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Determining Why Patients are Hospitalized via “Chart Review” TUPLE | HEALTH CONFIDENTIAL 2 The “Full Picture” Claims can provide a succinct summary of care, particularly across transitions in care 3 Honing In Using claims + clinical judgement à “why” a patient was hospitalized often becomes apparent 4 Keeping Track of Overall Practice Performance in OCM TUPLE | HEALTH CONFIDENTIAL 5 The “Big Picture” View Keeping track of where your organization is as a whole in OCM & where improvement in physician engagement is needed 6 Assessing Individual Physician Performan & How to Support Improvement TUPLE | HEALTH CONFIDENTIAL 7 Looking at Top Level Costs by Physician & Cancer Physician x cancer level analyses helps create hypotheses for care management interventions 8 Utilization Rates by Physician & Cancer Utilization vs cost à additional granularity in developing programs & interventions 9 Oncology is Different: Direct from Clinic /Physician Scheduled Admissions Care management requirements in oncology differ from other bundle payment models due to the severity of illness. Patients are admitted from clinic/by physician often. Medicare claims data can be organized & modeled to reflect this Hospital Admissions Through ED Observation Transfer Scheduled Ambulance Hospital Walk in Non-acute facility e.g. SNF Same Day Clinic Admits Planned Physician Admits Elective Procedure Admits 10 Care Coordination Functions vary by Source of Admission Shaping care coordination to reduce admissions in more targeted ways. Care coordination is really multiple different “programs” 11 Physician Score Cards Can be Effective Tools to Change Practice Patterns 12 Prioritizing Which Patients to Focus Your Care Coordinators Work On TUPLE | HEALTH CONFIDENTIAL 13 Segmenting the Population Way to prioritize staff & resources 14 What’s the ”Right” Cohort for Care Coordination? • Rates vs absolute totals • Different pictures of utilization • Different types of care coordintion functions 15 What Happens During a Hospitalization? ICU Utilization is critical to track in oncology utilization 16 ICU Care Utilization is a Major Issue in Oncology Examining ICU utilization and variations in utilization is critical to setting up OCM programs 17 Examining Pharmaceutical Utilization By Class of Agent TUPLE | HEALTH CONFIDENTIAL 18 Mapping Individual Agents to Class of Drug Examining utilization of newer classes of agents such as PD1/PDL1 inhibitors 19 Understanding Classes of Agents as they Grow in Size Multiple agents mapping to a class of agent 20 Drilling Down to Individual Agents from the Class Variation in utilization of different agents from a single class 21 Assessing the Impact of Your Practice Transformation Interventions Tracking Changes in Performance Over Time TUPLE | HEALTH CONFIDENTIAL 22 Understanding Trend • Global view of how performance is evolving • Break down into sub-groups • Mapping interventions 23 Tracking Episodes Over Their Life Cycle OCM enrollment à rolling windw. Claims run out > 12 months 24 Assessing Transitions in Care TUPLE | HEALTH CONFIDENTIAL 25 Looking Across Settings of Care • Claims provides strong insights on how patients move between settings of care e.g. hospital à post acute setting • Help guide internal care management protocols & policies e.g. all patients seen in clinic 48 hours after discharge, etc 26 Individual Physicians Access to Care How physicians are scheduled has a major impact on continuity of care & capacity for integrated management 27 Understanding Co-Morbidities to Manage Total Cost of Care TUPLE | HEALTH CONFIDENTIAL 28 Tracking CoMorbidities To Manage Total Cost • Co-morbidities can require different types of care coordination • Cancer + co-morbidity can have particular interactions 29 Patient Sharing Network Analysis -Understanding Care Outside Your Practice’s Wall TUPLE | HEALTH CONFIDENTIAL 30 Looking Inside & Outside Your Practice • Gaining insight into who else is touching the patient • Basis for thinking about “referral management" 31 Measuring Impact of Innappropriate Variations in Care TUPLE | HEALTH CONFIDENTIAL 32 Organizing CMS Claims Data Using Clinical Knowledge to Make it More Actionable One Way of Looking at the Cost of Radiation Oncology OCM Performance Feedback Report – Standard Way Radiation Therapy is Analyzed 33 Organizing CMS Claims Data Using Clinical Knowledge to Make it More Actionable Getting to the cause of avoidable costs TUPLE | HEALTH CONFIDENTIAL 34 Thank you.