1. Drivers of Healthcare Analytics

2. Medicine is Changing
FROM a craft-based practice, in which individual physicians, working alone, create a customized solution for each patient based on their personal knowledge and training and a core ethical commitment to the patient.
TO a profession-based practice, organized around patient or disease state, where groups of peers, treating similar patients in a shared setting, execute coordinated care delivery processes using agreed upon clinical guidelines and disease management protocols.
This transformational change in the medical delivery model is being driven by payment reform, and will be accompanied by:
individual physician autonomy and hierarchy replaced by clinically integrated, team-based systems of care
greater provider accountability for population health costs and outcomes
a significantly higher level of provider financial risk 2

3. How Healthcare is Currently Purchased7

4. Alternative Value Based Payment Models
Fee for Service
P4P
Shared Savings
Bundled Payments
Shared Risk
Capitation
Limited Integration
Moderate Integration
Full Integration
Provider
Financial Risk
Payer
Financial Risk 8

5. Clinical Organization and Delivery
Payment Model
Clinical Organization and Delivery
IT/Analytics
FFS
P4P
organized around medical specialty and hospital
disease focus, one patient at a time
hierarchal culture and high physician autonomy
low provider accountability for cost and quality of care
limited EMR interoperability
limited provider financial risk
Access databases and spreadsheets
retrospective dashboards
payer provided performance reports
disparate EMRs
Shared Savings
low-to-moderate clinical integration and physician- hospital alignment
some proactive chronic care and complex case management, though most visits still reactive to patient complaints
payer-defined patient care protocols and risk stratification
modest provider accountability for cost and quality of care for a defined patient population
moderate level of provider financial risk
early stage predictive analytics
payer provided risk scores and performance reports
early stage EMR interoperability

6. Clinical Organization and Delivery
Payment Model
Clinical Organization and Delivery
IT/Analytics
Bundled Payments
increasing clinical integration and physician-led care coordination teams
use of provider-defined, evidence based care management protocols
patient care cost, quality and outcomes actively monitored and reported
patients actively engaged in their care
quality control systems reduce variation and minimize error
meaningful provider financial risk
mature predictive analytics capability
provider defined cost, quality and outcome measurement and reporting
advanced EMR interoperability or single, system-wide EHR
Shared Risk
Capitation
providers organized around patient and population needs
system-wide acceptance and adherence to provider defined care protocols
clinically integrated, team-based systems substitute for hierarchy and result in seamless care for patients
care quality transparent and value-oriented
internal data warehouse collects data from multiple sources for sophisticated health risk modeling
significant provider financial risk
sophisticated population/process analytics capability
fully integrated clinical and financial data systems
HIEs and EMR interoperability provide a real-time, longitudinal patient view