern that informs Risk-Readiness SM

Pay for Value Readiness

Profiles

Identify highly efficient, Risk-Ready practices and physicians to profitably grow into. Improve profitability of lower performing practices with large panel sizes through modified arrangements or performance improvement plans.

Medicare FFS Part B: http://go.cms.gov/OCmyoy
Medicare FFS Part D: http://bit.ly/1mGyBxk
Referrals: http://1.usa.gov/1FzoEOV

post acute facilities that hospitals with poor chronic readmits are routing members to?

Pay for Value Readiness

EOL Hosp Days: Which hospitals fewer end-of-life days than their peers?

Chronic Admits: Which hospitals see their most chronic population repeatedly/ with the most frequency?

Cardiac Imaging: Which hospitals are more likely to over-utilize cardiac imaging compared to their peers?

Dartmouth Atlas: http://bit.ly/1GXvlJp
CMS Hospital Compare: https://goo.gl/p8MtoI
CMS Hospital Readmissions: http://goo.gl/02KnQd
CMS Nursing Home Compare: https://goo.gl/3DpT8m

risk

Match appropriate risk arrangements based on
provider practice patterns and
Population characteristics within a geography.

(CMS HHS, Gov, CDC)

Chronic Prevalence &
Physician Supply

Match Practice Patterns to the right
Risk Arrangements – PFV Readiness

Manage Clinical Care and Costs –
Remove No Value Care

spending

Shift focus from clinical edits, audits, and recovery efforts to identifying care that is clinically appropriate, but unnecessary. Historical efforts have shown returns, but they only look at a fraction of total spending. Unnecessary care can account for up to 30% of total spending and provides significantly larger opportunities for cost containment and quality improvement.

Clinically Appropriate,
but Unnecessary Care
(30% of spend)

Claims Spend for a Health Plan

Necessary Utilization
(70%)

“It’s generally agreed that about
30 percent of what we spend on
health care is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”

- Dr. Elliott Fisher,
Dartmouth Institute for Health Policy

health care spend
that goes to clinically appropriate, but unnecessary care

Over $9B in Orange County, CA

How much unnecessary spend is in your market?

Over $66B in Florida

$850 Billion Unnecessary Spend* in 2014

Least Unnecessary
Spend

Most
Unnecessary Spend

RowdMap tackles the 30% of U.S. health care spend that goes to clinically appropriate, but unnecessary care.  RowdMap’s models identify the cost-savings opportunities in a geography based on the collective intensity of care  delivered by doctors in that area.

* Unnecessary Spend =
(Dartmouth Avg cost) * (Population) * (RowdMap Network Opportunity Index)

there is over $7.6B in unnecessary spend.

Let’s look at which hospitals, groups and physicians account for this and for what conditions

risk arrangements based on provider practice patterns and Population characteristics within a geography.

Hospital Marketshare
by Major Clinical Categories

Provider Group Marketshare
by Major Clinical Categories

Unnecessary Spend in Broward
By condition across hospitals,
groups and physicians

This Physician.
Let’s start here

This Group

This Hospital

Circulatory

Muscular-skeletal

Respiratory

and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.

Physicians Driving Unnecessary Care in Broward

Musculoskeletal care is major contributor to unnecessary spend in Broward. Let’s take a physician who is not an outlier but in the middle of the pack such as Dr. Spend*. Let’s walk through what his clinically acceptable, but medically unnecessary, practice pattern creates in unnecessary spend.

performing providers and downstream referral patterns. Encourage referrals to
high-performing specialists.

highest-performing referral
and care pathways.
Increase the number of patient interactions with green dot doctors.

Option 1: Change provider behavior. Requires lots of provider education. Requires payer to make up a significant portion of a provider’s revenue. Increase the number of green dot doctors.

Zoom to zip

had same ratio as :
His decompression rate would drop from 6.01 to 0.436 per patient.
Which translates to 2,608 fewer decompressions per year.
At an average cost of $332 per decompression, this represents potential savings of over $850K

If decompression to fusion rate were average for orthopedic surgeons:
He would have 1629 fewer decompressions for a potential savings of $540K.

*Actual physician names have been changed.

For every 10 back fusions, does 103 decompressions

For every 10 back fusions,
does 2 decompressions.

Dr. Save*

Dr. Spend’s

Dr. Spend*

Dr. Save*

That’s one physician, with one procedure, in one clinical condition.
This savings would not be picked up in unit cost or utilization analysis,
but cumulatively dwarfs fraud, waste and abuse outliers.
Intense practice patterns like this power FFS arrangements
but success in Pay for Value comes from identifying Risk-Ready providers.

Dr. Spend*

at your finger tips

For Payers & Providers