Session #11: Partners HealthCare Analytics Strategy for Bundled Payments and Risk Management

1. Session #11:Partners HealthCare Analytics Strategy for Bundled Payments and Risk Management SreeChaguturu, MD, VP, Population Health Management Helen Chan, Senior Manager, Business Planning Pre-Session Poll Question Not at all effective Somewhat effective Moderately effective Very effective Extremely effective Unsure or not applicable On a scale of 1-5, how effective is your organization’s population health and accountable care strategy?

2. About the organization Not-for-profit integrated delivery system, ACO Two large academic centers, multiple inpatient and outpatient facilities, 6,000 physicians Preparing for accountable care, population health management

3. Population health management priority programs 9

4. And a reminder of why these programs… Develop team-based care Promote Medical Neighborhood Demonstrate value in bundles/procedures Reduce post-acute variation Empower patients in their care Information -> Insight -> Action 10

5. Providing the Tools for PHM Drivers impacting hospital, outpatient, and physician billing volume and margin 3 HEALTHCARE DIRECTIONS 2 EPISODES OF CARE Bundled payment management POPULATION INSIGHTS 1 Managing at-risk populations

6. Partners Population Insights: How are we performing on our risk populations? • How does our trend compare to prior year and benchmark? • What are the major changes in TME trend by key categories? - Resource area and site of care • Service grouping • Unit of action • Demographics • What are effective ways to visualize data to drive managerial action? • What ways to leverage data to construct a story about PHM trend performance?

7. Partners Population Insights: Dynamic QlikView Application to Analyze Trend 14

8. Partners Population Insights: How the tool engages physicians in risk • Empowered physicians and practices to assess trend performance of the system and of their own patients • Used tool to engage physicians using their own data to identify areas of clinical and managerial action • Developed a self-service model to make data easy, accessible, and not intimidating • Generated more bi-directional communication between administrators (corporate and local) and clinical practices

9. Partners Episodes of Care: Improving clinical care while preparing for future payment arrangements Assess Clinical Variation • Identify areas of clinical variation with the greatest opportunity and/or within the physicians’ control • Engage specialists • Manage utilization, cost, and quality • Objective: to reduce cost of episode (TME) and internal PHS costs; improve quality • CMS Mandate on Hips/Knees Bundles to begin Jan 2016 in 75 geographic regions • Objective: to reduce cost of episode (Total Medical Expense TME) • Opportunity to Engage 3rd parties directly (Employers, Other ACOs, etc.) • Minimal traction with commercial payers historically • Expect to follow CMS footsteps • Not immediate priority Prepare for CMS Episodic Payment Go to Market with Employers Commercial Contracting

10. Partners Episodes of Care:Screenshot of Variation Analysis

11. Partners Episodes of Care: Key questions answered by the tool • What is the average cost by episode and how is this shifting? • What is the distribution of episodes by cost and how is this trended? • How does my hospital and physician group compare with others and where are the outliers? • At the MD level, which cases are driving outlier status and why? • What caused complications for outlier cases? Did patients come in with that or caused by hospital/physician? • How much unmanaged variation is there month to month, year to year? Does the variation exceed what can be managed?

12. Partners Healthcare Directions: Monitor hospital volume and margin trends when system is in both FFS and Risk Drivers of Volume / Margin Change • Key Business Questions: • How are the following impacting PHS volume and margin? • Cost pressures and changing market dynamics • Our local / system initiatives • How are our Population Health Management efforts impacting our hospital business? 8. Shift in payer mixand other market dynamics 1. Site of Care (Shift of high / low acuity cases) 7. Patient Consumerism 2. Population Health Management Focus: System and hospital level volume and margin trends 6. EMASS Referrals / Market Consolidation 3. PHS Referral Strategy 5. Partners Employees Benefit Design 4. Primary Care Growth/ Ambulatory Planning

13. Partners Healthcare Directions: Key questions and intended audiences • In a fluid market environment, build an analytics tool that monitors actual hospital volume and margin trends in near real time Purpose Value Add • Bring together data from multiple sources in one place to identify key drivers of trend across facets of our business • Generating market context for observed trends • Focus analysts’ time on high value areas • Provide business intelligence to Senior Finance, Clinical, and Administrative leaders to develop strategy and understand trends • Serve as basis for a new quarterly report to senior system and hospital leaders Intended Audiences

14. Understanding Impact of PHM on Hospitals 14

15. Poll Question #2 On scale of 1-5, how effectively is your organization using healthcare analytics to support population health and manage at-risk contracts? Not at all effective Somewhat effective Moderately effective Very effective Extremely effective Unsure or not applicable

16. Results • Developed and implementing a comprehensive PHM strategy • Successfully integrated hospital, provider, and claims information to evaluate, compare, and improve clinical and financial performance • Made actionable information readily accessible to managers • Used customized groupers to develop service and clinical groups to accurately attribute TME • Identified non-analytic criteria for success • Made meaningful progress toward a data-driven culture

17. Future Plans Continue journey to a data-driven culture Continue to improve governance capabilities Increase adoption and tracking of outcomes and effectiveness Continue to enhance PHM applications

18. Lessons Learned Know what business and clinical questions you want to answer Involve the right people Take a rapid-cycle failure and improvement approach Data is not enough – need to build clinical programs that take advantage of the insights garnered from the data Building these self-service tools can become overwhelming for the organization

19. Analytic Insights Questions & Answers A

20. Choose one thing… Write down one thing will you do differently after hearing this presentation

21. Thank You

22. Session Feedback Survey • On a scale of 1-5, how satisfied were you overall with this session? • Not at all satisfied • Somewhat satisfied • Moderately satisfied • Very satisfied • Extremely satisfied What feedback or suggestions do you have?

23. Upcoming Speakers 3:45 PM – 4:35 PM • Delivering Excellence at Stanford Health CareAmir Dan Rubin, President and CEO, Stanford Health Care 4:35 PM – 5:00 PM • The Future World of Value-Based Healthcare (Documentary featuring Michael Porter)Caleb Stowell, MD, Vice President, Research and Development, International Consortium for Health Outcomes Measurement (ICHOM, Senior Researcher, Harvard Business School) Location Grand Ballroom Grand Ballroom