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COVER STORY


analytics-fi rst approach. Within THTY, there are several high-level goals: fi rst, to increase member and patient engage- ment through smarter tools that empower people to engage with their health. They are powered by activation tools that use the knowledge we have about the mem- ber including in-depth risk scores, and that’s where the analytics comes into play. The second high-level goal is to provide a better consumer experience of healthcare. And to achieve that, we have more clinically focused advocacy and care navigation models, that boils down


data, and get to where the retail indus- try has already gotten” in terms of its sophisticated ability to identify consum- ers and develop profi les of them. “Order tennis shoes on Amazon, and then you open Facebook, and it suggests tennis shoe retailers. We have to get to that level in healthcare,” he says. “I want to take us to where we can leverage artifi cial intel- ligence and machine learning. Machines can help us think outside the box. I want my team to be able to leverage machine learning to think outside the box, and put the data at the fi ngertips of clinician partners,” says Alam.


Leveraging analytics to get real results


Matthew Pirritano


to better care coordination. The third area is really the physician and clinical part- nerships and collaborations. And that’s where our advanced analytics help to improve care delivery, and what we call care optimization.” What’s more, Linares says, “By using data we are able to assist in forging these connections so care can be connected to the different care providers an individual may see, giving a total picture of the person.” And, he says, “We’re looking at provider collaboration and care optimi- zation as key areas where we can focus and make an impact. We’ve also identi- fi ed that about 45 percent of healthcare waste arises out of variation in care qual- ity, where there’s inconsistent application of care guidelines. We’re targeting that in our analytics, by improving care-gap analysis through what we call “hot-spot- ter reports.” With a hot-spotter report, we can identify in advance individuals who are likely to use the ED inappropriately or to not adhere to evidence-based guide- lines, and we can then alert the doctors or care team.” From the health plan leadership per- spective, says Shahid Alam, chief analyt- ics and information offi cer at Blue Cross and Blue Shield of Minnesota, “The goal is to combine not just our administrative and claims data, but combine that with providers’ clinical data and social deter- minants of health data, and genomic


Every one of the organizations whose leaders were interviewed for this story have strong results to show for their investment of time, energy, and funding into this work. Speaking of L.A. Care’s VIP Program, Pirritano says, “The inspi- ration for it was looking at the varia- tion in our network, and fi nding that there was considerable variation among high-performing and low-performing groups,” at the time the program was initiated in 2019. What’s of particular importance, Pirritano notes, is that the health plans’ continual sharing of data with the physician groups does not take place in a vacuum; instead, he notes, the program was launched with a series of meetings involving the organization’s chief medical offi cer, chief operating offi cer (COO), and chief medical infor- mation offi cer (CMIO), and the leaders of all 60-plus IPAs, representing several thousand practicing physicians in L.A.


include. Did they agree that these were valuable metrics? Remember, they had already been in a very similar program for the prior fi ve years. So for most of them, this was not new; it was raising the visibility of the program.” The program has continued to evolve forward very successfully, with increasing robustness of data, including, now, data being col- lected at all the school wellness centers in L.A. County, and Department of Mental Health data as well.


“Order tennis shoes on Amazon, and then you open Facebook, and it suggests tennis shoe retailers. We have to get to that level in healthcare. I want to take us to where we can leverage artifi cial intelligence and machine learning. Machines can help us think outside the box. I want my team to be able to leverage machine learning to think outside the box, and put the data at the fi ngertips of clinician partners.” -- Shahid Alam


Joseph Drozda, M.D.


County. “Those were very positive meet- ings. We laid out for the groups the evo- lution and thinking behind the VIP. There were some additional measures initially that we decided to move, and we got their feedback on the measures we did


8 hcinnovationgroup.com | NOVEMBER/DECEMBER 2019


The analytics-driven clinical perfor- mance work is happening on the inpa- tient hospital side as well. For example, at the St. Louis-based Mercy Health, Joseph Drozda, M.D., director of out- comes research at the 40-plus-hospital health system, has been leading a fasci- nating initiative to proactively improve the identifi cation of congestive heart fail- ure (CHF) patients for whom the implan- tation of cardiac pacemakers is appro- priate. (Mercy’s nationwide real-world evidence network was developed in partnership with enterprise application software vendor SAP.) As it turns out, the timely identifi cation of those patients had been lagging. “And patients can do much better with these devices in place,” Drozda emphasizes. “So we created a robust data set with all of our patients with heart failure, around 120,000 patients.” Drozda and his colleagues have learned a great deal so far on the journey. “It gets into data curation. It’s apparent to us that with previous efforts to use electronic health record [EHR] data, when it’s raw data in data dumps,


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