How Data Transparency is Driving Analytics to Drive Value

Measuring the value of healthcare and using the data to influence outcomes isn't a distant goal. It's happening now and physicians are starting to get the message.

The message to physicians and healthcare executives couldn't be any clearer: Since your outcomes performance is more and more a matter of public record, you had better get a handle on the value you deliver before the public does.

After attending the Health Catalyst Analytics Summit last week in Salt Lake City, I am convinced that health leaders are not just talking about measuring value sometime in the future. They are doing it today and driving better outcomes, using that data transparency to get through to recalcitrant physicians and healthcare executives.

One such leader is Jay T. Bishoff, MD, director of the Intermountain Urological Institute at Intermountain Healthcare. He has to convince his fellow urologists and surgeons to pay attention to a series of dashboards displaying prostate cancer patient outcomes, including not only the cancer's progress or control, but also side effects such as incontinence or impotency.

Fellow urologists "get really sensitive about it," Bishoff told conference attendees. "They say, why are you doing this? I say, 'I'm doing this to help your patients have a better outcome because somebody is going to measure that, and they're going to put it online, whether you like it or not. So let's work together now to get better outcomes.'"

Out in Front
To get ahead of public reporting of these outcomes, Intermountain is working quickly to publicly report its prostate cancer treatment potency and continence rates, individually by surgeon, Bishoff says.

The Great Transparency Movement?

Intermountain's "obligation to deliver a measured experience" also translates into fewer biopsies for prostate cancer, saving money and reducing unnecessary discomfort and pain to patients.

The effort starts by constantly scouring medical literature for evidence-based, but as-yet unimplemented protocols, some more than a decade old. Intermountain urologists perform 65,000 prostate-specific antigen (PSA) tests per year. Taken in isolation, a PSA measurement of 3.0 wouldn't seem to indicate a need to do a biopsy. But when clinicians risk-stratify, considering factors such as race and age, risk of an aggressive prostate cancer can rise to where a biopsy is definitely in order.

"There's only one other integrated healthcare system in the United States who's interested in incorporating that same logic," Bishoff says. "That is something that [other] healthcare systems could do."

Risk Stratification
By stratifying risk, Intermountain was able to drop its number of biopsies by 30%, while still finding those patients whose PSA might be 3.0, but "we want to find it when his PSA is 3.0, not when it's 30," Bishoff says. "We will spend less money on that guy by screening him and identifying his progressive cancer early than when we're trying to treat him later."

The patient also gets a say in the treatment conversation after the risk stratification. "So we have a meaningful conversation, and we let patients decide," Bishoff says. "Our own insurance company loved it."

Drawing this line between transparency, technology, and value is the top takeaway from conferences such as these.

"One of the things we find here, what has become pervasive in the industry… is lending more structure to how clients find that value," says Vi Shaffer, research vice president and global industry services director for healthcare providers at research firm Gartner.

While the knowledge transfer is getting a bit more organized, trying to keep on top of the firehose of case study-sharing at conferences such as this can still drive healthcare executives crazy.

"It feels like a zillion knowledge clouds out there with independent networking and no cohesion to it," Shaffer says. "That's going to happen for a while. I'm certain it's going to happen with the explosion of genomics and all these other use cases, now that people have clinical data in their warehouses and there's more benchmarking and more collaboration and it's easy to do technically."

A Vigorous Response
The response of many organizations at last week's event was to swarm the conference by sending entire analytics-savvy teams.

"We have now trained in our organization over 500 people in quality improvement and analytics, and they all understand what annotated run charts look like, and control limits," says Frederick C. Ryckman, MD, interim chief operating officer and senior vice president of medical operations at Cincinnati Children's Hospital Medical Center.

That figure represents 15% to 20% of the hospital's workforce. "More than that [percentage] from a clinical point of view are highly trained in analytics, so it's made the journey easier, but the early days were really an uphill climb," Ryckman says.

Reducing variations in care through analytics-driven process change allowed Cincinnati Children's to pass along $25 to $30 million worth of savings to families last year, with a total of $50 million in savings across the institution, he says.

"Our goal in our strategic plan for the next five years is to decrease our costs by 2% per year and make sure that that we keep the cost of patient care at exactly the same or 2% less per year over the course of the next five years while we improve outcomes by no less than 2 to 3% per year."

Curbing Costs
While many health systems have similar aspirations to cut costs, few are as under-the-gun as providers in Massachusetts, where legislation mandates the rate of cost growth in healthcare to no more than 3.6% per year, says Tim Ferris, senior vice president of population health at Massachusetts General Hospital Partners Healthcare in Boston.

"Given [that] the national inflation rate of healthcare in the 5% range, [makes it] a distinct challenge for us," Ferris says. "I'm more optimistic. We do have the data now. Data that is real-time and data that is clinically accurate. Our clinicians appropriately demand that we show them data, that data is accurate, that data is attributable, and the data is risk-adjusted."

Partners has signed different risk contracts with six different payer entities. "Each one of those contracts provides different methods for calculating the benchmark," Ferris says. "They provide different measures for assessing the quality. So our performance is different, but we don't treat patients differently depending on whether they come in with one commercial health plan or Medicare or in the Medicaid program.

"So as long as we don't have a national standard for how to do performance-based risk contracting, providers are going to live in a world where they are chasing multiple targets at the same time. It sounds like a full employment act for analytics."

"That was supposed to be a joke," he quips, and the audience laughs.

As providers chase elusive value goals which constantly get moved and increased by payers, including the government, I have no doubt that anyone in healthcare with analytics tools at the ready will have plenty to think about and do.