Stephen McHale: Co-Founder, Chief Chairman, Executive Officer, Explorys Missouri Health Policy Summit 2013

1. Big Data + Healthcare
October 8, 2013
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2. About Explorys
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3. Explorys
About US
Formed in conjunction with
Cleveland Clinic in 2009.
Value-based care network and
Platform for enabling the
transformation of healthcare.
Serve large integrated delivery
networks and provider led plans.
Our mission is to unlock the power
of Big Data to improve healthcare
for everyone.
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4. Explorys Member Systems
Network enabling platform of 300 hospitals
17 integrated delivery networks
200,000 providers
135 billion data points
Delivering over $52 billion in care annually
Across 35 million patients
Projected as 45 million as newly signed
systems go live in coming months
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5. Healthcare Market Dynamics
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6. The battle is on for…
 Healthcare consumers
 Patient share of chart
 Employer contracts
 Well aligned providers
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7. The
Perfect Storm
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8. Growing trend towards mass consolidation to compete
effectively and remain financially secure.
Number of M&A transactions, 2000-2011
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Source: The Health Care M&A Report, Irving Levin Associates, Inc., 2000-2011 and AHA Hospital Statistics

9. Growing trend towards mass consolidation to compete
effectively and remain financially secure.
"It's a numbers
game," he said. "To
effectively take on
the financial risk
providers are being
told to assume, they
need a certain
amount of critical
mass. The bigger
you are, the more the
numbers work to
your advantage.” -
Healthcare remains
highly fragmented
relative to other
industries
Ben Rooks, founder of San
Francisco-based ST
Advisors
Sources:
Kauffman Hall - Strategic Options in a Consolidating Market
Modern Healthcare’s 2011 Hospital Systems Survey
2011 AHA Hospital Statistics, iSuppli Corporation 2010 Semiconductor Suppliers
Air Transport Association 2010 Economic Report. Statistics are prior to the United-Continental merger. Proforma for that transaction, the top 5 and top 15
would have made up 70.0% and 89.5%, Drug Store News Top 50 Rx Power Players, April 2012. Market size is defined as the revenues of the top 50
players
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Top 5 Players
Top 15 Players

10. Growing
Demand for
Value
Payers, patients, and
employers and demanding
accountability in care and
outcomes.
Unsustainable trajectory of
costs coupled with few quality
improvement in the last
decade.
Source: The Commonwealth Fund: The National Scorecard on U.S. Health System Performance, 2011,
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11. Value-Based Models Developing Rapidly
ACOs, Bundled Payments, PCMH, and others…
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12. Share of Chart
In Network
Out of Network
Is an imperative for growing revenue and managing risk
Proactively manage your patient / customer or someone else will
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13. Pick Your
Initiatives Wisely
How timing, share of
chart, shared savings rate, and
cash flow impact both valuebased-care and fee for service
financials.
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14. The Connected World
Rapidly Forming
A New Healthcare Economy
Clinically Integrated
Networks
IDN 1
Employers
Patients /
Members
Risk Models
PHO
Finance
IDN 2
Health
System
Contact Center
Contracting
Guidelines
TPA
Apps & IT Tools
Regulators
Underwriters
Payers
IDN 3
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15. Aligning Provider Incentives
and making sure those deserve it get compensated
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16. “There is concern surrounding
how reimbursement will be distributed
mong the multitude of providers involved in a particular episode. This may
pose considerable challenges to urologists in community practice and
may further incentivize alignment with hospital systems.”
Matthew J. Resnick, MD, assistant professor of urologic surgery at Vanderbilt University Medical Center
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17. You’re Swimming in Big Data
whether you know it or not
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18. BIG DATA is Volume, Velocity, and Variety…
Volume
150
exabytes
of stored healthcare
data across disparate
care settings…
Velocity
1,000
Variety
/sec
vital-signs capture by
bedside, home, and
mobile devices…
80
coding variability
among diagnoses and
test results…
Source: “How big is 'big data' in healthcare?”, by Graham Hughes, MD
“Big Data Use In Healthcare Needs Governance, Education” – Information Week, by Neil Versel
“Why 'Big Data' Is a Big Deal”, Wall Street Journal, By L. GORDON CROVITZ
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%

19. Applying Big Data effectively could yield $300400 billion in healthcare costs
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20. In a Gartner 2012 survey, 68% of health systems
intend to make new investments in
business intelligence and analytics
in the next 2 years.
Even at the height of the U.S. EHR adoption,
that percentage never reach this level.
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21. However, EMRs are not well positioned to leverage
Big Data for population health….
“Early EHRs were not designed first and foremost to
facilitate and improve the delivery of care; they were
designed to facilitate billing.
- Rob Tholemeier and John Moore, Chilmark Research, June 2013.
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22. PCP
Specialist
Hospital
Post acute
Long term
Capturing The Continuum of Care is CRITICAL
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Home

23. Payer Claims
Charges, payments, Rx fills,
3rd party providers
Provider Billings
Part
of the Picture
EDI billing and payment
adjudication (EDI)
Healthcare System Operations
Allocated costs, actual costs,
labor, and materials
Provider Info
Physicians, nursing staff,
specialists, and care coordinators
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24. Payer Claims
Ambulatory EMR (employed & affiliates)
Charges, payments, Rx fills,
3rd party providers
Diagnoses, findings, labs, procedures, encounters,
appointments
Provider Billings
ED & In-Patient EMR
EDI billing and payment
adjudication (EDI)
Diagnoses, findings, labs, procedures,
encounters, appointments
Patient
Demographics, behaviors,
and attitudes
Healthcare System Operations
Allocated costs, actual costs,
labor, and materials
Provider Info
Physicians, nursing staff,
specialists, and care coordinators
Administrative
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Long Term Care
Diagnoses, findings, labs, procedures,
encounters, appointments
Homecare & Telemedicine
Readings, patient reported outcomes,
nursing visits, and mobile
Clinical

25. Big Data in the Real World
Use Cases
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26. Driving Knowledge from BIG DATA…
What’s the best that can happen?
Optimize
Competitive Advantage
What will happen next?
Predict
&
Model
What if these trends continue?
Why is this happening?
Forecast
Analyze
Alert
DrillDown
Query
Report
What actions are needed?
Future-oriented and
source of competitive
advantage
Descriptive Analytics
(the “what”)
What exactly is the problem?
How many, how often, when?
What happened?
Degree of Intelligence
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Predictive Analytics
(the “so what….
And the “now what”)
“Rearview mirror” –
Provides foundation and
insight

27. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
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28. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
30% quality improvement within
value-based care disease
management programs
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
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29. “We saw a 51% reduction in hospital admissions, a
35% reduction in readmissions and a 37% reduction in
emergency department visits”
Teaera Roland, Nurse Care Coordinator, Mercy Health
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30. “We have had improvements across all of our
measures throughout the course of the year.”
“Our pneumococcal vaccine rate rose from 52 percent in 2011 to 60
percent at the end of 2012; our colonoscopy rate went from 34 percent
to 40 percent during that time. And our tobacco cessation counseling
rate rose from 56 percent to 77 percent.”
Dr. Amy Frankowski, MD, Catholic Health Partners
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31. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Accurately price care bundles
for direct-to-employer
risk-based contracts.
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
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32. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Empowering Colorado Health
Neighborhoods’ physician-led
clinically integrated network
across more than 2,000 providers.
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
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33. Q&A
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