Download Data Integration - Encompass Medical Management

OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Data comes in many formats and
from different vendor silos
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Health claims
Pharmacy claims
Eligibility
Wellness programs
Data is not easily translated into usable information
• Integrating data can be difficult and time consuming
• In-house analysts can be expensive
• HIPAA and other regulatory concerns are important considerations
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
EMMDATA specializes in big data
solutions for both health plans and
provider organizations.
We provide current use and
predictive models to analyze
patients and members.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• Data consolidation
• Unified reporting
WEB PORTAL
FUNCTIONALITY
• Advanced analytics
• Usable information
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Can be instituted sequentially
- Starts with data that is immediately available
- Adds what is more difficult to obtain and use as
experience grows
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
Accountable Care Organizations
• More evidence based medicine
• More complete reporting of data
• Increased coordination of care
Meaningful Use
• Will reward compliance and punish non-compliance
ANALYSIS SERVICES
Medical Loss Ratios
• Many plans will have to meet the new MLR requirements
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Medical Management Programs
• Special needs
• Chronic condition management
• Medication therapy management
And Much More…
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
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Managing Medical Management Vendors
Assuring interventions target the appropriate patients
Measuring ROI and program results
Managing networks
Measuring provider quality and efficiency
Coordinating care
Helping members make the best use of plan resources
Containing inappropriate medical and pharmacy cost
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
Core Elements
DataMarts
Warehouses
BI, Dashboards,
Reports
Individual Views
Customer Patient
Portals Collaborations
Analytics
ANALYSIS SERVICES
Decision Support
Population and
Employer Analytics
Management
Support
Operational
Reporting
TREATMENT
TELE-SESSIONS
Care and Service Delivery Support
IMPLEMENTATION
Care Planning
CASE STUDIES
Care Collaboration
Outcome Evaluation
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
All sources of data can be integrated
into the models and analyses.
• Medical claims
WEB PORTAL
FUNCTIONALITY
• Rx claims
• Remote tele-monitoring
• HRA
ANALYSIS SERVICES
• Biometric screening
• Eligibility
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
• Lab data
• EMR data
• Medical management data including
tele-monitoring results
• Vendor information
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
Employer health plans achieve immediate benefit
from integrated data
WEB PORTAL
FUNCTIONALITY
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Consolidated patient view across plan segments
Claims and eligibility data
Provider data
Intervention data
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Consolidated patient view allows aggregation of
information in meaningful ways
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By patient risk
By predicted future cost
By current utilization
By member demographics
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
EMMDATA provides data warehousing services for
receiving and monitoring data feeds, performing data
scrubbing, data integrity checks, storage, and reporting.
WEB PORTAL
FUNCTIONALITY
All connections and data storage are HIPAA compliant.
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
In most healthcare environments the data sources are
disparate and often not integrated nor accessible for
analysis.
A typical health plan may have medical claims data,
pharmacy data, lab results, eligibility, electronic medical
record data, health risk assessment data, wellness
initiative data, and medical management intervention
data.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
EMMDATA receives data feeds from multiple sources.
For most customers data feeds include some or all of the following:
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WEB PORTAL
FUNCTIONALITY
From Health Plan
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From Network Carrier
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ANALYSIS SERVICES
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IMPLEMENTATION
CASE STUDIES
Pharmacy Claims
Specialty programs from plan and provider contracted vendors
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TREATMENT
TELE-SESSIONS
Medical Claims
Lab Results
From pharmacy benefit manager
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Eligibility
Member demographics
Disease Management Nurse Interventions
Discharge plan programs
Wellness programs
EMMDATA can also receive data from many other sources:
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Health Risk Assessments
EMR patient data
Satisfaction and other surveys
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• Accessing and storing the separate data elements into usable
decision-support information is a primary goal of EMMDATA
warehousing.
WEB PORTAL
FUNCTIONALITY
• Transforming and marshalling data into useful data marts facilitates
integration and gives a more complete picture of patients, providers,
and plan performance.
ANALYSIS SERVICES
• Health care data can very quickly become "big data". EMMDATA has
developed cost-effective tools for integrating loading and distributing
big data from our data warehousing solutions.
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• EMMDATA warehousing solutions result in fast, efficient, and readily
available data solutions.
• Decision makers need usable actionable information.
EMMDATA warehousing makes that a reality.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
• Inform health plan about issues and solutions
• Help physicians to make more informed decisions
• To involve patients in the management of their own conditions
• Improve outcomes of nurse intervention programs
• Better coordinate care
ANALYSIS SERVICES
• Improve timeliness of information
TREATMENT
TELE-SESSIONS
• Dramatically reduces the disruptions caused by
information trapped in silos
IMPLEMENTATION
• Enhances the achievement of positive outcomes,
both financial and clinical
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Collaboration between health plans, providers, and
medical management initiatives can benefit all.
The basic data elements are often in existence.
The challenges are
• Data integration and
• Meaningfully using the expanded patient data
Assuring interoperability and ease of use are vital
• If information is not delivered to clinicians in usable formats it is
not worth much
Missing from the current state of most plans are:
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Connections between data silos
Processing of all data by patient
Communication methods between data sources
Delivery mechanisms that are easily and seamlessly accessible by all
clinicians
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OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
OBJECTIVE
HOW IT WORKS
BENEFITS
INFORMATION CONTINUITY Key information exchange
Comprehensive patient care
records
Same view of the patient is
available to all providers
FACILITATE CARE
COORDINATION AND
TRANSITION
Enabling operation can integrate with
any technology or act as a stand alone
All captured data sets to create a
composite view of the patient
Timely access to most recent data
allows for coordination between
providers and case managers
SUPPORT BEST PRACTICES
Interoperable applications between
claims data and EMR/HIS data
Develop guidelines and care
processes for better coordination
Improve accountability and track
quality of care
ENGAGE PATIENTS
Integrate with personal health records
and patient portals
Enable patients access to their
health information
Improved patient adherence with
treatment protocols and
improved patient engagement
MANAGE DISEASES
Alerts, reminders, population analysis,
interaction with medical management
Population management by age,
sex, problem, plan status, etc.
Better achieve Healthy People
2010-2020 goals
CASE MANAGEMENT
COORDINATION
Integrate case managers into the
continuum of care
Deliver results and goals of
medical management
interventions to providers
Extend the reach of the physician
office to achieve better care
coordination and compliance to
treatment
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
TECHNOLOGY ENABLER
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
• Secure, HIPAA-compliant web portal to access integrated data in one place
• Make more informed decisions
• Test plan designs
• End users of all levels of expertise are supported
• Site configuration is client driven and responds to the requests of the users.
ANALYSIS SERVICES
ANALYZE
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
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Program effectiveness
Cost drivers
Patient cost risk
Health plan utilization and
performance
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MONITOR
UNDERSTAND
Performance & Risk Trending
Disease progression
Chronic conditions
High cost patients
• Interactive charts
• Detailed and aggregate reports
• Predictive analyses at patient
and population level
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
• Designed to give each user the information they need at
the level of complexity necessary for good decisions
• Can be customized to support health plan management
and measure plan performance
• Can be customized to reflect employer health plan needs
ANALYSIS SERVICES
• Can be configured for provider-patient management
TREATMENT
TELE-SESSIONS
• The Comprehensive Medical Record can be integrated with
most existing EMRs
IMPLEMENTATION
• Can support clinicians as a stand alone that delivers
information on demand
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
EMMDATA WEB PORTAL Dashboards give an overview of health plan
status and performance and allow drill down for further analyses and
exports to programs like Microsoft Excel.
Common metrics included in health plan dashboards are:
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Current and expected cost
Resource utilization
Inpatient utilization
Rx Generic penetration
High Cost Trending
Risk Score Trending
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Place of Service Utilization
Utilization by Plan Type
Projected cost and use predictions
Impact of comorbid chronic conditions
Rx refill and Rx possession rates
Current enrollment and plan type impact
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The WEB PORTAL allows access to the Consolidated Patient Record. This is an
effective tool for sharing data across physicians, facilities and intervention
services, and is composed of all available data.
• From the plan
- Paid claims
- Rx claims
- Eligibility
• From Physicians
- EMR (electronic medical record)
• From Facilities
- HIS (hospital information systems)
• From Care Management Organizations
(internal and external)
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Combining all data sources and processes in a single
usable record improves insights into patients.
Sources can include
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Eligibility demographics
Medical claims
Pharmacy claims
Lab results
Risk modeling
Diagnostic information
Service utilization
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Comprehensive patient records can be formatted for
specific purposes.
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Use in clinic EMR
Use in population detail summaries
Outcome measures
Trending
The advantage is all data is brought to bear
on patient status for a more complete view.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
We provide additional services that support plans
and provider organizations.
A few examples include:
• Surveys
• Absenteeism & Presenteeism
• Satisfaction
• Integration with EAP and other plan initiatives
• Integration with disease management programs
• Condition specific initiatives
• Discharge plan execution
• Holistic employee/patient environment initiatives
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
A wide variety of analyses are provided and many more are
available through the existing analysis library such as
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Utilization
Condition Frequency
Procedure and Rx Frequency
Patient Status and Future Risk
Patient Compliance
Plan Performance
Patient profile, risk and condition identification
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Analyses, profiles, and status can be viewed in many ways
depending on the questions being addressed.
• Patient-Specific Profiles
• By Plan Type
• The views can highlight:
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Time over Time (Trending)
Clinical Status
Cost Implications
Provider Performance
Plan Performance
and many others
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
Business and patient needs can require studies and analyses that go
beyond the existing standard libraries. These specialized studies
usually address particular clinical, cost, performance, ROI, and
opportunity issues.
These are performed and results delivered through the Portal.
ANALYSIS SERVICES
Examples include specific requests such as:
TREATMENT
TELE-SESSIONS
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IMPLEMENTATION
CASE STUDIES
Current utilization of maternity services
Patient geo-location for services
In vitro utilization, cost and patient impact
Illness burden by plan type looking for negative selection
Integration and analyses of special programs such as disease management
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
The Portal provides case identification for interventions as well as
quantifying the potential impact of a program or intervention potential.
WEB PORTAL
FUNCTIONALITY
Selection criteria can be by members, by cost, and by outcomes or condition
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
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Arthritis
Asthma
COPD
Chronic Renal Failure
Congestive Heart Disease
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Depression
Diabetes
Hyperlipidemia
Hypertension
Ischemic Heart Disease
The potential of condition-specific programs can be determined based on
utilization, risk, severity, and other criteria.
Evaluate initiative performance including case identification, risk, outcomes,
patient satisfaction and ROI.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
ADJUSTED
CLINICAL
GROUPS
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
IMPLEMENTATION
CASE STUDIES
PROVIDER GROUP A
PROVIDER GROUP B
MEMBERS
AVG
COST
MEMBERS
AVG
COST
EXPECTED
MEMBERS
AVG
COST
EXPECTED
CATEGORY 1
124
$918
55
$917
$918
69
$920
$918
CATEGORY 2
792
$366
432
$396
$366
360
$330
$366
CATEGORY 3
89
$8,652
56
$8,555
$8,652
33
$8,817
$8,652
12,500
$2,940
5,000
$3,300
$3,528
7,500
$2,700
$2,548
TOTAL
TREATMENT
TELE-SESSIONS
TOTAL GROUP
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Actual cost is determined from claims history of members in each category.
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Expected cost for members in a category is determined by the expected cost of the member.
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Risk adjusting each Provider Group’s mix of members accounts for patient illness burden.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
Members
Actual Per Member
(PM)
Illness
Burden
Expected
Per Member
(PM)
Efficiency
Risk
Adjusted Per
Member
A
5000
$3,300
1.20
$3,528
0.94
$2,750
B
7500
$2,700
0.87
$2,548
1.06
$3,115
12,500
$2,940
1.00
$2,940
1.00
$2,940
Provider
Group
Total
ANALYSIS SERVICES
 Illness Burden = Expected PM / Plan Average PM
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
 Expected PM = Plan Average PM * Illness Burden
 Efficiency Ratio = Actual PM / Expected PM
 Risk Adjusted PM = Total Actual PM * Efficiency Ratio
 Provider Group PM = Average Cost * Illness Burden * Efficiency Ratio
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
UTILIZATION
PROFILE RATES
PER MEMBER PER MONTH
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Actual
Expected
Provider
Intensity
Illness
Burden
Efficiency
Dr. Jones
$166
$109
1.43
0.94
1.52
Dr. Smith
$95
$89
0.79
0.77
1.1
Dr. Allen
$104
$172
1.05
1.48
0.6
Dr. West
$213
$242
1.95
2.09
0.88
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Many behavioral health counseling sessions and clinic
office visit follow ups can be effectively handled via video
tele-sessions.
Adding video tele-sessions can Increase availability to
employees and increase clinic capacity without adding
new personnel.
Video tele-session times can be managed as blocks of
time or on demand.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
The EMM platform supports HIPAA-compliant
physician/counselor video treatment sessions.
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Manage HIPAA compliance
Use of technology increases
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ANALYSIS SERVICES
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TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
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access
productivity
Counselors interact with patients through
computer, tablet, or smart phone
Leverages existing behavioral health networks
Real cost savings:
20% - 40% reduction in session cost
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Difficulty in getting quality, patient relevant referrals
• Travel to see a counselor can be very time consuming,
particularly in larger cities and rural areas
• Work schedules may not leave much time for other
appointments
• Over-reliance on general physicians for counseling which
may not be reimbursable or suitable for the physician
• Fear of stigma associated with having a psychiatric diagnosis
• Cost
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Most EAP programs offer at least some of the following
services:
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Crisis counseling
Behavioral health triage counseling
Behavioral health referrals
Behavioral health gate keeper
Non-health counseling
• Finance
• Debt
• Family and relationship counseling
• Work related issues
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The Employee Assistance Program (EAP) provides confidential and professional
consultation, counseling, and educational services at no cost to employees and
eligible dependents. The EAP provides services that include:
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Programs for grief recovery
Family or relationship issues
Workplace concerns
Critical incident stress
Legal and financial concerns
(including access to the Employee Financial Assistance Fund)
Substance abuse
Stress management clinics
Guidance for enhancing health, wellness, and productivity
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• HIPAA compliant video treatment sessions
• Creation and management support for counseling networks
WEB PORTAL
FUNCTIONALITY
• Custom behavioral network support
• Scheduling
ANALYSIS SERVICES
• Referral management
• Performance and analytic metrics
TREATMENT
TELE-SESSIONS
• Data integration
• Care coordination
IMPLEMENTATION
CASE STUDIES
• Follow up and satisfaction surveys
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
Employee Assistance Programs often handle a wide variety of issues.
• Mental health, primarily depression, stress, anxiety
• Many other issues are also handled including
• Marital
• Financial
• Job related
TREATMENT
TELE-SESSIONS
Many EAP programs use referrals as part of their triage process.
IMPLEMENTATION
EMMDATA supports management of the triage counseling process and
the resulting referrals.
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Using Current Provider network
• Determining the appropriateness of
the provider for an individual patient is
often difficult and becomes a “Who is
available?” process.
• No extra discount for volume
• No extra discount for use of video
sessions
Behavioral health network carved out
of the existing employer network
• Takes advantage of current network
accreditation and discounts
• Overhead costs go down
• Discounts can be increased for tele-health
sessions and will result in lower per service
costs.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
As the EAP gains experience with the skills of individual
counselors, the referral process becomes more efficient
and results in better care.
Patient satisfaction surveys can help EAP and the Plan
better base referrals on prior effectiveness of the
counselors and patient satisfaction.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Counselors can charge less than the carrier rate and
achieve greater earnings because:
1. Video sessions reduce the need for brick and mortar overhead
2. Video sessions are easier to schedule and more efficient
3. Authorizations contained in the referral and billing can be
direct and immediate
4. Participating in the employer network can increase patients
for a provider
5. Employer can add provider incentives such as direct pay
without delays
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Employer sponsored employee clinics can increase care
coordination.
With access to the comprehensive medical claims record,
the physicians can be aware behavioral issues of patients
as they are treated.
The Clinics can make referrals through EAP or direct to
the Behavioral Health approved network.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
REDUCED OVERHEAD
MORE REFERRALS
INCREASED REVENUE
QUICKER PAYMENT
IMPROVED PATIENT OUTCOMES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
Using a HIPAA-compliant telehealth tool
WEB PORTAL
FUNCTIONALITY
• Increases patient convenience
ANALYSIS SERVICES
• Eliminates travel time
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Improves counselor relationship
Required training is minimal and usually one
successful session answers all of the questions.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
Common causes of failure include
• Stakeholders don’t buy in
• The reasons to implement are not well defined
• Success metrics are not defined in advance
• Measures of success and goals do not align
TREATMENT
TELE-SESSIONS
• No management champion
• Early successes are not touted
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
Employer sponsored employee clinics can
increase care coordination.
WEB PORTAL
FUNCTIONALITY
With access to the comprehensive medical
claims record, the physicians can be aware of
behavioral issues of patients as they are
treated.
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The Clinics can make referrals through EAP or
direct to the Behavioral Health approved
network.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
1. Implement EMMDATA Data and Communication Hub
• Determine current data sources
• Determine current use of data
2. Identify gaps in current clinical data
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Determine what information would be useful
• Connect data silos
3. Implement Comprehensive Patient Record
• Make data available to users
• Integrate with existing systems
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Implementing the Communication and Data
Hub creates a comprehensive patient health
record and provide the mechanisms for
measuring
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Population health
Provider efficiency
Plan performance
Provider quality
Care coordination
The effect of implementing
integrated data is profoundly positive.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
Begin the Communication and Data Hub around existing
data sources.
• Provide currently available data
• Add data sources as available
Integrate data sources to give more complete
view of patients and population
• Consolidated patient record
• Integrate advanced decision support into current work flows
• Patient utilization patterns
• Provider efficiency and quality
• Predicted use
CASE STUDIES
53
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
Add new and increased data as available
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Physician EMR records
Hospital HIS data
Intervention vendor data
Optimize benefits from initial changes
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
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•
Not all data is equally important in making informed
care decisions or plan design and management decisions
Focus on those data sources and elements that improve
quality and reduce work load of clinicians
IMPLEMENTATION
CASE STUDIES
54
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Measurement and metrics
• Substantiate program use and performance
• Track compliance with regulatory requirements
Measure patient outcomes
• Monitor effectiveness of care coordination
• Monitor patient compliance
• Monitor patients longitudinally
Measure provider performance
• Measure provider efficiency
• Measure provider quality
• Measure return on investment for interventions
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
There are many analyses to measure impact
• Utilization modeling
• Risk adjustment of populations
• Predictive future use
• Cost
• Hospitalization
• Program effectiveness measures
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Return on investment
• Clinical effectiveness
• Patient personal impact
• Quality of life
• Patient satisfaction
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Start where the organization is now
• Start with low hanging fruit; high impact low disruption
• Pilot video sessions with employees with defined conditions
such as depression. Introduce video telecommunications to
EAP and the Clinic to determine comfort levels and use
strategies
• Contract with a subset of network counselors for fee
reductions when video conferencing is used.
• Use existing structures such as EAP and employee clinic
referral processes and oversight policies
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
Medical professional depression program study
WEB PORTAL
FUNCTIONALITY
Educator behavioral health and finance program study
ANALYSIS SERVICES
• Medical professionals including social workers and other
counselors suffer high rates of major depression
• Educators at all levels experience significantly higher rates
of major depression, stress, anxiety, and financial pressures
EAP Employ Assistance Programs
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Enhance behavioral health triage function
• Enhance referral process
• Improve counseling delivery
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
Case studies can be most useful in suggesting how services can be used
and what results can be anticipated
Hospital system employee health plan example
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
•
Medical professionals including social workers and other counselors suffer high rates of
major depression and anxiety
•
Medical costs are 2 to 3 times more in employees with depression
•
Treatment of health care professionals has special considerations
Educator behavioral health and finance program study
•
Educators at all levels experience significantly higher rates of major depression, stress,
anxiety, and financial pressures
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Educators being treated for depression have special concerns
EAP Employ Assistance Programs
IMPLEMENTATION
CASE STUDIES
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Enhance behavioral health triage function
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Enhance referral process
•
Improve counseling delivery
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• This case study follows a multi-hospital system located in
an urban area and its suburbs
WEB PORTAL
FUNCTIONALITY
• The plan population consists of 10,000 employees and
12,000 dependents
ANALYSIS SERVICES
• The employer health plan uses a major carrier network
to pay claims
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• The plan supports a single site employee medical clinic
• The plan provides an EAP program to triage behavioral
health, and to provided crisis, relationship, and financial
counseling
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Depression was identified as a significant employee issue.
Depression among its work force was observed at twice the national rate.
• Nurses are twice as likely to experience depression
• The employees are weighted female and women experience
higher rates of depression
Patients with depression were costing 2.7 times more than patients with
similar other comorbidities
Depression was observed to have a negative impact on work performance
as measured by absenteeism and presenteeism surveys
Most depressed patients were not receiving best practice treatments
The majority of patients were identified through a prescription usually
used to treat depression.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
• The Hospital System wanted to address high depression rates and
treatment within its employee population.
• Many studies have concluded depression doubles in nurses .
(INQRI, Clinical Nurse Specialist, American Journal of Nursing)
• Large studies of medical professionals have found the rates of
depressed are actually greater than the numbers identified from
claims data alone.
TREATMENT
TELE-SESSIONS
• There can still be stigma associated with a diagnosis of depression
or any mental health diagnosis in health care employees.
IMPLEMENTATION
• These and other reasons can increase reluctance to seek
treatment.
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Depression can result from a combination
of many factors such as:
• Biology: brain chemistry changes
• Genetics: family history can be a risk factor
• Gender: women are twice as likely to
experience depression
• Health conditions
• Trauma and grief: violence, emotional abuse,
death of a loved one
• Stressful events: marital, family, work
• Medications and substances
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Reasons often given for high depression rates in
medical workers include:
• Stress of working with sick patients; it is rewarding but can
be emotionally draining.
• Work hour schedules: 12 hour shifts, night shifts, on call, etc.
• Perception that as a healer you can’t get sick or be affected
by “emotional issues.”
• Perception that seeking counseling may be seen as a
weakness.
• Fear a psychiatric diagnosis will affect job or licensure.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
• Depression was occurring at high rates in the employee population
• Depression was impacting employee lives and performance
• Depression was often not treated according to best practices
• There were barriers and resistance to care
• EAP referrals were problematic and less effective
• Care coordination was not occurring at acceptable levels
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Existing resources were not being leveraged
• The employee population deserves better
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
1.
Leverage existing carrier network
2.
Enhance role of EAP
3.
Improve care coordination
4.
Use EMMDATA video counseling sessions where
appropriate
5.
Reduce the 200 counselors being utilized to a
smaller cohort of more highly skilled counselors to
improve patient outcomes, patient satisfaction and
reduce unit cost
6.
Use EMMDATA tools to monitor and measure
program success
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The existing list of 200 counselors currently providing services
were analyzed to create a referral panel of 35 preferred
counselors
The preferred status criteria included
• Requisite credentialing and skill set for treating depression
• Experience with the special issues in depression surrounding health care
professionals
• Willingness to use tele-health video counseling with patients
• Agreement to discounts beyond the carrier discounts because
• The plan paid directly
• The plan paid quickly
• More patients were referred
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
EAP enhanced its triage function through initial counseling
WEB PORTAL
FUNCTIONALITY
Referral selection
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• When appropriate, referrals were made to the preferred counselors
• EAP through the results of its initial triage counseling made referrals
based on:
• Best match with patient problems and counselor skill sets
• For those using video tele-health sessions, location was no longer a selection
criteria. The most appropriate counselor could be assigned regardless of location
Utilization and patient outcomes and progress are monitored through
the EMMDATA tools.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The health plan chose to make available to counselors the
consolidated patient record. This indicates the diagnostic,
pharmacy and utilization history of the patient through the
health plan.
Counselors now know who is prescribing medication. In this
case a significant number of antidepressant prescriptions were
coming through the health plan employee clinic. This was
another opportunity to leverage existing resources.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• Average counseling session cost reduced 35%
• Increased per patient sessions for depression and anxiety
WEB PORTAL
FUNCTIONALITY
• Increased use of non-health services (financial and relationship)
ANALYSIS SERVICES
• Increased care coordination between counselors and
prescribers for EAP
• Improved referral management
TREATMENT
TELE-SESSIONS
• Better reporting of utilization
• Improved ability to act as behavioral health gate keeper
IMPLEMENTATION
CASE STUDIES
• Improved patient satisfaction
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
Historically, care management has existed in separate
programs. The interventions may be internal to the
plan but often are through external vendors.
A typical collection of plan programs may include:
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•
•
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Disease Management
24/7 Nurse line
Case Management
Utilization Management
Complex Case Management
Wellness Programs
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
Nurse interventions and activities when
available to treating physicians can add value
The effects of proper interventions can be:
• Extension of Physician office
• Reconcile transitions of care
• Monitor signs and symptoms
• Monitor treatment compliance
• Follow through on self management
• Triage patient service selection
CASE STUDIES
72
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
• Wellness and disease management vendors have
notoriously low engagement rates.
WEB PORTAL
FUNCTIONALITY
• In Smart Enrollment models are run before
enrollment identifying all members that would
benefit from vendor programs.
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• As part of the enrollment process, members are
enrolled in the applicable programs.
• Smart Enrollment integrates with virtually all
enrollment vendors and systems.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
• Determining program effectiveness rates is dramatically
complicated by low engagement rates
• Well defined criteria to determine who can benefit from
a program is crucial
• Criteria can be based on diagnoses, utilization,
demographics, or any combination in advance of
program launch
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
Observations:
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Options:
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IMPLEMENTATION
CASE STUDIES
Group A is treating sicker patients more efficiently.
Group B is less efficient with healthier patients.
The discounts for Group B are actually greater than
Group A but the inefficiency results in greater cost.
Reexamine the Group B contract.
Increase co-pays or co-insurance for Group B.
Inform members at enrollment of the cost differential
especially in HSA plans.
Examine case management and utilization review
options for Group B.
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
By analyzing all of the claims and Rx data for a patient a more complete
clinical utilization and cost profile can be achieved. The more complete
consolidated view of the patients diagnostic and utilization history from all
sources informs better clinical decisions.
ANALYSIS SERVICES
The longitudinal patient health record is an effective tool for sharing data
across physicians, facilities and intervention services.
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
The data can remain separate on the platform or be integrated into the Clinic EMR
• The Clinic Consent Form must include authorization for the Clinic to access the data
• The level of detail can be determined by the Clinic
• A combination of summary data and detailed data usually works most efficiently
• Care coordination can be greatly enhanced
OVERVIEW
DATA INTEGRATION
AND WAREHOUSING
WEB PORTAL
FUNCTIONALITY
ANALYSIS SERVICES
TREATMENT
TELE-SESSIONS
IMPLEMENTATION
CASE STUDIES
EMMDATA is committed to the
proposition that patient compliance
with evidence-based medicine improves
patient outcomes and ultimately helps
contain cost.
We believe patient-centric analysis is
critical to population health
management.
RESTART