Break All The Rules: What the Leading Health Systems Do Differently with Analytics and Data Warehousing

Break All The Rules
What the Leading Health Systems Do Differently with
Analytics and Data Warehousing
© 2014 Health Catalyst
www.healthcatalyst.com Creative Commons Copyright
www.healthcatalyst.com
Creative Commons Copyright

Health Catalyst’s Philosophy
We educate, we don’t sell.
An educated person decides what’s best for them to buy.
2

Overview & Context
• Healthcare Data Warehousing Association
(HDWA), 2001
• How do we create role models for analytic success in
healthcare?
• Can we recreate it?
• Health Catalyst is the commercial manifestation
of HDWA
• Today’s webinar
• What are the common traits of the leaders?

• I was hoping for checklists, recipes and
algorithms for Analytic Success
• No such luck
• It’s much squishier than that, but it’s still replicable
• Today’s discussion will be more about intangible
qualities of culture, leadership, and attitude

It Starts With Culture
Followed closely by strategy and execution

Leaders Are Operating Consistently At Level 6.5
Creative Commons Copyright 6

There Aren’t Many Leaders
A Few Examples
• Intermountain Health Care
• Quietly, consistently, leading for 30+ years
• Allina
• Becoming the Intermountain of Minnesota
• Kaiser
• Per-capita prepayment and quality baked into its DNA
• Geisinger
• The mindset of Intermountain, the culture of Mayo
7

Why Isn’t Everyone Doing It?
Is it really that difficult or complex?
8

Culture
9

outset fail. Agile and lean wins in data warehousing
as in small businesses.”
• “I believe the most important lesson I have (and still
am) learning is to let imperfect but useful things lose
into the wild.”
permission” to their BI leaders to evaluate rules and
precedents based on risk and motives.”
Asked Dear Friends…
…What key pieces of advice should I emphasize?
• “Be brave with data.”
• “The teams that try to plan everything out from the
• “…let it lose and iteratively refine…”
• “…smart healthcare CIOs expect and “give
10
Thank you Eric Just, Steve Catmull, and Mike Doyle

How Do You Identify A “Leader”?
• They balance the tension of care delivery, economic risk, affordability
 Lead Past Competing Interests
of care, and accessibility to care… all under one CEO
 Risk Takers
• They take risks, on their own, with new care delivery models and
population health… no government mandates required
 Consistently Principle-Driven
• They do the right thing for patients and their communities, even at the
risk of financial loss in a fee-for-service environment
 Data Trumps Ego & Anecdote
• They have the courage to face the truth of data
• Data drives their decisions, not anecdotes and hunches
 Motivate people through Mastery, Autonomy, and Purpose
 They recognize what motivates people and organizations
11

By accident or design, leaders practice this…
Thank you, Daniel Pink
What Motivates People?
12
Nurture and
encourage these…
Be aware to avoid
stepping on them…

Inherently positive motives as they affect behavior
 Risk Takers
 Mastery, Autonomy, Purpose
Generally negative motives as they affect behavior
The Motives Behind Behavior
Creative Commons Copyright 13
Enlightenment
Peace
Joy
Love
Reason
Acceptance
Willingness
Neutrality
Courage
Pride
Anger
Desire
Fear
Grief
Apathy
Guilt
Shame
The Turning Point
*-- Power vs. Force, Hawkins

Leading Past Competing Interests
14
Balance is elusive… it moves… and
might not always be appropriate

 Risk Takers
Leaders Are 100%
Consistent On This…
16

Simple Equation
Leaders are constantly thinking in these terms, and
living in the realm of risk tolerance
17
 Risk Takers

Data Quality
18
 Risk Takers

Trust With Data
19
 Risk Takers

Centralized vs. Decentralized
Resources and Staffing
20
 Risk Takers

Determination & Commitment
21
 Risk Takers

Internal Small Business Mentality
22
Nobody has to do business with the EDW team

Characteristics of
Successful Small Businesses
23

Small Business Checklist
1. Have you clearly documented your products and services AND the customers that
want/need them?
2. Do you have product line managers and teams?
3. Do you track who uses which of your products and how often?
4. Do you have a strategic product roadmap?
5. Do you have a web site that makes it easy…
‒ For new customers to find you, understand your products, and consume them?
‒ For existing customers to get the most out of your products and encourage those customers to collaborate?
6. Do you have a team member that leads and executes your marketing strategy to
attract new clients?
7. Are you operating with financial efficiency?
8. Do you regularly poll your customers for their satisfaction and suggestions for product
enhancements?
9. Do you regularly poll your team members to track their satisfaction?
10. Do you have a Board of Directors (i.e., Data Governance Committee)?
24

Personality Of The
Analytics Leader
25
 Risk Takers

Personality Of The
Analytics Team
26
 Risk Takers

Strategy
27

Leaders Are
Covering The
Continuum
Of Analytic
Use Cases
28 Robert Wood Johnson Foundation, 2014
Requires a collaborative
strategy between leaders
in healthcare, politics,
charity, education, and
business
 Risk Takers

They Invest In Analytics
• This is not an “additional duty”
• EMRs required investments in technology and
people… so do enterprise data warehouses
(EDW). But, luckily, a small fraction of an EMR.
29
 Risk Takers

The EMR Is A Means, Not The End
30
 Risk Takers

Where Are They Focused?
31
 Risk Takers

Aligning Strategy: Data to Monitor Variation
Range
85% - 95%
Range
94% - 98%
The Joint Commission Index Across Hospitals:
Demonstrated Progress in Reducing Variation
Thank you, Lisa
Shilling, Kaiser
Permanente

Analytics Strategy
Vertical and Horizontal… Tactical and Strategic
Primary Care
Women & Newborns
Intensive Medicine
Cardiology
Oncology
33
Lab
Admissions
Radiology
Registration
Pharmacy
Nursing
AR/AP
Materials Mgt
Step Two:
Clinical Excellence
Programs
Step One: Operational Excellence Programs
More complex
Less complex

Organize Your Analytics Teams
Boards and C-Levels: Let your clinical and administrative
leaders establish their specific clinical and financial goals
34

Matrixed Collaboration
35

Move On Parallel Fronts
36

Replacing Existing Reporting Systems
Use the EDW for its unique capabilities… stop squabbling with the
Departments
37
 Risk Takers

Analytics Tools Dogma
There’s a reason Excel is still so popular… it works
Give data analysts what they want; not what you want them to want
38
 Risk Takers

• Can you define all the use cases for the books in
a library? No… same is true for a data warehouse
data in its true form, you can repurpose that data,
an infinite number of ways
Traditional Software Engineering vs.
Data Engineering
• The thickness of a requirements document is
inversely related to the success of a data
warehousing project
• As long as you gather and retain the granular
39
 Risk Takers

The Data Warehouse Platform…
It’s Not Just For Analytics
Secondary Use of Transaction Data
40
 Risk Takers

Execution
41

Geisinger
Managing gaps in care
Lipid Panel, HgbA1c
Lab Result
Imaging Result
Clinical Goal BP <140/90, LDL <100
Aspirin for CAD
42
42
Care Gap Examples
Advance Directives
Depression and Asthma
Active Medication
Scanned Document
Patient Reported Data
Mammogram, DXA
Nephrology for CKD Stage 4
Referral
Diagnosis Coding HCCs
Patient Education Heart Failure
Asthma Action Plan
Clinical Documentation
Thank you, Dr. Fred Bloom

Geisinger
Redesign and Care Coordination Delivers Rapid Impact
43
43

Care Gap Programs
 AAA Screening  Malignant Melanoma
 Adolescent Well Visits—
Birthday Model
 Medical Weight
Management
 Adult Preventive Care—
Birthday Model
 Osteoporosis Program
 Colonoscopy Screening
Program—Birthday Model
 Peds Transition to Primary
Care (after age 18)
 CKD Stage 4  Sleep Medicine Outreach
(BMI 35-39)
 Dexa Scans  Women’s Health: Annual
GYN Exams—Birthday
Model
 Emergency Department
Transition to Primary Care
Provider
 Influenza, Pertussis &
Pneumococcal
44

Proven Health Navigator
Results for Medicare
45 (Am J Manag Care. 2010;16(8):607-614)

PHN Return On Investment
46

Three-Year Results in 25,000
DM Patients
47
305 MIs
Prevented
NNT to prevent
one (1) MI
=
82 patients
140 Strokes
Prevented
NNT to prevent
one (1) Stroke
=
170 patients
166 Cases of
Retinopathy
Prevented
NNT to prevent one
(1) case of
Retinopathy
=
152 patients

Kaiser’s Quality Goals Timeline – 2011 – 2013
Domain 2011 2012 2013
Population Health
Self perceived health status data
for 15% of members
for 20% of members
for 25% of members
Population Care
Management - Chronic
Conditions
Medicare Stars Part C 4 Stars
HEDIS composite at 90th percentile
All CV, diabetes, and cancer screening
metrics at 90th percentile
Behaviorial Health, Musculoskeletal 90%
Medication Management 75%
Behaviorial Health, Musculoskeletal and
respiratory @ 90%
Behaviorial Health, Musculoskeletal and
respiratory @ 90%
Inpatient
HSMR
TJC Composite
Reduce HSMR: Below US Medicare
average, crude mortality 10% from 2010
baseline
TJC Composite at national 90th percentile
Readmit rate<15% of all cause
readmissions
TBD - May shift to inpatient outcomes
Readmit rate<10% of all cause
readmissions
TJC Composite at national 90th
percentile
TJC Composite at national 90th percentile
Patient Safety Never
Events
10% less events than 2010 10% less events than 2011 10% less events than 2012
Workplace Safety Per regional targets Per regional targets Per regional targets
Clinical Risk
Management
0 to 5% reduction in lawsuits
with a payout from 2010
Service
Hospital
Outpatient
HealthPlan
Medicare Stars
At National 75th percentile (final
quarter)
75th percentile in local or national
in 3 of 8 regions
in 6 of 8 regions
4 Stars on Overall CAHPS
At national 75th percentile (rolling
12 months)
in 5 of 8 regions
75th percentile in local or national 7
of 8 regions
4+ Stars on Overall CAHPS
Above National 75th percentile (rolling
12 months)
8 of 8 Regions at goal
8 of 8 regions at goal
4+ Stars on Overall CAHPS
Equitable Care
Identify interventions to
reduce the gap
Decrease the gap by x%
Decrease by x% more over
2012
Thank you, Lisa
Shilling, Kaiser
Permanente

Thank you, Intermountain web site
Intermountain’s Board Goals
Six “Dimensions of Care” goal areas
1. Clinical Excellence
2. Patient Engagement
3. Operational Effectiveness
4. Employee Engagement
5. Physician Engagement
6. Community Stewardship
49

Intermountain’s Clinical Excellence Board Goals
1. Behavioral Health Clinical Program: Decrease inpatient psychiatric 30-day readmission rate for the Intermountain system.
2. Cardiovascular Clinical Program: Integrate the treatment of heart failure patients across the continuum to improve care and reduce
hospital readmissions.
3. Intermountain Homecare: Improve care transitions to and from Homecare through effective communication, collaboration, and
coordination among care providers.
4. Intensive Medicine Clinical Program: Decrease mortality in patients diagnosed during their hospital stay with severe sepsis.
5. Oncology Clinical Program: Improve the appropriate utilization of genetic screening to determine if families are at higher risk for
colon and endometrial cancer.
6. Patient Safety: Reduce the system rate of catheter-associated urinary tract infections.
7. Pediatric Specialties Clinical Program: Build a care model for children with type 1 diabetes.
8. Primary Care Clinical Program: Establish an individualized approach to diabetic care by engaging patients in self-management,
primary care visits, and specialty consultations.
9. SelectHealth: Increase the percentage of SelectHealth members with diabetes who meet four measures of diabetes care: blood sugar
control, cholesterol control, kidney function, and eye exam.
10. Surgical Services: A three-part goal that reduces blood utilization, defines clinical outcome measures for specific development teams,
and develops and implements a standardized process to decrease intracase supply utilization. Intracase utilization means the
processes or units of care used within each health episode.
11. Women and Newborns: Improve care, cost efficiency, and resource utilization in the neonatal intensive care unit (NICU), and
accurately estimate the number of babies with early onset bacterial infection.
12. Primary Children’s Hospital: Increase the involvement of infectious disease specialists in decisions to use outpatient antibiotic
therapy via infusion, injection, or implantation.
13. Rural Facilities: Implement electronic physician orders to guide evidence-based care for patients with the primary diagnosis of
pneumonia, labor induction, pancreatitis, and sepsis.
14. CMS Value-Based Purchasing: The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services
(CMS) initiative that rewards hospitals with incentive payments for the quality of care they provide to people covered by Medicare. The
focuses for Intermountain’s goal in this area are to:
● Attain a significant improvement in the value-based purchasing process and outcome domains for select measures.
● Sustain progress for those hospitals that already meet or exceed national benchmarks.
Thank you, Int5e0rmountain web site

In Conclusion
51

How Do You Become An Analytics “Leader”?
• Balance the tension of care delivery, economic risk, affordability of
care, and accessibility to care… all under one CEO
 Take Risk
• Take risks, on their own, with new care delivery models and
population health… no government mandates required
 Consistently Practice Principle-Driven Decisions
• Do the right thing for patients and their communities, even at the risk
of financial loss in a fee-for-service environment
 Value Data Over Ego & Anecdote
• Have the courage to face the truth of data
• Data drives their decisions, not anecdotes and hunches
 Motivate through Mastery, Autonomy, and Purpose
• Recognize what motivates people and organizations
52

Thank You
Upcoming Educational Opportunities
Healthcare Transformation Series: Chapter Seven
Date: September 4, 1-2pm, EST
Presenter: Dr. John Haughom, Senior Advisor, Health Catalyst
http://www.healthcatalyst.com/knowledge-center/webinars-presentations
Healthcare Analytics Summit
Join top healthcare professionals for a high-powered analytics summit using analytics to
drive an engaging experience with renowned leaders who are on the cutting edge of
healthcare using data-driven methods to improve care and reduce costs.
Date: September 24th-25th
Location: Salt Lake City, Utah
Save the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

Transforming Healthcare
Through Analytics
Billy Beane
General Manager
Oakland A’s
Glen D. Steele, MD, PhD
President and CEO
Geisinger Health System
Ray Kurzweil
Director of Engineering
Google and Leading Futurist
James Merlino, MD
Chief Experience Officer
Cleveland Clinic
Creative Commons Copyright © 2014 Health Catalyst
Provide a tangible vision of healthcare analytics
Leading keynote speakers
Engage the audience with analytics in a unique way
Hands-on learning experiences
Interactive audience engagement, optimized for
teams
User and special interest group follow up
Provide meaningful networking opportunities
Share Health Catalyst vision, products, roadmaps
Have Fun
Access to a mobile app will be used for
audience response and participation in
real time. Group-wide and individual
analytic insights will be shared throughout
the summit, resulting in a more
substantive, engaging experience while
demonstrating the power of analytics.
hasummit.com
Penny Wheeler
President and Chief Clinical Officer
Allina Health
Charles Macias, MD, MPH
Chief Clinical Integration Systems Office
Texas Children’s Hospital
Governor Mike Leavitt
Former Secretary of HHS
Founder of Leavitt Partners
Ms. Lizette Yearwood, JP
Chief Executive Officer
Cayman Islands
Health Service Authority (HAS)
Keynote Speakers

Q&A, Contact Information
dale.sanders@healthcatalyst.com
@drsanders
55

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