Transparency in health care: Perspectives on the potential of heath care “big” data Public Sector HealthCare Roundtable November 7, 2014 Jeanne De Sa, Principal Healthsperien, LLC 1

Where is all the money going? Some context… Movement away from FFS and silo in payment, toward “value based” and population health models, ways to transfer risk Focus in areas with unexplained variation in care, growing cost Input on clinical transformation, care models for specialty providers Right tools & data to caregivers, families and patients (shared decision making) “Appropriateness” of care, emphasis on use of evidence-based guidelines Focus on care coordination, smoother transitions; primary care and integrating with specialty care Performance-based contracting, purchaser leverage on providers 2

Nothing to see here! Why transparency? Researchers – want data on prices and quality to fill in gaps in system—wide knowledge; how transparency can impact provider prices, consumer behavior Policy makers/regulators – want to support range of initiatives related to quality and efficiency, understanding cost drivers, advancing health reform goals, implementing cost-sharing rules Providers – benchmark cost and quality against peers, more consistency in measures to report, show value to purchasers Health plans – develop initiatives to combat cost growth, offer members lower cost, higher-quality options, reduce costs of innovation Consumers – information to help engagement, empower relationships with providers, reduce out-of-pocket costs; concerns with Purchasers - paying for value and quality, reduce costs, meet needs of employees and encourage engagement, develop good relationships with providers in networks, communities. 3

“Big data” – the data is here and more is coming More than traditional claims data Clinical sources, EHRs, medical charts, socio-demographic, adverse event/patient safety reporting, vital statistics Day-to-day practice of medicine Genomic Mobile devices, patient-generated, social networks Images, video Sourced from providers, payers, public and private data utilities, patients Trends and tools have evolved – way beyond where we were 5 to 10 years ago Tools map, normalize and validate data, to facilitate use in research and analysis Enabled by data warehousing, extraction and mining techniques Advances in statistical methods on working with structured, unstructured data; advent of machine learning/natural language processing Computing power enables fast analysis of large information sets Multiple ways to access, organize, present data; application programming interfaces (APIs) for complex data sets allow programmers/developers to make accessible 4

Health care data and analytics - yielding insights Generation of vast new knowledge Identification of variance, avoidable utilization; prediction of non-adherence Opportunity identification Allows different views of total cost of care, episode/care paths… Improved accuracy of diagnoses Data integration – claims and clinical; clinical data lets you look at situational/early risks, adds value to claims analysis Unstructured formats provide rich, observational data, can supplement RCTs Drives population analytics; risk-stratification, predictive disease models, focused opportunities to improve Real-time data; oriented toward workflow, clinical decision support 5

Health care data and analytics - enabling innovation Practice improvement, care process redesign Improve prevention, risk-assessment, quality (Star) ratings, compliance, patient experience Inform payment and delivery model development; design and evaluate multi- payer demonstration models Benchmarking to peers, development of risk-based analysis tools Develop risk-sharing, partnership opportunities with other providers Develop episodes of care, quality metrics Support outcomes-based payment approaches (performance bonuses, warranties) Facilitate transparency initiatives, research Show value to consumers, purchasers and payers 6

Transparency in action State all-payer claims databases (APCDs) Medicare and QE’s Commercial claims data sets, Health Care Cost Institute, FAIR health Clinical-claims initiatives Private transparency tools for consumers openFDA Mobile apps Quantified self movement The future? 7

Questions/risks for the future Vast potential to address costs and quality – but will it be realized? How can purchasers of care be more effective? Capturing what we need to in a targeted way? Do we just have more noise? Is data getting to the right people in the right way for the right purpose? Are the incentives there and appropriately aligned? Are providers on board? Agents or barriers to change? Might price transparency lead to provider collusion? Will consumers really engage/shop with more information? 8