© 2014 Health Catalyst
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Proprietary and Confidential
© 2014 Health Catalyst
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© 2014 Health Catalyst
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The Buzzword:
Population Health Management
What...
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Common Thread: Outcomes
Provide the highest qua...
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3 Ingredients of Fire
4
Fire
Fuel
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3 Ingredients of Fire
5
Fire
Fuel
What should w...
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A Tautology…
6
"Every system is
perfectly desig...
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How systematic are we at Outcomes Improvement?
...
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Content System
Outcomes
Improvement
3 Systems f...
© 2014 Health Catalyst
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Proprietary and Confidential9
Content System Overview
What should we be doin...
© 2014 Health Catalyst
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Infrastructure:Hosting/Hardware Analytics Sys...
© 2014 Health Catalyst
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Deployment System Overview
How do we transfor...
© 2014 Health Catalyst
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Content System
Outcomes
Improvement
3 Systems f...
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Content System Overview
What should we be doi...
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Care Improvement Map
Sepsis and septic shock
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Identify Potential Improvements
Process AIMs an...
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Standard Patient Registry
Start with administra...
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Supplemental
ICD9 (38,250)
Medications
(72,581)...
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18
Adopt Standardization Aids
or Knowledge Asse...
© 2014 Health Catalyst
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Home
(Patient Portal)
* To Invasive
Care Proc...
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= Negative Impact = Positive or Negative = Posi...
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Actionable Visualizations
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Poll Question #1
Content System
What types of s...
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Content System
Outcomes
Improvement
3 Systems f...
© 2014 Health Catalyst
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Infrastructure:Hosting/Hardware Analytics Sys...
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Strong Analytic System
Non value-add Value-add
...
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Less Transformation
Provider
Patient
Bad Debt...
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EMR SOURCES
(e.g. Cerner, Epic,
NextGen)
Onco...
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Metadata (EDW Atlas), Security and Auditing
D...
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Information Management
2929
DATA CAPTURE
• Acqu...
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Less Effective Approach
“Punish the Outliers”
#...
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Effective Approach to improvement:
Focus on “Be...
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Excellent OutcomesPoor Outcomes
# of
Cases
Exce...
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Internal Variation versus Resource Consumption
...
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Prioritize: Pareto Analysis App
34
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o...
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Poll Question #2
Analytics System
How is data f...
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Analytics System
What technica...
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Content System
Outcomes
Improvement
3 Systems f...
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Deployment System Overview
How do we transfor...
Organizational Assessment I October 15, 2014 I 40
Readiness Assessment Example
1) Data Access
Process
2) Registry
Definiti...
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Small Teams (Designs Innovation)
• Meet weekly ...
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Improvement Types
42
Outcomes
Improvement
Examp...
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Requirements Gathering
Project Plan/ Estimati...
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Accelerated Practices Program
PREPARING HEALT...
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Poll Question #4
Deployment System
How are team...
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Outcomes
Improvement
Content System
46
Science ...
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Population Health Analytics: Improving Care One Patient at a Time

Population Health Analytics is about more than just identifying a group of patients. It involves helping physicians care for their patients as individuals, improving their own practice through evidence-based best practices, and enacting cultural change that results in better outcomes for entire populations. Population Health Analytics—with the capability to look at one patient at a time and one physician at a time—will enable providers and organizations to answer three important questions: 1) What best practices should I be doing with this population? 2) How well am I following these best practices with this population? And 3) How can I change to create better outcomes for this population? In addition to addressing these population health questions, please join Tom Burton, Co-Founder and Senior Vice President of Product Development, Health Catalyst, as he discusses Population Health Analytics and presents the Three Systems Model of Care Delivery. Tom will share Health Catalyst’s experiences and learning’s and why each system is essential to create long-term change and transform healthcare. Attendees of the webinar will: Learn about the Three Systems Model of Care Delivery required for effective Population Health Analytics. Understand the issues that must be addressed at each stage in order to optimize care delivery. Discover the role analytics play in enabling physicians to deliver better care to their patients leading to improved outcomes for an entire population of the patients. In the future, healthcare executives with a solid Population Health Analytics system will be better prepared to deliver better outcomes and more efficient care. Both will be key for succeeding with payment models based on risk, value, and performance.
Published on: Mar 4, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Population Health Analytics: Improving Care One Patient at a Time

  • 1. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Improving Care One Patient at a Time February 4, 2015 Population Health Analytics
  • 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The Buzzword: Population Health Management What does it really mean? • Managing the health outcomes of a population of patients with a similar condition? • Going at risk with payers for the outcomes of a population of patients (Fee-for-Value)? • Using care management to improve outcomes for high-risk, high-cost patients? • Engaging patients and communities for better health outcomes?
  • 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Common Thread: Outcomes Provide the highest quality care with an optimal care experience for a population of patients at the lowest appropriate cost 3 Quality Outcomes Experience Outcomes Cost Outcomes The key population health management question: How do we systematically improve outcomes for a population of patients, one patient at a time?
  • 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 3 Ingredients of Fire 4 Fire Fuel
  • 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 3 Ingredients of Fire 5 Fire Fuel What should we be doing? How are we doing? How do we transform? Content System Outcomes Improvement 3 Ingredients of Outcomes Improvement
  • 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential A Tautology… 6 "Every system is perfectly designed to get the results it gets.” - Dr. Paul Batalden ... so re-design your system to get better results.
  • 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential How systematic are we at Outcomes Improvement? 7 Fire Fuel
  • 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Content System Outcomes Improvement 3 Systems for Outcomes Improvement 8 What should we be doing? How are we doing? How do we transform?
  • 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential9 Content System Overview What should we be doing? 9 Map the Process Care improvement map – Includes workflow & clinician's decision-flow across care continuum Identify Common Problems - Potential Improvements Specific AIM Statements for outcomes and process to measures for focused improvement Scope the problem – Define Precise Patient Registries Specific clinical inclusion and exclusion criteria for the sub-cohort of patients for the AIM Adopt Standardization Aids Checklists, order sets, and protocols to make it easy for clinicians to choose the best action Produce Actionable Visualizations Scorecards and dashboards that promote best practice behaviors and invite action
  • 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential10 Infrastructure:Hosting/Hardware Analytics System Overview How are we doing? 10 e.g. EPSi, Peoplesoft, Lawson e.g. Lawson, Peoplesoft, Ultipro Subject Area Mart Designer Source Mart Designer EMR EMR Financial Patient Sat. HR Administrative Claims Financial Patient Sat. HR Administrative Claims e.g. Epic, Cerner NextGen e.g. Press Ganey, NRC Picker e.g. API Time Tracking e.g. Medicare Private Payers Shared Frameworks & Tools for improvement Comorbidity Analyzer, Registry Repository, Attribution Modeler, Common Definition Repository, Hierarchies, CAFE, Atlas, IDEA, Eventalytics, Geospatial, Risk & Severity Profiling, etc Metadata Driven ETL Engine Enterprise Data Warehouse Platform Analyze and Interpret Data • Show correlation and causation • Integrate clinical, financial, and patient experience data • Predict outcomes and prescribe actions Shared Reoccurring Data Tasks • Cohort Definitions • Patient/Provider Attribution • Severity/Comorbidity Analysis • Calculation/Term Definition • Comparative Repositories Source Data Integration • Automatically co-locate data from different source transactional systems (EMR, Claims, Financial, Patient Satisfaction) • Automatically connect data together with key identifiers (Patient, Location, Provider) Infrastructure • Security and Auditing capabilities • Metadata Repository
  • 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential11 Deployment System Overview How do we transform? 11 Improvement Capacity Assessment Evaluation of organizational capacity for change, current capabilities, and gaps GovernanceData Governance/Data Stewardship and Advanced Organizational Governance & Prioritization Improvement MethodologySystematic improvement incorporating LEAN / PDSA principles, AGILE software development, etc. Accelerated Practices TrainingSystematic training of Adaptive Leadership, Quality Improvement/LEAN skills, and Technology 11
  • 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Content System Outcomes Improvement 3 Systems for Outcomes Improvement 12 What should we be doing? How are we doing? How do we transform?
  • 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential13 Content System Overview What should we be doing? 13 Map the Process Care improvement map – Includes workflow & clinician's decision flow across care continuum Identify Common Problems - Potential Improvements Specific AIM Statements for outcomes and process to measures for focused improvement Scope the problem – Define Precise Patient Registries Specific clinical inclusion and exclusion criteria for the sub-cohort of patients for the AIM Adopt Standardization Aids Checklists, order sets, and protocols to make it easy for clinicians to choose the best action Produce Actionable Visualizations Scorecards and dashboards that promote best practice behaviors and invite action
  • 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Care Improvement Map Sepsis and septic shock
  • 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Identify Potential Improvements Process AIMs and Outcome Goals Transformation Process Starter Set Content Implement Intervention Measure & Sustain Review & Select AIM Define Cohort Iterate on Metrics Heart Failure: AIM #1 Starter Set Content Implement Intervention Measure & Sustain Review & Select AIM Define Cohort Iterate on Metrics Heart Failure: AIM #2 Process Improvement AIM: Improve Follow-up Visit Scheduling From 43% to 90% by October 31, 2015 Process Improvement AIM: Improve Medication Reconciliation From 58% to 80% by June 30, 2015 Heart Failure Outcome Improvement Goal: Maintain and Improve Cardiac Function = Increase % of HF population with adequate cardiac function from 64% to 80% by December 31, 2015 2-4 Process Improvement AIMS should produce a significant outcome improvement
  • 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Standard Patient Registry Start with administrative codes
  • 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Supplemental ICD9 (38,250) Medications (72,581) Problem List (22,955) ICD9 493.XX (29,805) Additional Potential Rules (101,389) 17 Total Count of Distinct Patients = 106,714 Precise patient registry Move to clinically defined cohorts Standard Registry Precise Patient Registry
  • 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 18 Adopt Standardization Aids or Knowledge Assets Admits/1000 members IP days/1000 members OP visits/1000 members Procedures/1000 members ED visits/1000 members Readmissions/1000 members Utilization Who should get the care? Cost/case Cost/procedure OR minutes L&D minutes Other LOS Order Sets Workflow Cost per case Nursing hours by unit OR minutes L&D minutes Cycle times Cost per ancillary test Environmental services What care should be included? How can care be delivered efficiently ? Indications for Intervention Diagnostic algorithms Indications for Referral Triage Criteria Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Standardized Follow-up Checklist Post-acute care order sets IP (SNF, IRF) Home health, Hospice Clinical Ops Procedure Guidelines Knowledge Asset Type Substance Selection Clinical Supply Chain Management Admission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post-procedure Order Sets Bedside Care Practice Guidelines Discharge Checklist Patient Injury Prevention Protocol Risk Assessment Transfer Checklist Question to ask Examples Possible Measures
  • 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential19 Home (Patient Portal) * To Invasive Care Processes Clinic Care Non-recurrent Clinic Care Chronic Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Triage to Treatment Venue Substance Preparation Invasive* Subspecialist Chronic Disease Subspecialist Screening & Preventive Symptoms Procedure Indications for Intervention Diagnostic algorithms Indications for Referral Triage Criteria Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications (scientific flow) Utilization Treatment and Monitoring Algorithms Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Substance Selection Substance Selection Clinical Supply Chain Management Admission Order SetsAdmission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post- procedure Order Sets Order sets and indications for selection of substances and clinical supplies (scientific-flow focus) Order Sets Post-procedure Care Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Clinical ops procedure guidelines and patient injury prevention Implementation of protocols based on MD orders and clinical operations-initiated activities (Lean/TPS workflow focus) Workflow Care Process Models Value Stream Maps MD Population Knowledge Assets
  • 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential = Negative Impact = Positive or Negative = Positive Impact Knowledge Asset Type Discounted FFS Per Diem Per Case Bundled Per Case Condition Capitation Full Capitation CMS Commercial CMS Commercial Workflow Diagnostic Variation Standing Orders MedicationSelection Triage Patient Safety Ambulatory Treatment and Monitoring Indications for Referral Indications for Intervention Payment structure considerations
  • 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Actionable Visualizations
  • 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Poll Question #1 Content System What types of standardized content have you implemented to support Population Health Management? 192 respondents A. Just Starting – 42% ‒ We have not standardized content to support Population Health Management. Our clinicians use their best judgment based on their individual training. B. Mid-Journey – 49% ‒ We have begun to standardize some content (e.g. CPOE to implement standardized order sets – provided by our EMR vendor). We have not yet created standard content for both workflow and clinical domains across the continuum of care. C. Mature – 9% ‒ We have implemented standardized content to manage ambulatory and inpatient care management (e.g., ambulatory treatment algorithms, order sets, bedside care protocols) and utilization criteria (e.g., diagnostic algorithms, triage criteria, indications for referral and intervention) regardless of what unit or facility a patient enters the same workflow and care delivery content is followed and measured.
  • 23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Content System Outcomes Improvement 3 Systems for Outcomes Improvement 23 What should we be doing? How are we doing? How do we transform?
  • 24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential24 Infrastructure:Hosting/Hardware Analytics System Overview How are we doing? 24 e.g. EPSi, Peoplesoft, Lawson e.g. Lawson, Peoplesoft, Ultipro Subject Area Mart Designer Source Mart Designer EMR EMR Financial Patient Sat. HR Administrative Claims Financial Patient Sat. HR Administrative Claims e.g. Epic, Cerner NextGen e.g. Press Ganey, NRC Picker e.g. API Time Tracking e.g. Medicare Private Payers Shared Frameworks & Tools for improvement Comorbidity Analyzer, Registry Repository, Attribution Modeler, Common Definition Repository, Hierarchies, CAFE, Atlas, IDEA, Eventalytics, Geospatial, Risk & Severity Profiling, etc Metadata Driven ETL Engine Enterprise Data Warehouse Platform Analyze and Interpret Data • Show correlation and causation • Integrate clinical, financial and patient experience data • Predict outcomes and prescribe actions Shared Reoccurring Data Tasks • Cohort Definitions • Patient/Provider Attribution • Severity/Comorbidity Analysis • Calculation/Term Definition • Comparative Repositories Source Data Integration • Automatically co-locate data from different source transactional systems (EMR, Claims, Financial, Patient Satisfaction) • Automatically connect data together with key identifiers (Patient, Location, Provider) Infrastructure • Security and Auditing capabilities • Metadata Repository
  • 25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Strong Analytic System Non value-add Value-add Understanding the question Hunting for data Interpreting data Data distribution Gather, compiling or running Weak Analytic System Strong Analytic System The majority of time is spent analyzing and interpreting data Understanding the question Hunting for data Interpreting data Data distribution Gather, compiling or running 25
  • 26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential26 Less Transformation Provider Patient Bad Debt Diagnosis Procedure Facility EncounterCost Charge Employee Survey House Keeping Catha Lab Provider Census Time Keeping More Transformation Enforced Referential Integrity Enterprise Data Modeling (Many Technology Vendors) FINANCIAL SOURCES (e.g. EPSi, Lawson, PeopleSoft) ADMINISTRATIVE SOURCES (e.g. API Time Tracking, Lawson HR) EMR SOURCES (e.g. Cerner, Epic, NextGen) DEPARTMENTAL SOURCES (e.g. Apollo) Pt. SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) EDW
  • 27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential27 EMR SOURCES (e.g. Cerner, Epic, NextGen) Oncology Diabetes Heart Failure Regulatory Pregnancy Asthma Labor Productivity Revenue Cycle Census Pt. SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) DEPARTMENTAL SOURCES (e.g. Apollo) FINANCIAL SOURCES (e.g. EPSi, Lawson, PeopleSoft) ADMINISTRATIVE SOURCES (e.g. API Time Tracking, Lawson HR) Redundant Data Extracts Dimensional Data Modeling (EMRs & Healthcare Point Solutions) EDW Less TransformationMore Transformation
  • 28. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential28 Metadata (EDW Atlas), Security and Auditing Diabetes Sepsis Readmissions Common, linkable vocabulary Financial Source Marts Administrative Source Marts Departmental Source Marts EMR Source Marts Patient Satisfaction Source Mart FINANCIAL SOURCES (e.g. EPSi, Peoplesoft, Lawson) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) EMR SOURCEs (e.g. Cerner, Epic, NextGen) DEPARTMENTAL SOURCES (e.g. Apollo) Pt. SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) Adaptive Data Modeling Less TransformationMore Transformation
  • 29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Information Management 2929 DATA CAPTURE • Acquire key data elements • Assure data quality • Integrate data capture into operational workflow DATA ANALYSIS • Interpret data • Discover new information in the data (data mining) • Evaluate data quality DATA PROVISIONING • Move data from transactional systems into the Data Warehouse • Build visualizations for use by clinicians • Generate external reports (e.g., CMS) Knowledge Managers (Data quality, data stewardship and data interpretation) Application Administrators (optimization of source systems) Data Architects (Infrastructure, visualization, analysis, reporting) = Subject Matter Expert = Data Capture = Data Provisioning = Data Analysis
  • 30. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Less Effective Approach “Punish the Outliers” # of Cases Current Condition • Significant Volume • Significant Variation # of Cases Option 1: “Punish the Outliers” or “Cut Off the Tail” Strategy • Set a minimum standard of quality • Focus improvement effort on those not meeting the minimum standard Mean Focus on Minimum Standard Metric Excellent OutcomesPoor Outcomes Excellent OutcomesPoor Outcomes 1 box = 100 cases in a year
  • 31. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Effective Approach to improvement: Focus on “Better Care” Excellent OutcomesPoor Outcomes # of Cases Current Condition • Significant Volume • Significant Variation Excellent Outcomes # of Cases Option 2: Identify Best Practice “Narrow the curve and shift it to the right” Strategy • Identify evidenced based “Shared Baseline” • Focus improvement effort on reducing variation by following the “Shared Baseline” • Often those performing the best make the greatest improvements Mean Focus on Best Practice Care Process Model Poor Outcomes 1 box = 100 cases in a year
  • 32. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Excellent OutcomesPoor Outcomes # of Cases Excellent OutcomesPoor Outcomes # of Cases Excellent Outcomes # of Cases Poor Outcomes Excellent Outcomes # of Cases Poor Outcomes 1 2 3 4 Variability High Low Resource ConsumptionLow High Improvement Approach - Prioritization 32
  • 33. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Internal Variation versus Resource Consumption Y-Axis=InternalVariationinResourcesConsumed Bubble Size = Resources Consumed Bubble Color = Clinical DomainX Axis = Resources Consumed 1 2 3 4
  • 34. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Prioritize: Pareto Analysis App 34
  • 35. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of Total Cumulative % 35 X-Axis = Care Processes by resources consumed (High to Low) Y-Axis=Percentoftotalresourcesconsumed Pareto Analysis >> Prioritization Top 85 Care Processes account for 80% of the opportunity (+45) Top 40 Care Processes account for 62% of the opportunity (+27) Top 13 Care Processes account for 34% of the opportunity
  • 36. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Poll Question #2 Analytics System How is data from disparate transactional systems integrated? (e.g. EMR, Cost, Patient Satisfaction) 215 respondents A. Just Starting – 37% ‒ Analyst manually integrate data into spreadsheets. B. Mid-Journey – 50% ‒ We use one of our transactional systems (e.g. EMR or Financial) to integrate a limited subset of data for some of our transactional systems for key operational reports. C. Mature – 13% ‒ We have implemented an Enterprise Data Warehouse Platform, fully automated load from all of our transactional systems runs at least daily which integrates data based on common linkable identifiers (e.g. patient and provider IDs), with near-real time loads for selected data.
  • 37. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Poll Question #3 Analytics System What technical tools do you use to move your organization away from reactionary, emotional decisions toward data-driven decisions? 193 respondents A. Just Starting – 27% ‒ We don't use any technical tools to help us with data driven prioritization, although we have some reports. B. Mid-Journey – 57% ‒ We use some spreadsheet analysis and reports to evaluate options but opportunities are still typically selected based on politics, a crisis or the most vocal advocate. C. Mature – 17% ‒ We have robust applications which provide our centralized clinical and operational governance team with objective criteria for use in prioritizing improvement initiatives, including identifying our key processes based on size and variability.
  • 38. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Content System Outcomes Improvement 3 Systems for Outcomes Improvement 38 What should we be doing? How are we doing? How do we transform?
  • 39. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential39 Deployment System Overview How do we transform? 39 Improvement Capacity Assessment Evaluation of organizational capacity for change, current capabilities, and gaps GovernanceData Governance/Data Stewardship and Advanced Organizational Governance & Prioritization Improvement MethodologySystematic improvement incorporating LEAN / PDSA principles, AGILE software development, etc. Accelerated Practices TrainingSystematic training of Adaptive Leadership, Quality Improvement/LEAN skills, and Technology 39
  • 40. Organizational Assessment I October 15, 2014 I 40 Readiness Assessment Example 1) Data Access Process 2) Registry Definition Process 3) Data Governance & Data Quality Process 4) Sustained Care Improvement Process 5) Standardized Criteria for Treatment & Venue 6) Cost Allocation Methodology 12) Data Integration Infrastructure 11) Missing Data Element Capture 10) Data-driven Prioritization 9) Prescriptive Modeling 8) Standardized Calculations & Definitions for Internal Reporting 7) Standardized Protocols for Population Health Deployment Content Analytics
  • 41. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Small Teams (Designs Innovation) • Meet weekly in iteration planning meeting • Build DRAFT processes, metrics, interventions • Present DRAFT work to Broader TeamsOB Innovators Guidance Team (Prioritizes Innovations) • Meet quarterly to prioritize allocation of technical staff • Approves improvement AIMs • Reviews progress and removes road blocksOB Newborn GYN W&N W&N Innovators Innovators Early Adopters Broad Teams (Implements Innovation) • Broad RN and MD representation across system • Meet monthly to review, adjust and approve DRAFTs • Lead rollout of new process and measurementOB W&N W&N W&N Innovators Early Adopters Early Adopters Executive Leadership Team • Prioritizes sequence of formation of Guidance Teams • Approves Board Level Outcomes Goals • Reviews progress and removes road blocks
  • 42. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Improvement Types 42 Outcomes Improvement Examples: Reduction in Mortality Rate; Hard Cost Savings; Time Savings (Soft Cost); Improved Health Function DifficultytoAchieve Process Improvement Examples: Process Step: % of Patients with scheduled follow-up visit at discharge; Data Quality: % of Heart Failure Patients with Ejection Fraction captured in EMR Opportunity Identification Improvement Examples: Potential $ Savings from Variation Reduction (Key Process Analysis) ; Potential $ Leakage reduction by encouraging providers to refer patients in network
  • 43. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential43 Requirements Gathering Project Plan/ Estimation Use Cases/ Functional Specs Design Specifications Code Test Fix / Integrate High Level Stories Vision Release 1 Release 2 Release 3 Release 4 $ $ $ $ $$ $$ $$$$$ Documentation Customer sees the product Value to the Customer Traditional “Waterfall” Agile Sources: Adapted from various ideas taught by Alistair Cockburn and Martin Fowler – see alistair.cockburn.us and www.thoughtworks.com Traditional Approach vs. Agile Approach
  • 44. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential44 Accelerated Practices Program PREPARING HEALTHCARE TEAMS TO ACCELERATE OUTCOMES IMPROVEMENT Immersive Quality Improvement Training • 8 Session Course - taught over 4-6 months, 2 ½ days per month • Train the trainers – required for coaches and team leaders • Quality Improvement Theory applied on actual project with 2-4 person team Executive Training • 2 day executive course taught quarterly • Provides leadership visibility into training and high level principles Just-in-time Training • Library of 10-15 minute modules used as needed by permanent teams • Readily available to clinical, technical and operational team members
  • 45. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Poll Question #4 Deployment System How are teams organized to improve the quality of care and sustain improvements? 237 respondents A. Just Starting – 33% ‒ We have ad-hoc improvement teams organized on a project basis in a reactive mode (e.g., to respond to a TJC sentinel event). After a project ends, many of the gains achieved may be lost because limited organizational infrastructure remains to sustain the gains. B. Mid-Journey – 55% ‒ Our Quality Resources Department provides support to Service Lines and Departments apply quality improvement and workflow principles to improvement initiatives. Some individual units or facilities may focus on quality but dispersion of improvements to all units or all facilities is limited. Improvement is still project based. C. Mature – 11% ‒ We have organized permanent interdisciplinary cross facility teams, which include clinical and technical subject matter experts with process improvement skills; these teams permanently own the quality, cost, safety and satisfaction of their care delivery domain. Senior executive leadership and Board meetings spend the majority of their time reviewing the goals and progress of these permanent improvement teams.
  • 46. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Outcomes Improvement Content System 46 Science Project Centric Pockets of excellence, Limited roll-out of improvement across all facilities Research Centric Academic ideas with no practical application. Lots of published papers. Information System Centric “If we build it they will come.” Focus on reducing information request queue. Automation Centric “Paved Cow Paths” (Process is automated but not improved – many EMR deployments) Organization Centric Management “Flavor of the month” Clinicians disengage if evidence and measurement are both missing LEAN Centric Un-sustainable Improvements. Can’t manually measure after 2 or 3 projects. Ignite Change Scalable & Sustainable Outcomes Improvement in Population Health
  • 47. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Questions?
  • 48. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Thank You Upcoming Educational Opportunities The Pioneers Take the Arrows and the Settlers Take the Land: Healthcare Predictions for 2015 Date: February 11, 2015, 1-2pm, EST Host: Dale Sanders, Vice-President, Strategy Register @ www.healthcatalyst.com

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