Delivering data and analytics that enable better health care decisions 

RED/082311

What Makes Us Unique

LexisNexis Risk Solutions is a $1.5B business division of a ~$10B company

Reed Elsevier Revenue Snapshot 

LexisNexis Legal & Professional 14%

Reed Exhibitions

26%14%

11%Reed Business Information

15% 34%Elsevier

LexisNexis Risk Solutions Elsevier

RED/082311

33

We provide insight to customers across multiple industries

customers

• All 50 U.S. States • 80% of U.S. Federal Agencies

customers

• 70% of Local Governments• 100% of U.S. P&C Carriers• 100% of the top 50 U.S. Banks

• Decades of experience in managing identity 

p• 90% of the Fortune 500

p g g yrisk in Insurance, Finance and Government

• Solutions combine LexisNexis Data, Customer Data and Scoring/Analytics to reduce Identity Fraud

S t ib t l ti d t h lRED/082311

• Secure, proven contributory solutions and technology

4

Our proprietary technologies allow us to aggregate, link, analyze, and manage vast sources of data to deliver answers to critical business questions

The ingredient behind our products that turns disparate information into meaningful insights. Thi h l bl iThis technology enables customers using our products to identify, link and organize information quickly with a high degree of accuracy.

Data intensive processing and delivery platformData‐intensive processing and delivery platform developed that incorporates a software architecture implemented on commodity shared‐nothing computing clusters to provide high‐performance data parallel processing andperformance, data‐parallel processing and delivery for applications utilizing Big Data.

RED/082311

8 9

LexisNexis maintains over two petabytes of unique data comprising billions of public and proprietary records, with the capacity to scale up easily and cost effectively

8.9Billionunique 

name/address combinations

4Billion

property records

3.7Billion

motor vehicle registrations

417 269

37Million unique

417Million criminal records

269Million auto and 

home claim records

188.5Million unique 

cell phones

60million more unbanked 

individuals than traditional credit 

bureaus unique businesses

bureaus

RED/082311

6

Partial snapshot of US data sets as of 07/25/14

Our accumulated wealth of health care data assets also provide a comprehensive view into behaviors and interactions across practitioners, patients, and facilities 

> 6,000 Hospitals> 33,000 Outpatient Clinics> 11,000 Home Health agencies Data 

> 17,000 LTC/Extended care facilities> 3,500 Hospice agencies

> Physician offices representing 725,000 community physicians Coverage Channels

> 1.2 Billion Medical Claims> 150 Million Unique Patients

> 1.4 Million Unique PractitionersMetrics > 133 Million unique practitioner  

connections in our integrated Influence Network

Metrics

RED/082311

7

We leverage all of this data about people, businesses, and assets to assess risk and opportunity associated with industry‐specific problems

Identity Authentication and Risk Assessment

Contributory Data

PublicRecords

CreditHeaders

PhoneListings Insurance

Financial Services

Assess underwriting risk and verify applicant data; identify and intercept fraud;  improve policy administration and client retention

Prevent/investigate money laundering and comply with laws Prevent/investigate identity fraud 

Collections

g y

Assist collections by locating delinquent debtorsAssess collectability of debts and prioritize collection efforts

Retail Protect revenue and maximize operational efficienciesPredict and prevent retail fraud

Government

Health Care

L t / t it t / i ti f ti i l l

Locate missing children/suspects; research/document cases; reduce entitlement fraud; accelerate revenue collection

Verify patient identity, eligibility, and ability to payValidate provider credentials; prevent/investigate fraud

Legal Locate/vet witnesses, assess assets/associations of parties in legal actions; Perform diligence on prospective clients (KYC)

RED/082311

8

The result is a unique portfolio of capabilities that help transform the way health care is coordinated, delivered and administered

Data MiningMaster Data Management

Predictive Science

Claims Analytics

Linking AnalyticsIdentity Analytics

RED/082311

9

Our broad portfolio of health care solutions are underpinned by unique datasets, powerful processing power, and industry‐leading analytics

U i D t A tPublic Records

Provider Referential 

Data

Medical Claims

Affiliation Data

Pharmacy POS

Unique Data Assets

LexID® MEDai Science AccuSync® MDM platform and moreLexID® MEDai Science AccuSync® MDM platform and moreLeading Analytics

Data

driven by

HPCC Technology

LexID®, MEDai Science, AccuSync®, MDM platform, and more…driven by

HPCC Technology

LexID®, MEDai Science, AccuSync®, MDM platform, and more…

Solutions 

Provider Pharmacy Life SciencesPayer

Payment ProtectionClinical Solutions

Identity AnalyticsRED/082311

y yProvider Data Management

LexisNexis helps customers meet current challenges and demands

Managing data complexities

Optimizing sales and marketing resources

Curbing wasteful spending

Engaging members and improving outcomes

Mounting regulatory requirements

Manage provider relations more effectively

Delayed and decreasing reimbursements

No insight into referral sources and provider network gaps

RED/082311

11Presentation Title

Our data and analytics fuel solutions that reduce fraud, manage identities, improve health outcomes, and increase efficiency tied to data management

Payer Fraud, Waste & Abuse Population Health Management Id tit th ti ti

Provider Performance Management Provider and Member Data 

Management

Provider

Identity authentication

Population Health Management Provider Performance Management Knowledge‐based Authentication

Management

Patient Data Hygiene Provider Data Management

Life Sciences

Knowledge based Authentication

Expense Remediation Expense Standardization Master Data Management

Data Cleansing Record Linkage and Merging

Pharmacy Data Access and Integration Data Profiling Parsing

Standardization Identity Resolution Record Linking

Data Hygiene Geo‐coding

Government Claims Fraud Program Integrity Identity & Beneficiary Verification

Data Cleansing Provider Data Management

RED/082311

12

The LexisNexis Health Care portfolio has grown as a result of acquisitions that have further built our ability to support the needs of the segments we serve

End‐to‐end  Clinical  Provider data and analytics

Health care fraud, waste and abuse solutions.

analytics focused on population health 

and analytics solutions.

data, information 

and technology 

management and provider performance.

solutions.

RED/082311

1313

The HMS Acquisition StoryPresenter: Name, Title

Date and Location

RED/082311

Who is Health Market Science?

Background– Headquarters: King of Prussia, PA

F d d i 2002– Founded in 2002– 225 FTEs

Core Business– Health Care Provider Master Data– Medical Claims (PxDx)

Convergent Analytic Solutions– Convergent Analytic Solutions– Hosted UI Applications 

Culture– Data Driven Analytics– Innovation– Open Source High Performance

RED/082311

Open Source High Performance Computing Technology 

15HMS Acquisition

Offerings, technology, and markets

RED/082311

16HMS Acquisition

What makes Health Market Science unique?

Unique Data Assets– Health Care Provider Data 

(Individuals, Organizations, Affiliations)

d l l– Medical Claims Data

Software– Big Data Processingg g– Platform services

Services– Industry/solution focused

Professional Services

RED/082311

17HMS Acquisition

The result is data clarity

Bringing together:

Best in classBest in classcredentials

Best in class d hidemographics and group practices

Best in class publicrecords data

RED/082311

18HMS Acquisition

HMS Corporate Strategy and Focus

MasterFile Medical Claims

• Medical claims, PDC, and proprietary data feeds are key sources that differentiate the MasterFile• MDM and Commercial solutions are complimentary and build on the advantage

RED/082311

250+ clients across the healthcare continuum

Pharmacy/ PBMLife Sciences Healthcare Providers

Government

Home Health & Hospice Payers and Health Plans

RED/082311

CMS Fraud Prevention Powered by Health Market Science

Speaker:  Health and Human Services Secretary Kathleen SebeliusSubject: HHS Kicks 3 000 Providers off Medicare Following Criminal ChecksSubject:   HHS Kicks 3,000 Providers off Medicare Following Criminal ChecksSummary: 

“The first month of new screening efforts led to the ousting of 3,000 providers from Medicare rolls. New safeguards include a database that screens existing and prospective providers against recordsthat screens existing and prospective providers against records including provider licensing and criminal background, and ferrets out doctors who have died, retired or become ineligible.”

Link:  

h // /RED/082311

http://1.usa.gov/HKSP8s (13:22)

Comprehensive Solutions

Data ProductsData Products

Commercial OfferingsMDM Offerings

– MarketView– Early Alerts*– Influence Networks– KOL

– HMS Provider MasterFile™• HCPs• HCOs• Affiliations

– Readmission Rates– Payer Mix

Deployment Mechanisms– eBooks

– Provider Online– Salesforce.com Application

Data Enhancement Services– Cleansing eBooks

– MarketView– Tactician Pulse (iPad)

Analytical ServicesAdvanced Segmentations

g– De‐duping– Enrichment

Data Management SolutionsC l t Vi ® – Advanced Segmentations

– Market Share Analysis

Consulting Services– Sales Force Sizing and Alignments

– CompleteView®

Compliance Solutions– Prescriber Eligibility®– Expense Manager

RED/082311– Market Sizing Analyses

HMS MasterFileHMS MasterFile

RED/082311

HMS Provider MasterFile™

Healthcare Practitioners (HCP) ~8m with 10 years of historyPractitioner Types

• Chiropractors

• Assistive Therapy

• Technologists & Technicians

• Physicians (MD, DO)• Dentists (DDS, DMD)

PRESCRIBERS

Practitioner Types

py

• Pharmacology

• Alternative Care

• Behavioral Care

• Emergency Medical Practitioner

• Healthcare Service Assistant

( )• Advanced Practice Nurses• Optometrists• Physician Assistants• Podiatrists • Nursing

• Other• Non‐health Related

• Podiatrists• Veterinarians

NamePrefix, SuffixSpecialtiesIndividual AddressesGender

Birth DateDeath DateStatusTAX ID

DEANPIAffiliationsSanctions

State‐controlled substance Nos.

Medicaid ID and participation

Practitioner TypeSchools AttendedState Licenses

RED/082311

24

participation

Practitioner Elements

HMS Provider MasterFile™

Healthcare Organizational (HCO) ~ 450kFacility TypesFacility Types

• Acute Care Hospitals

• Pediatric Hospitals

• P hi t i H it l

• Assisted Living Centers

• Home Health Agencies

• Rural Health Clinics

• Community Mental Health Centers• Psychiatric Hospitals

• Rehabilitation Hospitals

• Ambulatory Surgery Centers

R il Ph i

Home Health Agencies

• Hospice Facilities

• Skilled Nursing Facilities

• Labs

• End Stage Renal Centers

• Federally Qualified H lth C t• Retail Pharmacies

• Comprehensive Outpatient Rehab Facilities

• LTC/Hospice Pharmacies

Labs

• ACO’sHealth Centers

• Mental Disability Centers

NameAddressFacility Type

HINPOS

DSHGLN

NPITAX ID

Practice SpecialtyAffiliations

DEA340B

/ p

RED/082311

25

Facility Elements

MasterFile Reveals Complex Relationships

Practitioner Elements• Name• Prefix, Suffix• Specialties

Facility Elements• Name• Address

F ilit T

Practitioner Types• Medical

• Physician (MD, DO)• Dental

Healthcare Practitioners (HCP) ~8m Healthcare Organizational (HCO) ~ 450k

Facility Types• Administrative• Agency

b lSpecialties• Individual Addresses• Gender• Practitioner Type• Schools Attended• Languages & Ethnicity

• Facility Type• Specialty• DEA• HIN• POS• NPI

Dental• Dentist (DDS, DMD)

• Allied• Advanced Practice Nurse

• Assistive Therapy

• Ambulance• Animal• Blood Bank• Equipment/Supplies• Extended Care

H it l• Certifications• State Licenses• Birth Date• Death Date• Status• UPIN

• TAX ID• GLN• 340B• DSH• Affiliations

• Behavioral Therapy• Emergency Medical• Healthcare Service Assistant• Nursing*• Optometrist• Pharmacology

Affiliation Relationships

• Hospitals• Imaging• Insurance Provider• Integrated Health Serv• Lab• ManagementUPIN

• TAX ID• DEA• FDA• NPI• Affiliations

S ti

Pharmacology• Physician Assistant• Podiatrist• Technologist and Technicians

• Veterinarian• Alternative

Relationships • Management• Military• Miscellaneous• Operation Services• Pharmacy• Practice• Sanctions

• KOL• Clinical Investigators• Emails

• Alternative• Acupuncture• Chiropractor• Massage

• Practice• Prison• Research• School

RED/082311

26

HMS Provider MasterFile™

Credentialing Sources

Syndicated SourcesClaims Data

HMS MasterFile

Sources

HMS innovations

MasterFile

Web Harvesting

Provider Data 

C ti

Unique combinations

Primary Phone Research

Consortium

RED/082311

27

Relationships Revealed

RED/082311

28

Medical Claims Data – An Overview

RED/082311

Hone in on high value physicians

PxDx helps healthcare companies optimize market opportunities and improve sales execution including:– Targeting of hospital based and specialty based sales forces– Call planning– Segmentation– Territory AlignmentSales force sizing and structure– Sales force sizing and structure

– Compensation design– Patient flow analysisPatient flow analysis– Non personal promotion

RED/082311

Objective Physician level data

Directly Observed Claims DataDirect Sales + Projected Counts

Precise Physician Visibility

Decile 6 Decile 2 Decile 10

Zero Physician Level Visibility

? ? ?

RED/082311

Health Care Financing Administration (HCFA) Claim Form

• Glean useful information:› Physician ID, 

• Glean useful information:› Physician ID, 

Drug Name & Strength, NDC: 12345-6789-01

Diagnosis Code:ICD‐9‐CM code for appropriate diagnosis or nature of illness

Office Visit Code:174 9

V56.0

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

diagnoses and procedure codes, facility ID, etc

diagnoses and procedure codes, facility ID, etc01 06 03 01 06 03 11 1 99211 1 $$ $$

CPT code for services provided to an established patient

Procedure Code:

174 9197 7

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J1055 1 $$ $$

123-45-6789 xxx xx

John Brown M D

123-45-6789 xxx xx

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

Procedure Code:CPT code for an injection

R i d D C dJohn Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

John Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

Required: Drug CodeAppropriate HCPCS Drug Code for medication administered

RED/082311

HMS PxDx Claims Collection Process

Multiple PayersMultiple PayersClaims Switches/Claims Switches/ClearinghousesClearinghouses

Claims DataClaims DataClaims DataClaims DataClaims DataClaims Data

Office Practice Office Practice Management SoftwareManagement Software

State AgenciesState Agencies

RED/082311

MarketView™ PxDx at a Glance…

• 150M unique patients   1.4M unique practitioners 1400 IDNs

WHO is included in the data?

• >900 Payers   > 450K Accounts  

WHAT is the capture and coverage?

• 1.2 Billion Medical Claims• No geographic bias• Inpatient, Outpatient, Office, ASC, Lab, DME/HME, Home Health, Hospice, SNF…

• The majority of HMS data comes from sources that update monthly

WHEN is the data updated?

• Government Agencies• Clearinghouse & switches

WHERE do we get the data?

RED/082311

• Clearinghouse & switches

1000 claims nationally and 275 physiciansDecile Example

1000 claims nationally and 275 physicians 10

9

3 “Decile 10” physicians account for 10% of all claims!

Few Docs with high claim volume!

Deciles divide claims into 10 equal portions.

8

7

6

30 “Decile 7 and greater” physicians account for 40% of all claims. (Just add the layers!)

4

3

5

2

1

Many Docs with lowMany Docs with low claim volume.

RED/082311

HMS Targeting SolutionsHMS Targeting SolutionsPxDx

RED/082311

HMS PxDx Rankings

– Health Market Science’s PxDx delivers valuable insight into the  relative volume and workload of procedures (Px) and diagnoses (Dx), at the practitioner and facility level using a decile rank

Rankings

decile rank– HMS pinpoints where these HCPs see their patients and 

submit procedure/diagnosis claims based on specific ICD, CPT, and HCPCS codes

RED/082311

HMS PxDx ‐ Projected Volumes

– Enhanced level of granularity beyond traditional decilerankings by providing an actual volume.

– HMS deploys advanced statistical methodologies to project from our “as captured” claims up to full volumefrom our  as‐captured  claims up to full volume.

– Approach takes volumes estimated at a physician level and aggregates to facility level.

Projected Volumes

RED/082311

HMS Influence Networks

Medical claims data can be used to derive physician‐physician relationships based on shared patients for a disease state of interest

• Methodology is based on longitudinal tracking of patients across physician visits by leveraging an anonymized patient IDphysician visits by leveraging an anonymized patient ID.

• A pair of physicians that share a statistically significant number of patients within a specified time window are assumed to have a professional relationship.

Influence Networks • HMS has > 49 Million unique practitioner connections in our integrated Influence Network

RED/082311

Mobile Platform

RED/082311

40

Mobile Platform

RED/082311

41

HMS Publications

The HMS Publication Mining Solution leverages data mined from the National Library of Medicine’s PubMEd database.  

This database is searched with appropriate terms for relevant publications/therapeutic categories.

Th h li f h bli i i h h d hPublications

The author list for these publications is then matched to the HMS MasterFile™ to determine physician authors, and the number of publications per physician is translated into a volume that can be used to compare other relevant practitioners.

RED/082311

Using claims to track patients across setting

As patients move through the h lth t l i

Simplistic flow of hospitalized patients

healthcare system, claims are submitted for reimbursement at different stages

By capturing these claims, HMS can 

SNFSNFSNFSNFClaim

submitted

y p gtrack patients across multiple settings and create a more holistic view of a healthcare network

Home Home HealthHealthHome Home HealthHealth

ClaimsubmittedHospitalHospitalHospitalHospital

Claimsubmitted

networkThis unique capability enables our 

clients to target the highest value accounts in their market HospiceHospiceHospiceHospice

Claimsubmitted

RED/082311

43HMS Solutions for Home Care and Hospice