Issue link: https://beckershealthcare.uberflip.com/i/289185
76 Executive Briefing: Data Analytics clinical data, registries will be incomplete. An analysis of Optum's clinical database of more than 40 million patients reveals that nearly 20 percent of patients with clinical evidence of diabetes lack a coded diagnosis of diabetes. 1 That means one out of every five patients will not appear on reports from electronic health re- cord systems by diagnosis code, on problem lists or in registries. A true snapshot of risk Generating and utilizing good data is merely a first step. The next step requires investment in advanced analytical systems that can provide accurate, timely and precise risk perspectives. Baylor Quality Alliance, a clinically integrated organization of em- ployed physicians, independent physicians, hospitals and others associated with Dallas-based Baylor Health Care System, uses a blend of Optum analytics and home-grown systems for popu- lation segmentation, predictive modeling and performance mea- surements around quality and cost, according to Carl Couch, MD, president of Baylor Quality Alliance. By focusing data analyses on specific functions, Baylor is able to quickly and effectively manage risk and make corrections to patient protocols where needed. The Optum system utilized by Baylor applies four distinct compo- nents to maximizing all-source data analysis: 1. Integration of clinical and claims data across the continuum of care to give providers a complete view of population health 2. Better prediction of at-risk patients to reduce preventable costs via clinical analytics 3. Improved performance via deep comparative clinical benchmarks 4. Easy-to-use interfaces so non-technical people can interact without extensive training and support "The fundamental assumption of analytics is you can't manage what you don't measure, and in healthcare we are particularly looking for performance measurement," Dr. Couch said. "When we look at Dr. A and Dr. B and Dr. C, we need to know why one of them has far better clinical performance or one of them has far worse financial performance than the others. That leads to discussions on what we need to modify." Getting to the best protocols through robust analytics can mean combining different data sets within the analytic systems. For ex- ample, an organization can marry care management information and other analytics to see how it is improving over time. "If an organization uses analytics to find a group of high-risk pa- tients and assign some of them to intervention A and others to intervention B, in a year's time they can go back and bring those intervention variables back into the analytical platform," said Jere- my Orr, Optum Analytics' CMO. "They can see which one worked better and now have a tool that powers a continuous improvement process." Powerful data = Better patient care Physicians want to provide the best possible care to their patients. Although there is often wide variability in patient care patterns, the problem may be that physicians don't know how the care they provide varies in relation to peers within the same organization and in the industry as a whole. That's where quality data analytics can mean success within the realms of pay-for-performance and even fee-for-service. When it comes to improving patient health, robust data needs to be applied to two related disciplines: identifying patient popula- tions in need of intervention and identifying specific patient needs. When compared against evidence-based guidelines, these two disciplines represent true gaps-in-care management. Analytic tools help organizations at a strategic level by identify- ing broad cohorts and segmenting those cohorts into targeted risk populations. For optimum usability, gaps in care should be stratified as age-, gender- and disease-specific. At a more tacti- cal level, gaps-in-care management identifies specific gaps in the care of specific patients, which can be presented to physicians as a work list or within an electronic medical record environment. Measure reporting, such as that done under Physician Quality Re- porting System and Healthcare Effectiveness Data and Informa- tion Set, is more challenging. There are dozens of analytic tools that perform accountable care organization reporting and others that specialize in PQRS reports. Efficiency comes with consolidat- ing data analyses and reporting from one platform. "Organizations want one solution to do ACO and PQRS report- ing, plus other patient registry functions and pay-for-perfor- mance," said Dr. Orr. "They've been adding complexity to their IT environments for decades and now it's time to simplify." Dr. Orr believes CMIOs are hungry for a single data analysis tool they can use to parse all of the information from divergent sources quickly and efficiently. "Analytic tools help organizations at a strategic level by identifying broad cohorts and segmenting those cohorts into targeted risk populations. For optimum usability, gaps in care should be stratified as age-, gender- and disease-specific." "Using analytics, care coordinators can reach out to patients to ensure they're seeing their physicians, taking medications, communicating with all of their care providers and understanding the different instructions they may get from multiple providers."