Informatics and Analytics 2016 Value Visit

Toolkit: EDGE Server HCC confirmation
In this case study presentation from the December 2017 Informatics Value Visit, Community First Health Plans (CFHP) presents a simple, low-cost approach to validating and troubleshooting risk scores.

Audio: Using data insights to design and implement effective care management programs for persistent high cost individuals
As you tailor your services for population health management and value based purchasing , how do you detect high-risk members, engage them, design programs for care management to optimally promote high-quality, cost-effective healthcare? Learn how several managed care organizations effectively approached the identification of individuals with persistent and emerging high needs and retooling care management programs away from event based management to person based management.

Audio: Community First Case Study: Validating EDGE server risk scores
Understanding how HHS computes your enrollees’ risk scores can help ensure accurate data submission to the EDGE Server. In this case study presentation, Community First Health Plans (CFHP) presents a simple, low-cost approach to validating and troubleshooting risk scores. CFHP demonstrates how to bring various pieces together to simulate their enrollees’ risk scores within the risk adjustment model. Various data, systems and configuration issues are discussed in a start-to-finish manner. By manipulating data, programs and files, CFHP shows how to extract information that yields an understanding of how important data completeness is to risk adjustment.

Audio: Presbyterian Case Study - Data and analytics done right: Driving value creation
This case study presentation from Presbyterian focuses on recognizing the changing data and analytics requirements faced by health care providers with health plans and will analyze a new seven-step data and analytics operating model. In addition, Soyal Momin and Amor Brannin of Presbyterian will lead the group through a discussion on appraising the integration challenges a data and analytics transformation represents in a joint payer/provider organization; Evaluating experience-based recommendations for staging a successful data and analytics transformation in a complex digital environment; Assessing the benefits an end-to-end data and analytics transformation can deliver.

Audio: Case Study: CHPW Clinical Integration Solution
Over many years, Community Health Plan of Washington has evolved their clinical integration solution (CIS) and now have expanded the program into most of their clinics. Today, data aggregated from 7 disparate EMRs, combined with claim data, drives CHPW’s P4P program, their risk adjustment processes, not to mention member outreach and care gap closure.

Audio: The predictive power of social determinants of health
Michael Cousins of Forecast Health leads a discussion on the next generation of population and risk management with a focus on how social determinants of health can improve the accuracy and actionability of predictive analytics, as well as the difference between members who are high risk and members who are impactable and how predictive analytics can be used to achieve continuous improvement in population health.

Audio: Using analytics to assess the 6 categories of waste
According to the Institute of Medicine (IOM), over 30% of every dollar in healthcare can be attributed to waste. While multiple initiatives have helped identify ways to reduce waste, they have not provided an outline for a more direct approach. The 2010 IOM study identified six targeted categories of waste: Fraud and abuse; missed prevention; unnecessary services; inefficiently delivered services; prices that are too high; and excess administrative costs. In this session, we discuss analytical methods to comprehensively assess these six categories and provide actionable ways to reduce medical waste.

Audio: SummaCare Case Study: Strategy drives structure
In this case study presentation, Steve Albrecht of SummaCare outlines the strategic goals of the Clinical informatics department and outlines how this informs the Health Services operational structure. He discusses specific areas of support and projects, data sources and business intelligence tools used to measure and impact outcomes, and the team-based structure and skill sets required to make it all possible.

Audio: Case Study: Clinically meaningful actionable relevant interventions
Health plans and health care providers have access to more than data than ever before. Unfortunately, only a fraction of the valuable data is being used to impact patient care. The challenged faced by fractionated care that often silo’s data among providers, specialists, hospitals, and pharmacies can make utilization of big data a real challenge. However, there are a number of ways that data can be retrieved and analyzed to create real-time actionable intervention opportunities that result in improved care, better STAR ratings, and other quality metric improvements.

Audio: Next generation analytics: Getting past the hype and finding real value
We are at an interesting crossroads in the journey to better healthcare and the analytics that support it. Market forces like population health management, consumerism, public and private exchanges, value-based care initiatives, and new provider relationships are intersecting with newer technology and data sources to move us to new frontiers. It can be challenging to navigate the crossroads of new technology and data sources when, day to day, you’re facing an immediate need for information and analyses to successfully manage your business while simultaneously hearing about what you could be doing.