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FMCC 2016 MACRA Plenary by Amy Mullins
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Is Your Data & Analytics Strategy Enabling You to Successfully Take on Risk Contracts?

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This presentation throws light on how to:
• Use the right data to get the right insights
• Develop meaningful patient personas
• Gain a clinical perspective of analytics and value-based care.

For more information on our Care optimization solutions, please visit: http://www.sciohealthanalytics.com/offerings/solutions/care-optimization

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Is Your Data & Analytics Strategy Enabling You to Successfully Take on Risk Contracts?

  1. 1. |1 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved.©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. Is Your Data & Analytics Strategy Enabling You to Successfully Take on Risk Contracts? David Hom Chief Evangelist SCIO Health Analytics Teresa Rueckert, RN, MSN Clinical Solution Consultant SCIO Health Analytics
  2. 2. |2 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. THESIS: USE OF DATA TO CREATE AN ENHANCED VIEW OF THE PATIENT/MEMBER FOR ENGAGEMENT DATA MART CLAIMS RXELIGIBILITY SOCIAL ECONOMIC LAB EMRFITNESS DEVICES DATA MART USES CASES What is The Total Cost of Care By Patient and Provider What Risk Will A Member Have Without Claims Data What Lab Data Will Enhance The Prediction of Financial Risk With Claims, Data What is The Financial Risk of The Member Ability to Predict Which Members Will Be Compliant What New Data Can Be Used To Understand Compliance What Data in The EMR Enhances The Prediction of Risk Data Intuitiveness To Reduce False Positives How Often Should The Data Be Updated 1 2 3 4 5 6 7 8 9
  3. 3. |3 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. PROFILES AS AN ANALYTIC FOUNDATION CLAIM, PATIENT & PROVIDER PROFILES Behaviors & Attitudes Demographic & Attribution Clinical Factors Cost & Quality Utilization Risk
  4. 4. |4 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. OBJECTIVE OF PATIENT PERSONAS: PREDICT LIKELIHOOD FOR RISK WITH LITTLE DATA PROVIDER Integrate Multiple Data Sources: Health de-identified medical claims/RX data, ZIP level demographics, call center and outreach data , lab values, EMR key notes, economic area data, fitness data, other data values PREDICTIVE ANALYTICS PRESCRIPTIVE ANALYTICS PATIENT Clinical and Financial Risk Management of Patient Populations Provider Performance Management for Outcomes Treatment Pathways Individualized for each Persona Patient Ability to Complete the Service Eligibility Files Which Capture Demographic Data Zip Code Data - 9 Digit Zip Code and Household Level Data Files
  5. 5. |5 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. Healthy & Affluent Balanced Adults High Utilizers Quality Driven Cost Conscious Chronic older Adults High Cost Baby Boomers EXAMPLE OF PERSONAS – CLINICAL No.of chronic conditions ER Paid PMPM IP Paid PMPM ER Utilization IP Utilization 0.54 0.70 0.71 0.86 0.82 1.02 1.13 Median Risk Prospective Score 0.6 0.7 0.8 1.2 1.2 1.3 1.6 0.09 0.05 0.10 0.04 0.07 0.08 0.09 0.25 0.22 0.34 0.23 0.18 0.21 0.23 $75 $73 $147 $54 $75 $118 $248 $10 $9 $14 $9 $7 $10 $11
  6. 6. |6 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. APPLYING PERSONA ANALYTICS Consumer Types • Healthy and Affluent • Balanced Adults • High Utilizers • Quality Driven • Cost Conscious • Chronic Older Adults • High Cost Baby Boomers Viewing membership this way helps organizations develop, evaluate, and market care management programs to the most appropriate members.
  7. 7. |7 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. 12% 68% 19% 1% 65+ 55-64 35-54 16-34 Age Group 27% 43% 22% 8% $200k+ $100k - $200k $50k - $100k Less than $50k Estimated Income BALANCED ADULTS Description Well managed and balanced middle age adults. Mostly female, predominately with college level education and white collar employees with medium income. They are a healthy population with low utilization and PMPM cost which is aligned to average number of chronic conditions. Intervention: Low risk and well managed individuals, so no need to spend high value resources. Demographic Attributes % Above Poverty Level 94% % Blue Collar Employed 14% % Single Family Dwelling 73% % Household with children 30% Clinical Attributes IP Utilization 0.05 ER Utilization 0.22 # Average Chronic Conditions 0.69 Paid Amount PMPM ER $9 Paid Amount PMPM IP $72 Gender Education School College Individuals with Income Level > $50K Median Age 48 $285K 73% Frequent Spending Median Home Value Socio-Economic Score 90 70 100 Spending Pattern Low Risk Median Risk Prospective Score 56
  8. 8. |8 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. LEVERAGE NON-CLINICAL DATA TO IDENTIFY HIGH-RISK Community Area Name Low Birth Weight Prenatal Care Beginning in First Trimester Teen Birth Rate Below Poverty Level No High School Diploma Per Capita Income Unemployment Avalon Park 19.7 74.5 63.9 16.7 13.3 $23,495 16.6 Washington Heights 19.6 75.4 65 15.7 15.6 $19,709 18.3 Washington Park 17.7 74.9 82.6 39.1 28.3 $13,087 23.2 East Garfield Park 17.5 73.2 93.2 39.7 26.2 $13,596 16.4 Woodlawn 17.4 73.3 51.1 28.3 17.9 $18,928 17.3 Fuller Park 17.1 71.4 69.2 55.5 33.7 $9,016 40 West Garfield Park 17 71.4 114.9 40.3 26.2 $10,951 25.2 West Englewood 16.1 63.6 116.9 32.3 30.3 $10,559 34.7 Austin 15.4 72.9 81.8 27 25 $15,920 21 Chatham 15.4 72.5 68.2 25.3 13.7 $20,320 19 North Lawndale 15.3 75.8 108.9 38.6 30.4 $12,548 18.5 Riverdale 15.3 74.1 64.5 61.4 24.6 $8,535 26.4 Lincoln Park 6.6 75.7 2.1 11.8 4.3 $71,403 4.5 Jefferson Park 6.6 82.9 28.6 6.4 13.5 $27,280 9 East Side 6.4 73.3 53 18.7 35.5 $15,347 14.5 Lake View 6.3 79.1 15.8 10.5 2.9 $58,227 4.7 Hyde Park 5.9 80.3 7.6 18.2 5.3 $39,243 6.9 Loop 5.3 78.2 1.3 11.1 3.4 $67,699 4.2 Norwood Park 4.9 89.4 3.4 5.9 13.5 $31,659 7.3 Beverly 4.9 84.8 11.9 5.2 5.1 $40,107 7.8 West Elsdon 4.6 81.2 45.5 9.8 39.6 $16,938 13.5 Lower West Side 4.5 80.8 49 27.2 44.3 $15,467 13 O'Hare 3.5 82 15.9 9.5 11 $29,402 4.7
  9. 9. |9 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. NEW DATA SETS ENHANCEMENTS CLEARER VIEW OF THE PATIENT FINANCIAL RISK BUT FOCUS ON: • Avoidable IP and ER visits • Extended length of stay impact • Readmissions • Excessive testing and specialist care OUTCOMES • Improved prediction at the patient level • Recommended prescriptive outputs by patient Claims Data Rx Data Community Data CDC Data Lab Data EMR Data Eligibility Data Zip Code Data
  10. 10. |10 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. IMPACTABLE POPULATION ANALYSIS Population 100% Impactability Prospective Risk Moderate Impactability 12% of Members Low Impactability 75% of Members High Impactability 12% of Members High Low Opportunity Goal Close Gaps and Steerage to Managed Networks Close Gaps and Steerage to Managed Networks Manage High Costs and Risk Factors Manage High Costs High Risk 10% Moderate Risk 1.5% Low Risk 0.5% High Risk 8% Moderate Risk 3% Low Risk 1% High Risk 13.5% Moderate Risk 27% Low Risk 34.5% High Cost 1% of Members
  11. 11. |11 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. VALUE-BASED CONTRACTING CONTINUUM Measurement Systems • PMPM • Hospital events/1000 • HEDIS compliance metrics • Readmissions • Comorbidities Finalize Pay for Outcomes Metrics Provider Scorecards • PCP and Specialist Attribution • HEDIS metrics • CMS quality metrics Member ID In Last 12 Months Cost Incurred in Last 12 Months Probability of ER Admission Predicted Probability of ER Admit IF all the gaps are closed Difference Impactability Score # Hospitalization # ER Visits In Patient (PMPM) ER (PMPM) Out Patient (PMPM) Professional (PMPM) Pharmacy (PMPM) 000000010506 1 1 $2,999 $302 $209 $201 $130 93% 22% 71% 1.68 000000010331 0 0 $237 $158 $147 90% 27% 64% 1.51 000000010043 0 2 $287 $231 $225 $133 91% 22% 69% 1.64 Member ID Risk Score Impactability Score Gap1 Gap2 Gap3 000000010506 0.89 1.68 Diabetes - Consider Foot Exam HbA1c Less Than 7 Target RX 000000010331 0.83 1.51 Lipid Panel Spirometry RX 000000010043 0.81 1.64 Consider Pulmonary Rehabilitation AST Test Physical Therapy Identify What Gap Should be Prioritized at the Member Level
  12. 12. |12 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. ANALYTIC INSIGHTS
  13. 13. |13 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. ANALYTIC INSIGHTS High-Level View of Greatest Impact By Cost % Risk Bucket Impactability Bucket High Medium Mild Low High 14.6% 6.3% 9.2% 48.5% Medium 0.4% 0.4% 0.3% 13.0% Mild 0.0% 0.1% 0.1% 5.8% Low 0.0% 0.0% 1.5% Potential Savings Risk Bucket Impactability Bucket High Medium Mild Low High $1,363,086 $69,264 $16,162 $136 Medium $80,984 $37,529 $5,558 $81 Mild $20,040 $12,580 $2,865 $67 Low $746 $417 $0 Risk ScoreRisk Score Where to Find High Opportunity Members Identify highly impactable populations who will deliver greatest savings
  14. 14. |14 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. Identify specific gaps with the highest savings potential / impactablity ANALYTIC INSIGHTS Drill Down to Member/Patient Level DRILLDOWN DRILLDOWN
  15. 15. |15 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. Viewing the relationship between cost, condition and impactability to help in planning programs ANALYTIC INSIGHTS B Y T O T A L C O S T Condition Level Analysis
  16. 16. |16 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. Understand where to focus resources and outreach based on identifying gaps with greatest potential savings ANALYTIC INSIGHTS T O P 1 0 G A P S O P E N DRILLDOWN Gap Analysis
  17. 17. |17 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. CASE STUDIES Stratifying The Opioid Patient & Identifying The Untreated Patient
  18. 18. |18 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. OPIOID USE & IMPACT ON TOTAL COST OF CARE Sample Population Profile 2014–2015 • Average risk for general patient population is 1.00 • Average risk for Opioid patient population is double to 2.00 • This forecasts that patients to spend 100% more in the next 12 months • Average risk for this comorbid patient population is significantly higher @ 3.5! • This forecasts that patients will spend 350% more in the next 12 months
  19. 19. |19 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. DIABETES Compliance Summary for High Value Services
  20. 20. |20 ©2017 SCIOInspire, Corp. d/b/a SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. SUMMARY The New World of Analytics Eligibility Data Zip Code Data RISK Health Care Services CLAIMS DATA EMR Data Lab Values Medical Data Rx Data Impactabilty Model Surgical Models • Internet of Things (IOT) • Wearables • Weather patterns • Gross Domestic Product (GDP) • Provider clinical data from devices • etc., NEW DATA SETS Intevenability Models of Do–ability Propensity to Consume

This presentation throws light on how to: • Use the right data to get the right insights • Develop meaningful patient personas • Gain a clinical perspective of analytics and value-based care. For more information on our Care optimization solutions, please visit: http://www.sciohealthanalytics.com/offerings/solutions/care-optimization

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