COMMUNICATING WITH ANALYSTS

1. COMMUNICATING WITH ANALYSTS

2. WHY ARE WE TALKING ABOUT THIS? Sought-for information in a useable format is rarely close at hand Analysts are a valuable resource to find it So, accurate communication with analysts regarding information needs is key

3. Recognize this Scenario? You ask your analyst: “Would you please pull some data on how much care we provide to active-duty personnel?” He or she says, “Sure,” writes a Business Objects query to extract M2 data, and provides the results to you. You note that the results don’t include outpatient care, which you wanted. So the analyst modifies the query to include outpatient care, reruns it, and delivers the updated results. 3

4. Recognize this Scenario? (2) You look at the updated results and ask: “How much of this care was for the Navy afloat population?” The analyst says, “I didn’t know you wanted the afloat population; I’ll run it again.” It’s Friday afternoon. What happens Monday morning? What’s going on here? 4

5. Problem Identification/Definition Einstein is quoted to the effect that, if he had an hour to save the world, he would spend 55 minutes defining the problem and only 5 minutes solving it. The point, … The quality of our solution is dependent upon how well we define the problem we are trying to solve. Often, sufficient time spent defining the problem leads directly to its solution. 5

6. OBJECTIVES • Coordinate and communicate using clear and feasible questions. • Understand how M2 can help and also what it can’t do. • Provide the clinical, technical, or other “meat” needed to define the problem and interpret results. • Foster free and open dialogue with the analysts. • Balance rigor, need, and cost of gathering needed information

7. In the absence of guidance, the likely default for an analyst is to provide results in counts with no restrictions on data. But, management may have made other assumptions about the desired information. To be clear, the data request should include specific outcomes desired and restrictions or boundaries on applicable dimensions of the problem. CLEAR AND FEASIBLE QUESTIONS

8. TO BE FEASIBLE. . . • Data must be available • The analyst must have enough time to construct the query • M2 architecture must allow for addressing the issue. (more later) CLEAR AND FEASIBLE QUESTIONS

9. HOW ABOUT THESE QUESTIONS? How many Active Duty beneficiaries live near our base? What are we spending on enrollees in our area? Where do beneficiaries around here go for outpatient care? What types of care are most often provided in the civilian network?

10. Perspective Level of Aggregation Timeframe Costs Geography Workload measures Beneficiaries Dimensions for Clarifying Questions Encounter types Care setting Type of care Payment categories

11. Perspective “What are we spending on enrollees in our area?” • Should I be looking at such questions from the: • Beneficiary Perspective (where the beneficiaries reside)? • Plan Perspective (to what plan and where beneficiaries are enrolled)? • Provider Perspective (where the care is delivered)?

12. Perspective (Plan/Provider) • Care I provide for my Enrollees. • Care other MTFs provide for my Enrollees • Care the Contractor provides for my Enrollees • Care I provide for other Enrollees • Other MTF Enrollees • Contractor Enrollees • Care I provide for unenrolled beneficiaries • MERHCF • Other

13. FY11 RWPsMartin ACH, Fort Benning, GA Row: Martin ACH Plan Perspective Col: Martin ACH Provider Perspective

14. Timeframe “Pull me recent data for _____.” • Annual or monthly data? (check for completeness) • Would CY work better than FY? • What do you mean by “recent?” • Most recent month? • Most recent complete year? • For time trends: • How far back should we go? • Seasonality? • Programmatic or data changes during the period of interest? (e.g., CY07 E&M, CY11 PE RVU changes)

15. Geography “Where do beneficiaries around here go for outpatient care?” “Report workload for the NCR.” • Geographical constructs: • PRISM • Catchment Area • MTF Service Area • Market Area • Multi-Service Market Area (MSMA) • MTF parent-child relationships (local versus remote) • OCONUS included? • Level of aggregation for results? Caution on changing parent/child relationships over time!

16. Impact of Geographical Constructs “Please get script counts for the BAMC area.”

17. Impact of Geographical Constructs “What is the ambulatory case-mix (RVUs per Encounter) for Evans ACH?”

18. Beneficiary Designations “What are we spending for care of our beneficiaries? Report Active Duty separately.” • Do we want eligibles or enrollees? • Which beneficiary categories should we include? • Do we want all age groups? • For “Active Duty”: • Is Guard/Reserve included? • What about the non-DoD Uniformed Services? • How should the results be summarized?

19. Beneficiary Designations “What are we spending on Enrollee care” • Do you mean all Enrollees or “our” Enrollees? • If “our” Enrollees, do you mean: • … to our hospital? • … including those at our child clinics (local; remote)? • Do you want to include our costs for Enrollees to other MTFs or the Contractor? • Should we include Plus as well as Prime? • I heard some always include Reliants in with Prime, should we do that in this case? • Should we include Navy afloat?

20. Beneficiary Designations

21. Care Setting “How many visits & dispositions were there in FY11 for all MTFs?” “What was spent last year on inpatient care in the network?” • Direct care: • Include Army, Air Force and Navy sites only (e.g., exclude Coast Guard clinics)? • Include DHP sites only (e.g., exclude line units, VA, civilian settings)? • Purchased care: • Distinguish “network” from “non-network”? • Exclude internal resource sharing (POS=26)? • Exclude external resource sharing (partnerships)? • For ambulatory, do we include/exclude Offices, Outpatient Hospitals, ERs, ASCs, etc.?

22. Payment Categories “What are we spending on retiree healthcare?” “What is the cost per RVU downtown?” • Should MERHCF be included? • What about claims with OHI payments? • Do we include supplemental care? • What about those SIDRs, CAPERs or TEDs that we find for USFHP enrollees?

23. Payment Categories FY11 TRICARE Paid per MS-RWP: Acute Care Institutions (TED-I)

24. Type of Care “What are we spending for Inpatient Care in the MTF vs. purchased care?” “How many civilian ER encounters were there for our Enrollees in 2010?” “What procedures are we doing for OB/GYN?” • Should we include Inpatient Professional with Institutional in purchased care? • Should PC data be restricted to Acute Care facilities only? • Should mental health be included? • How do we define an ER encounter? • Visits, services, line items? • ER identified by E&M/Critical Care codes or place of service or both? • Should Drugs (PIC=D) and ancillary from TED-N be included?

25. Type of Care • What do you mean by “procedure”? • CPT codes? • E&M included? • Surgical only? • ICD-9 procedure codes • How should we define a specialty area such as OB/GYN? • Major Diagnostic Category? • Range of DRGs? • Diagnosis or Diagnosis Group? • Product Line • For Direct Care, MEPRS code? • Provider Specialty?

26. Direct Care Professional Encounters “Please pull monthly visits in Primary Care for the past two years” • Discourage concept of visit or count visit, suggesting encounters or appropriate RVUs instead • Consider MEPRS-B only? What about FBI/FBN? • Report by Compliance Status? Include Inferred? • Should Telephone Consults be included? • Should analysis be restricted to selected provider types? (e.g. what about encounters for General Duty Nurses and Corpsmen?)

27. Workload “Is our workload increasing or decreasing” “How does ALOS compare for direct & purchased care?” “What’s happening to market share?” • What inpatient measures do you want? • Admissions/Dispositions? • Bed Days (for claims, if no admissions – home health, hospice, etc. – exclude bed days from ALOS calculations or restrict analysis to acute care only) • RWPs or MS-RWPs • Exclude DRGs 469/470, MS-DRGs 998/999? HINT: If asked to pull RWPs, pull dispositions and bed days also. Why?

28. Caution on TED-I Institution Type

29. Workload • Which outpatient measures do you want? • Visits or Count Visits? (hopefully not) • Encounters? • RVUs – which ones (Work, Practice, Enhanced measures)? • APG or APC weighted workload for institution portion? • For Direct Care should we include telephone consults or report separately? • What about pharmacy workload (script/refill counts, days of supply)?

30. Impact of T-Cons on Workload

31. Costs* “What is the cost of OB care in our MTF compared to purchased care?” • What costs are relevant to the discussion? • Direct Care Costs • Should we use Full or Variable costs? • Should I use Pharmacy costs from my CAPER data or estimate from PDTS and report separately? • Purchased Care • Note that for purchased care our cost is what we pay. • Should only TRICARE Paid Amounts be considered or would Allowed Amounts make a better comparison? • Should we include claims with OHI? • Should we consider the amounts paid by patients?

32. Level of Aggregation • Advice When in doubt, err on the side of lesser levels of aggregation than needed to allow for follow-on investigation. • Examples • If you want RWPs, ask for dispositions and bed days also, so case mix and ALOS can be examined • For questions where Ben Cat Common (aggregated counts) might suffice, ask for Beneficiary Category also, so Active Duty vs Guard/Reserve or Other vs Dependents of Retired/Survivors can be separated • If you want worldwide, pull by HSSC Region so OCONUS can be dropped or studied separately • If you want encounter counts, pull by Compliance Status so Inferred can be identified

33. OPERATIONALIZING DATA REQUESTS IN M2 (Typical analyst process) Pick the right data type to answer the question. List conditions for what to include/exclude Pick the data fields necessary to get the right answer Run (execute) the program (query) Manipulate the extracted data to get the right information Prepare data for presentation

34. OPERATIONALIZING IN M2 (WORKS FOR MOST THINGS. . .) M2 IS NOT GOOD FOR: DOUBLE-PASS TYPE QUESTIONS DATE ARITHMETIC (WHEN EXTRACTING DATA) DATE WINDOWS CENTERED ON EVENTS “KEEP LAST” TYPE QUESTIONS DATA SET SUBTRACTION IN THE EXTRACTION ANY ANSWER THAT REQUIRES MORE THAN 500K ROWS

35. KNOWING THE DETAILS • WHAT A RECORD REPRESENTS • WHAT FIELDS ARE THERE? WHAT DO THEY MEAN? • WHAT YEARS/MONTHS ARE AVAILABLE? • WHAT IS MISSING? • WHAT IS WRONG WITH THE DATA? • WHAT DO THE CODE SETS MEAN? THE M2 ANALYST MAY KNOW BETTER THAN THE MANAGER, FOR AN M2 DATA TYPE:

36. KNOWING THE DETAILS • WHICH DIAGNOSIS CODES WORK BEST? • WHICH PROCEDURE CODES WORK BEST? • WHICH DRUGS OR THERAPEUTIC CLASSES? • WHICH PROVIDER TYPES? • OTHER RELEVANT CONSTRAINTS OR NEEDS. THE MANAGER MAY KNOW BETTER THAN THE M2 ANALYST, FOR A GIVEN QUESTION: HELP THE ANALYST GET IT RIGHT!

37. COMMUNICATION CHANNELS • IT IS NORMAL TO NEED MORE INFORMATION FOR A QUESTION. • IT IS NORMAL FOR THE ANALYST TO ASK ABOUT AN UNHEARD OF AREA TO CLARIFY. • BOTH MANAGER AND ANALYST NEED TO BE COMFORTABLE ASKING QUESTIONS OF EACH OTHER. • BEWARE OF “HAND-OFF” QUESTIONS THAT CAN’T BE CLARIFIED!

38. COMMUNICATION CHANNELS • HANDLING “HAND-OFF” QUESTIONS • MANAGER SHOULD DO THE GUESSING BUT • ANALYST CAN SUPPLY “EASIEST” • BOTH MAY ADDRESS “FEASIBLE” AND “PROBABLY MEANT” • DOCUMENT THE GUESSES; SUPPLY WITH THE ANSWER

39. THE INFORMATION-COST TRADE-OFF ANALYST EFFORT PRECISION QC AND DOCUMENTING

40. ANALYST COST • CLARIFYING THE QUESTION/ PLANNING THE ANALYSIS • CAPTURING/EXTRACTING THE DATA • MANIPULATING/ANALYZING THE DATA INTO INFORMATION • (MAKING IT PRETTY) • DOCUMENTING THE METHODOLOGY • (QC OR PARALLEL PROCESSING FOR VALIDITY)

41. HOW VALUABLE IS THE INFORMATION? THE MORE VALUABLE THE INFORMATION, THE GREATER THE INFORMATION COST THAT IS JUSTIFIED. * THIS COURSE BEGAN WITH A “BENIGN” CASE STUDY.

42. COMMUNICATING WITH ANALYSTS Questions?