The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Getting to Enterprise Analytics in the Government Healthcare Sector Begins With a Modern, Connected Data Warehouse

By Rick Williams/Monday, June 30, 2014
Rick Williams imageEnterprise analytics is a hot buzz phrase these days. What used to be an analyst-only topic has moved to the executive level. And it’s no secret that the idea of analyzing disparate data from across an organization is becoming increasingly important in all of healthcare today – perhaps even more so in the government sector.

Policymakers are talking about it, elected officials want it, and taxpayers expect that it’s already happening.

Meanwhile, state agencies, such as Medicaid and Departments of Health and Human Services (HHS), are facing an urgent need to curtail rising costs, boost efficiencies, report accurate information, and improve quality of care.

To achieve that, they need to see not only the big-picture of program data, but also to understand the intricacies of population health and even coordinate patient-level care across agencies. And thanks to Affordable Care Act-driven concepts, like ACOs and risk-based contracts, it’s all at a tipping point.

The key lies in an interoperable data hub – a modern, connected warehouse that  facilitates the flow of data and reporting, automates workflows, and helps staff be more efficient while providing the right decision-making knowledge to the right stakeholders. 

Of course, as this type of warehouse is developed, particular attention must be paid to data integrity – because without that, enterprise analytics are meaningless.

The development should be guided by an iron-clad master data management process, ensuring that all data values being collected and connected speak the same language. This results in a data warehouse that truly becomes a single source of truth across departments and agencies.

At Truven Health, we see the warehouse development process unfolding with these steps:
  • Identify stakeholders and “champions”
  • Assemble strong executive leadership
  • Create a shared vision of the modern data warehouse
  • Formalize the governance structure
  • Establish a clear decision-making process
  • Evaluate the governance system and adapt as necessary
  • Maintain transparent communications throughout development
  • Identify an enterprise reference model as part of the information architecture
After the enterprise warehouse is developed, we can then apply the all-important, advanced metrics and modeling. Just a few of the typical analytics and applications we recommend include:
  • Calculations for episode grouping
  • Hierarchical Condition Categories (HCC) score calculations
  • Risk stratifications
  • A measures engine
  • Practice-to-cohort comparisons
  • Disease registries
Ultimately, the end result will be an ultra-connected depth and breadth of useful data that can be streamlined and analyzed at all levels, from a policy analyst to a caseworker on the front lines.

Rick Williams
VP Data Warehouse

PULSE Healthcare Survey Captures Opinions Despite Communication Preferences

By George Popa/Friday, June 27, 2014
The perceived risk of taking painkillers is an issue for people of all ages and communication preferences. Our polling shows that one in three adults only have a cell phone instead of both a cell phone and a land line. This is especially important as we collect opinions from the more mobile Millennials and Generation Xers, as well as the more traditional Baby Boomers and Seniors, who often have cell phones in addition to land lines.
Every other month, the Truven Health Analytics™-NPR Health Poll surveys approximately 3,000 Americans to gauge attitudes and opinions on a wide range of healthcare issues. Poll results are reported by NPR on the health blog Shots and on air. Complete survey results are also posted. NPR’s reports on the findings are archived.

The Truven Health Analytics-NPR Health Poll is powered by the Truven Health Analytics PULSE® Healthcare Survey, an independently funded multi-modal (land line, cell phone, and internet) survey that collects information from more than 82,000 U.S. households annually. 3,010 survey participants were interviewed from May 1–15, 2014, and the article, Americans Weigh Addiction Risk When Taking Painkillers, reflects their responses. The margin of error is +/- 1.8 percent.

The biggest advantage of using multi-modal survey over strictly land-line telephone surveys is that fewer and fewer people are using land-line telephones. By employing a multi-mode approach to the PULSE Healthcare Survey that includes land-line phone, cell phone, and internet, Truven Health is ensuring that all segments of the population are included in the sample.

By 2010, 21% of the adult population used cell phones exclusively. By 2012, this number increased to 30% and has continued to increase. Additional research suggests that the 18-35 year old population is the largest group of cell phone “only” or cell phone “mostly” users. The 18-35 age group is becoming more difficult to reach and other methods must be used besides land-line telephones.

People have expanded their means of communication, and our work  reflects consumer preference in our polling  sampling methodology. As people leverage technology  to communicate in many different ways, it‘s important that surveys develop sampling methodologies that are broadly inclusive. The PULSE Healthcare Survey is doing just that.

George Popa
Research Scientist, PULSE Healthcare Survey

Five Things Employers Want from Health Plan Reporting

By Jennifer Huyck/Thursday, June 19, 2014
Jennifer Huyck imageThese days, health plans are under pressure to deliver more comprehensive and reliable information to their employer clients.

After all, population health is on everyone’s radar, and employers are trying to keep a tight rein on rising costs. Plus, with all the talk of healthcare Big Data, employers have higher expectations of the kinds of information health plans can provide. Information transparency and combining financial and clinical data from multiple sources are becoming critical.

In other words, traditional reporting isn’t going to cut it anymore.

But what, specifically, do employers want from health plan reports?

Based on our partnerships with over 150 of the nation’s largest employers — including 25 percent of Fortune 500® companies — Truven Health experts have compiled the following list of the five most important things employers want when it comes to the health plan reporting.
  1. Acknowledge their different needs. Step away from one-size-fits-all reporting. Each employer client will want to see different slices of data and varying levels of analysis to fit their specific business questions. Reports need to be flexible enough to meet those diverse requests and stakeholders.
  2. Help them educate and inform their senior management team. Benefits managers need to be able to prove to the Powers That Be that the company’s investments in employee health are worth it, and health plan reporting is an important part of that.
  3. Provide consistent, accurate, and timely reporting. Employers want data that they can trust, and they want it quickly.
  4. Show them how to compare themselves to the outside world. Reporting solutions should allow employer clients to compare costs and other points of interest to national and regional benchmarks, so they can identify areas for improvement and recognize successes.
  5. Be consultative and creative. This is perhaps the most notable change in what employers need today versus what they needed in the past. Today, it’s not just about the numbers on a spreadsheet. Employers need those numbers to be meaningful and useful as they try to solve new challenges. And it’s now the health plan’s job to offer guidance along with the numbers.
In short, plans that can provide data and analytics that are flexible and trustworthy, and that answer the “So what?” and the “Now what?” will be the best-positioned to become problem-solving partners that employers can’t live without.

For more details about these five employer reporting needs, download our latest insights brief.

Jennifer Huyck
Vice President, Analytics and Consulting

The Expanding Role of Pharmacists: Out of the Basement and Into the Spotlight

By Tina Moen/Wednesday, June 18, 2014
Tina Moen imageWhat does it mean to be a pharmacist in 2014? I recently presented at the Health Connect Partners Spring Pharmacy Conference to a room full of pharmacy leaders from across the country. We discussed the evolution of the practice of pharmacy, the things we have seen change over the years, and the opportunities (and challenges) we see on the horizon. Throughout the conference, many attendees shared stories of how their responsibilities as a pharmacist have evolved throughout their careers. Our conclusion is that now – more than ever – there are visible, meaningful changes to our role as it relates to patient care, collaboration with our peers, and in leadership participation in the healthcare community.

Clinical pharmacy services, as we know it, are a result of continuous evolution of the historical pharmacy role – namely dispensing medications from behind the counter or in the basement. This evolution has taken many years. Pharmacists now deliver enhanced value to their organizations and their patients with a focus on quality, safety, and efficacy of medication therapies. Programs such as enhanced Medication Therapy Management continue to highlight the impact pharmacists can make on reducing adverse effects and improving efficacy of a patient’s medication regimen. Additionally, pharmacists contributing to Medication Reconciliation and specialty services, like Anticoagulation or Diabetes Clinics, continue to demonstrate that rounding out the care team to include a medication specialist improves patient outcomes and enhances the practice and performance of clinical peers. And recently, I have seen emerging cross-functional leadership teams working toward goals such as the IHI “Triple AIM,” begin to include Pharmacy; tying personal goals and incentives for DOPs to these efficiency and quality objectives.

Clearly, great progress has been made in the practice of pharmacy, and I for one am proud of the role pharmacists play in enhancing the patient experience and outcomes. So, what's next? Here are the things that come to mind when I ask myself this question.

Healthcare IT
A recent article in Healthcare IT News advocated for pharmacists playing a larger role in EHR strategy. As a pharmacist who works within the healthcare IT industry, I couldn’t agree more. What percentage of patients in a hospital has at least ONE medication order? I would venture to say “most.” It’s an obvious conclusion that the profession charged with the safe and effective use of medications should have a significant role in the development, selection, and implementation of tools used to properly care for those patients. And then there is Meaningful Use. How many of the Meaningful Use Objectives are related to medications and the services in which pharmacists participate? Who better then to take the lead in organizational efforts for Stage II attestation and Stage III planning?

Care Collaboration
Cross-departmental coordination for initiatives that span hospital leadership continues to grow in scope and importance. Benefits of pharmacists as integral members of rounding teams within the inpatient setting are well-documented. With organizations designing and implementing Population Health and ACO strategies, pharmacy leaders can capitalize on the combination of data analytics and clinical insight that are the hallmarks of pharmacy practice. As Population Health initiatives evolve – who better than a pharmacist to guide trends in medication recommendations in treating high-risk conditions and ensuring safe, cost-conscious practice remains top of mind?

Quality Patient Care
Providing quality patient care has always been a focus of healthcare providers. Today’s environment adds a variety of incentives and penalties to drive quality. How are pharmacists contributing? In many ways! Pharmacists are well-suited to lead the charge on initiatives like Antimicrobial Stewardship, a quality and a cost management initiative. The importance of medication education and adherence in the improvement of HCAHPS scores and the reduction of readmissions are additional examples how pharmacists can and should use their skills as medication specialists to drive improved patient care. Because results summaries from nation-wide HCAHPS surveys indicate that Medication Safety and Pain Management questions are still amongst the lowest performing areas – shouldn’t pharmacists’ input at the patient care level be paramount?

As I said during my visit to Health Connect Partners, it’s good to look back occasionally to see the progress that has been made and to help motivate us for the challenges and opportunities ahead of us. What is next? What have I missed? I would love to hear from my fellow pharmacists on where the practice of pharmacy will be in the next 10 years. What are you doing today to move the needle in the evolution of pharmacy?

Tina Moen, PharmD
Chief Clinical Officer

CMMI Releases Updated Baseline Pricing for Bundled Payments

By David Jackson/Saturday, June 14, 2014
David Jackson imageOn May 1, 2014, the Center for Medicare & Medicaid Innovation (CMMI) released Model 2 and Model 3 Mock Reconciliation Results for Q2 2013 to provider organizations going at risk under Phase II of the Bundled Payments for Care Improvement Initiative (BPCI). While the results shared were intended to be informational and to help awardees better understand the reconciliation process, reported changes in baseline target prices raised a few eyebrows across the community of BPCI stakeholders. CMMI notified participants that the 2012 baseline prices were different than previously reported to awardees in August of 2013 due to changes in baseline episodes assigned to participants. Specifically, those participants who had entered into risk agreements (Phase II) have precedence over not risk bearing (Phase I) participants in assignment of episodes. However, there were also notable changes in case mix weights, historic trend factors and risk track thresholds for the 2010 – 2012 baseline period. The combined impact of these changes may significantly impact  2012 baseline target prices. Depending on the direction and magnitude of impact, the financial savings or loss projections for a given participant may change. We recommend all participants revisit those initial projections as part of their work to create a process for ongoing reconciliation.

Many of the BCPI stakeholders were under the impression that target prices reported in August 2013 were in essence “locked in,” so they were surprised to see some target prices driven down, in some cases significantly, for key higher volume DRGs, as we observed for major joint replacement surgeries. Lower than expected target prices ultimately mean lower than expected hard-earned savings a participant may recoup as a result of care redesign and coordination efforts.

According to CMMI representatives, upon advice from the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS), CMMI switched from deriving national historic episode statistics from a national random sample of 7,000 cases per DRG to the entire national universe of all Original Medicare episodes. The switch in national baseline episodes altered the historic trend factors, case mix weights, and risk track trim points affecting calculated target price, in some cases unfavorably. CMMI has commented that this degree of change was unexpected, but is a one-time occurrence and is not expected to change to this degree in the future. CMMI will continue to utilize the national episode universe baseline. While the shift to a national universe for establishing trend is positive, we believe CMS should consider an additional change to exclude participants from the trend calculation. Furthermore, we believe participants should anticipate substantial variation in quarterly financial results especially for low volume episodes and plan accordingly.

On the plus side, CMMI is making strides in providing greater resources to support participants through more frequent engagement and development of feedback mechanisms to help them understand how they stand in comparison to other episode initiators participating in the BPCI program. CMMI has established dedicated representatives, who will each work with approximately 25 awardees, to schedule regular discussions. They hope to have additional feedback mechanisms available for the first reconciliation time frame. In the meantime, to help drive success, it’s important for all BCPI participants to stay proactively engaged with CMMI and express their concerns and needs around information.

As organizations attempt to predict the financial success and the impact on their relationships with other participating providers through gain sharing or other business arrangements, they must keep track of many moving parts. Target prices will continue to be a moving target and CMMI will only be able to provide the final target prices quarterly, along with each retrospective reconciliation period. So it's important for the BCPI community to establish internal forecasting processes and request additional information, for example, historic quarter to quarter trend factors to better assess potential pricing volatility. CMS has invested heavily in providing data that when used to its full potential, can help facilitate positive transformation.

But it’s imperative for participants to monitor the impact of changes or clarification to BPCI program policies and to provide feedback. We encourage you to share your thoughts with CMMI. The e-mail address for feedback and questions regarding the BPCI program is BundledPayments@cms.hhs.gov.

David Jackson
Senior Consulting Manager