1

Carilion Clinic’s Journey on the Population Health Management

and Big Data Highways

June 5, 2014

Tom Denberg, MD

Chief Strategy Officer

Executive Vice President

Carilion Clinic

22

Greetings from Western Virginia

3

4

Tonight’s Topic

Health IT And

Population Health

Big Data and Healthcare-behind but catching up

Health Catalyst

Big Data and Healthcare

• Big data is a term used for massive amounts of information that can be interpreted by analytics to provide an overview of trends or patterns.

• Organizations leverage big data by gathering records and information captured and then interpreting it with analytics.

• Common in other industries, big data has only recently begun to become a factor in healthcare. It has applications range from provider-specific business intelligence to scouring over an entire state's health records to pinpoint people who are at risk for certain ailments.

• Many believe that big data can help target early warning signs and improve patient safety

Healthcare IT News 2014

77

Enterprise Data Warehouse

Claims Data

AetnaEmployee

Group,ACO

(Wholehealth)Claims

LabRx

Eligibility

TMGMedicare

AdvantageClaims

CMSMedicare Shared Savings

SAP/BusinessObjects

Enterprise

EPIC EMROperationalDatabase(Cache)

QNTXMedicare

HMO (Majesticare)

OtherPlans - TBD

CLAIMS/PlanData Sources CARILION CLINIC

NIGHTLY

ETL

ET

L

Clarity Relational Database

Cloud-Based/ASP services

TemporaryClaims Staging

Database

Care Conerns/Gaps,

Risk

Stratific

ation Data

PopulationAdvisor

Premier/Verisk

Web-based User Interface

Enterprise Data Warehouse

EPIC EMR

88

Healthcare IT and ACOsThe Critical List

• Population identification - attribution• Identification of care gaps – Decision Support • Risk Stratification• Cross Continuum Care management • Quality and Outcomes measurement• Patient engagement• Telemedicine • Mixing claims and clinical data • Predictive modeling • Clinical information exchange

Excess Cost Domain Estimates

$210

$130

$190

$105

$55

$75

Cost in Billions of $$$

Unnecessary Services ($210 B)

Inefficiently Delivered Services($130 B)Excess Administrative Costs($190 B)Excessive Pricing ($105 B)

Missed Prevention Opportunities($55 B)Fraud ($75 B)

IOM. The Healthcare Imperative, 2010.

Clinician-Driven Sources of Excessive Health Care Costs (Population Health Management Focus)

• Preventable/avoidable hospital (re-)admission and ED visits (Case Management, Readmission Reduction)

• Missed prevention (Pay-for-performance)

• Unnecessary care (Utilization Management)

Key patient populations

Key Strategic Initiatives

Ambulatory Case ManagementPatient engagement, care coordination, Extensivists, palliative care, transitions of care protocols

Ambulatory Quality / Pay for Performance (P4P)Cancer screening, BP, lipid, A1c, etc.; various patient engagement and contact components

Sickest and/or highest-utilizing 5-10%Advanced CHF, COPD, IHD, DM, asthma, cancer, psychosocial problems

Rising-risk 40-50%Patients with less severe chronic illnesses or behaviors that significant elevate morbidity or mortality risks; HTN, DM, hyperlipidemia, tobacco use, obesity

Low risk 45-55%Patients without medical problems; focus on prevention, wellness, and connectivity to health system

Behavioral Health / Psycho-social

Pay-for-performance

• Core measures, value-based purchasing (Hospital)• HCAHPS (Hospital)

• HEDIS, NQF (Ambulatory) • CGCAHPS (Ambulatory)

•Pro

fusio

n of

met

rics

•Prim

ary c

are

emph

asis

•In

crea

singly

shar

ed p

rimar

y-ca

re/sp

ecial

ty ac

coun

tabil

ity

•In

crea

sing

num

ber o

f spe

cialty

-spe

cific

met

rics

Ration

ale:

- Reim

burs

e fo

r valu

e, n

ot ju

st

volum

e (m

axim

ize sh

ared

savin

gs)

- Dem

onstr

ate

not s

kimpin

g on

care

CLBSICAUTICHF Readmission rate……BP controlA1c controlBreast CA screening…

“Off hand, I’d say you’re suffering from an arrow through your head, but just to play it safe, let’s get an echo.”

Utilization Management

% CBCs ordered without apparent clinical indication during preventive exams

% CBCs ordered without apparent clinical indication during preventive exams

The Future- Proactive Care

• Identify patients at risk before they develop symptoms of heart failure • Maximize treatment of underlying conditions• Closer follow up• Delay or prevent the onset of severe heart

failure • Bend the disease curve

CHF Onset Project

• Collaboration ( Carilion, IBM, Epic) • 3 years data / 500,000 records reviewed• NLP used to obtain unstructured data (20M)• 8500 patients at risk

• 3500 identified with NLP• Risk score generated based on clinical , social

and demographic data • Score available in EMR • Develop treatment protocols to address at risk

patients.

Big Data – Lessons Learned

• A journey, not a project• Hard work • Expensive • New skill sets• Organizational discipline • Executive support • Dividends can be huge