1. IndiGO® Population Health and Individual Patient Predictive Analytics

2. Agenda
The IndiGO Model
Demo

3. Illnesses causing death – 1900 vs 20103

4. Background on Corporate Ownership of IndiGO
Development started in 1993
David Eddy MD, PhD
Len Schlessinger PhD
Core technology - Archimedes Model
Mathematical model of human physiology, diseases, interventions, and healthcare systems
Highly detailed
Carefully validated
Spun out from Kaiser as an independent organization called Archimedes in 2006
IndiGO – an application of the Archimedes model, was developed and clinically validated
Paper on Individualized Guidelines published in Annals of Internal Medicine
Clients include Kaiser Permanente, Intermountain, ONC Beacon Communities, and others
SPH Analytics acquired IndiGO in 2014
SPH Analytics is part of the Symphony Technology Group of companies

5. What does IndiGO do? Calculates accurate individual risks
Based on rich set (~62 data elements) of individual health data
Calculates impact of preventive interventions on those risks
Quantifies impact of interventions across chronic conditions
Presents this information to clinician and patient in visual form
Point-of-care user interface
Patient portal user interface (under development)
API used in mobile app

6. Incentive for providers
Uses of IndiGO
Stratifies by actionable risk
Right patients
Prioritization options for patient
Identify important treatment options outside of guidelines
Right treatments
Personalized
Informative and engaging
Offers choices
Motivate patients
GO Score
Averted events relative to peers
Incentive for providers 6

7. What data does IndiGO use?
Category
Data elements
Demographics
Age, gender, height, weight
Biomarkers
Cholesterol, HDL, LDL, TG
Blood pressure
A1c and FPG
Creatinine, urinary albumin
Lifestyle
Smoking and exercise
Medical history
Prior MI, stroke, CHF, atrial fibrillation, history of revascularization
Family history
Diagnosis of diabetes, neuropathy, retinopathy
Medications
Current and previous
Allergies and contraindications
Ace, Arb, Aspirin, Beta, CCB, Diuretic, Metformin, Statin, Antidepressant
Missing data?
Potential risk is aggregated based on known data and population incidence with similar factors
Confidence interval is calculated

8. IndiGO Risk and Intervention Models
Risks
Cardiovascular disease MI
Stroke
Diabetes
Onset
Complications
Cancers
Breast
Colon
Lung
Renal disease
COPD
Depression
Interventions
Statins
Anti-hypertensives
ACE, ARB, Beta Blockers Diuretics, CCBs
Aspirin
HbA1c reduction
Weight loss
Smoking cessation
Exercise
Fish oil
Cancer screening
Depression treatment

9. Independent Validation of Risk Formulas
Kaiser Permanente independent validation
Comparison to “gold standard” Framingham Model
Predicted risks of 1M KP Southern California members based on 2008 data
IndiGO predictions closely matched actual outcomes
Risk is overestimated for high-risk patients and underestimated for low-risk patients
Because of requirement that all inputs are available and excluded groups (prior MI or stroke, diabetics) Framingham can predict risk for only 40% of population 20 40 60 80
100 5
Percent of MI in 2 yrs 20 40 60 80
100 5
Percent of CVD in 2 yrs
About 2x high 20 40 60 80
100 5
Percent of stroke in 2 yrs
Key: o observed risk predicted risk

10. Validation of the study in AJMC
In May 2016, the American Journal of Managed Care published an important paper for IndiGO.  The primary conclusions of the paper are:
·         That the IndiGO model has excellent accuracy and predictive ability based on a study of over a million adults
·         That there is a large potential to reduce population risk (and cost) of cardiovascular events by using such a risk-based tool
In addition to being one of the largest cardiovascular risk model validations ever published, it qualifies as an independent validation because all the analysis and conclusions were from the researchers at Kaiser Southern California. 
A completely different team at Kaiser Northern California published a paper that seriously questions the accuracy of the current “gold standard” US cardiovascular risk model which was developed two years ago by a team at the NIH.  Their paper in the Journal of American College of Cardiology found that the risk predictions of that tool were off by a factor of 5x in many cases.
Here is the link to the IndiGO paper:
And the one debunking the current national standard model:

11. IndiGO Demo

12. Evaluation by KP Care Management Institute
Increased adherence
6x More likely to close the care gap for statins under standard guidelines after PCP visit with IndiGO
High Acceptance
“All doctors agreed that IndiGO helped them to make the best clinical decisions for their patients”
“Almost all participants believe the Indigo Tool helped the doctor to motivate them, and helped them participate in their treatment choices”
Projected impacts
(per Million Members)
$98M Saved annually
1400 Heart attacks and strokes averted annually
Reduced Risk
11% Reduction in 5-year CVD risk – more than EHR and panel support tool alone

13. Clinician incentive program
Lifestyle opportunity: opportunity to prevent additional cardiovascular events through lifestyle changes (e.g. smoking cessation, exercise)
Medication opportunity: opportunity to prevent additional cardiovascular events through improved medication prescription and adherence
Contribution: number of heart attacks and strokes over the organizational target the physician is predicted to prevent
Threshold: target number of heart attacks and strokes that need to be prevented to meet minimum organizational standards; for this particular organization, the number is 50% of events that would be prevented through treating the entire panel of patients to guideline.

14. GO Score over time
Increase in GO Score between Q and Q = 2.3
Increase in incentive value over same period = $14,800

15. Example of provider incentive dashboard prototype

16. Prototype of new provider UI

17. Example of patient portal prototype

18. Additional resources on IndiGO
·         IndiGO encounter re-enactment video ( ~ 2 ½ minutes):
·         Patient training video (3 minutes):  
·         Patient and Physician testimonials video (3 minutes):
·         Helen Darling video about the GO Score (National Business Group on Health, RWJ, NCQA) (~4 minutes)

19. Papers Annals of Internal Medicine
Risk based targeting improves treatment effectiveness 60% over existing guidelines
Health Affairs
Risk based performance measurement
Validation papers (in press AJMC, written by Kaiser So. Cal Research)
IndiGO more accurate than Framingham or ACC
Opportunity for risk reduction outside guideline as great as opportunity from gaps in guidelines