How Northwestern Medicine is Leveraging Epic to Enable Value-Based Care

1. How Northwestern Medicine is Leveraging Epic to Enable Value-Based Care

2. ABOUT PERFICIENT Perficient is a leading information technology and management consulting firm serving clients throughout North America. We help clients implement digital experience, business optimization, and industry solutions that cultivate and captivate customers, drive efficiency and productivity, integrate business processes, reduce costs, and create a more agile enterprise.

3. PERFICIENT PROFILE Founded in 1997 Public, NASDAQ: PRFT 2014 revenue $456.7 million Major market locations: Allentown, Atlanta, Ann Arbor, Boston, Charlotte, Chicago, Cincinnati, Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Lafayette, Milwaukee, Minneapolis, New York City, Northern California, Oxford (UK), Southern California, St. Louis, Toronto Global delivery centers in China and India >2,600 colleagues Dedicated solution practices ~90% repeat business rate Alliance partnerships with major technology vendors Multiple vendor/industry technology and growth awards

4. 4 PERFICIENT HEALTHCARE PRACTICE

5. SPEAKER INTRODUCTIONS Rob Desautels, Director IT, Northwestern Medicine Rob has more than 15 years of experience within the IT industry including 11 years dedicated to healthcare and life sciences. Since 2013, he has served as a senior IT leader at Northwestern Medicine (formerly Cadence Health) and helped champion and lead the analytics effort with Epic to shape the tools that enable the population health management program for Northwestern Medicine Physician Partners (formerly Cadence Medical Partners). John Ideler, Healthcare Director, Perficient John has more than 25 years of experience in the IT industry, including more than five years in life sciences and healthcare. He is responsible for ensuring client satisfaction and the successful completion of large scale projects. John has extensive experience in providing clients BI analytics capability using Epic's Cogito data warehouse as a centralized source.

6. 6 THE TRANSFORMATION OF HEALTHCARE John Ideler, Healthcare Director, Perficient

7. HEALTHCARE IN THE UNITED STATES U.S. is the most expensive healthcare system in the world Many assume we pay more because we get better health outcomes The evidence, however, doesn’t support that view

8. THE IMPACT: SHRINKING HOSPITAL MARGINS Studer Group, Value-Based Purchasing At A Glance – Fiscal 2015 and Your Organization 2011 2021 2.2% -16.8% The average hospital has a 2.2% operating margin. Reimbursement Cuts 2.2% WILL BE A 16.8% DEFICIT By 2018, CMS quality- based payment initiatives will put more than 11% of payments at risk.

9. THE SOLUTION: A NEW CARE DELIVERY MODEL Volume Value Fee for Service – Per Case Payment to Manage Populations No Rewards for Quality Incentives and Penalties for Quality Metrics (Outcomes Drive Incomes) Collaboration/Partnerships and Coordination of Care Not Valued Shared Accountabilities (Healthcare Providers, Health Plans, etc.) No IT Investment Incentives IT Core Part of the Strategy

10. TRANSFORMING DATA: KEY TO VALUE-BASED CARE We have access to an abundance of data. The problem is not how to get it – it’s bringing it together and knowing what to do with it once we have it. Information must be managed so it is useful, operationally relevant, insightful and secure.

11. WHAT IS VALUE-BASED CARE? Healthcare reimbursement model based on the value of the services provided rather than the volume. Goal: Lower healthcare costs and improve quality and outcomes

12. 5 MAIN FUNCTIONS CONTRIBUTING TO A VBC PROGRAM

13. 8 KEY CAPABILITIES NEEDED BY A VBC PROGRAM 1. Define, understand, engage, and track patient populations 2. The ability for clinicians to identify patients with important care considerations 3. Manage population health, outreach and care management, care coordination and planning, and patient engagement 4. Ability to identify, categorize, and manage chronically ill patients 5. Patient attribution 6. Measures, scorecards and reports 7. Integrated analytics and reporting for clinical and business intelligence 8. Integrate claims and other external sources into the EMR, so they are visible and actionable at the point of care

14. LEVERAGING THE NATIVE CAPABILITIES OF EPIC

15. 15 NORTHWESTERN MEDICINE Rob Desautels, Director IT, Northwestern Medicine

16. NORTHWESTERN MEDICINE Total Workforce of Over 18,000 Employees 70 Acute and Outpatient Care Sites National Leader in Quality and Consumer Preference 3,700 Medical Staff Includes 1,500 Employed Physicians 600,000 Square Feet of Additional Research Lab Space by 2018 Primary Clinical Affiliate of Northwestern University Feinberg School of Medicine “… Where the Patient Comes First.”

17. GROWING TO SERVE PATIENTS CLOSER TO WHERE THEY LIVE AND WORK Measurement FY 2009 FY 2014 NM Today* Acute Care Locations 1 2 4 Licensed Beds 854 1,011 1,517 Inpatient Admissions 47,700 52,600 83,400 Outpatient Sites 14 29 70 Employed Physicians 111 1,185 1,502 Northwestern Medicine Growth: 2009-2015 *Pro forma FY14 combination of Cadence and NMHC

18. ORGANIZATION TO DELIVER VALUE-BASED CARE  Northwestern Medicine Physician Partners (NMPP) is the NM vehicle for emerging value-based contracting, payment and care delivery - Formerly Cadence Medical Partners (CMP) - Network of employed and independent physicians/providers - Payer/Employer contracting organization - Meets legal criteria for “clinical integration”  Common approach across all payers and physicians - One program - One set of measures and clinical protocols - One set of administrative procedures - One infrastructure for care management - One set of incentives

19. WHY EPIC/COGITO WAS CHOSEN • Epic is the EMR platform at legacy Cadence Health and foundation for Northwestern Medicine • Leveraging the tools within the system EMR allows for care management to occur in the tool providing the analytic information (single platform) • Expansion of the Cogito analytics platform to include the data warehouse provided: o Ability to seamlessly load native Epic data into Cogito o MSSP interface already written by Epic to ingest CMS file o The development of smart data elements (SDE) to send information from the Cogito data warehouse to Epic hyperspace o Reports already available/used via Radar and workbench o Scalability (Johns Hopkins risk stratification, in future release) • Speed to market, as new platform did not have to be purchased, configured and integrated with Epic data

20. MAPPING REQUIREMENTS TO TECHNOLOGY Business Requirement Technology Solution Cohort Establishment Identify cohorts of patients with chronic conditions, or those whom qualify for wellness screenings, based on a specified inclusion and exclusion criteria. Chronic Disease, Wellness, & Risk Registries • Asthma, Diabetes, CHF, Hypertension, CAD (5) • Wellness Registries (11) • General Risk (1) Clinical Quality Measures Develop Clinical Quality Measures that help measure and track the quality of health care services provided by eligible providers and hospitals within our health care system. Healthy Planet • Develop 44 Registry-Based CQ Measures • 25 Chronic Disease • 19 Wellness Care Management & Coordination Enable care managers to actively manage health of patient population via the use of care planning & coordination tools such as patient outreach, longitudinal care planning, goal setting, tracking, and population health analytics. Healthy Planet • Care Management Workflows & Care Coordination Tools • Patient Goals, Longitudinal Plan of Care • Electronic Patient Outreach Tracking • Reporting Dashboards & Workbench Reports Risk Stratification Stratify total patient population and identify highest risk patients based on a host of risk criteria such as; comorbidities, walking limitations, disability, # of ED/Inpatient stays, a discharge readmission risk factor score, living status, etc. Healthy Planet • Developed a risk score and applied to total patient population based on Epic data • Risk score made available directly in care manager workbench reports and workflows

21. MAPPING REQUIREMENTS TO TECHNOLOGY Business Requirement Technology Solution Obtaining Clinical Data for Patients seen at Non-Epic Locations Obtain clinical information for patients not seen within our hospital network, or employed practices. Healthy Planet – Abstractor Navigator • Extended Epic Access to Non-Employed Practices • Abstractor Encounter • Care Gap Reporting & Inbasket setup to route messages to Care Managers Reporting tools for Physicians Provide physicians with an overview of the performance of their patient population across all registry-based measures, incorporating internal and external data. Radar Dashboards & Reporting Workbench Reports • Centralized view of population performance on registry- based measures • Drill down capability to identify non-compliant patients • Quarterly performance & trending Leverage External Data for Population Health Import, Store, & Analyze claims & eligibility data from various sources; payers, hospital quality, oncology, for population health purposes. Cogito Data Warehouse (CDW) • External Claims & Eligibility Data • Hospital Quality Measures • Physician Roster • Oncology & CMP Measures

22. MAPPING REQUIREMENTS TO TECHNOLOGY Business Requirement Technology Solution Patient to Physician Attribution (Claims-Based) Attribute Patients to Physicians based on plurality of outpatient visits, and store attributed PCP & Specialist information in Hyperspace Cogito Data Warehouse – Attribution Algorithm • Develop custom logic to analyze claims and eligibility files to assign patients to 1 PCP & multiple specialists based on claims activity Primary Care Team • Developed custom primary care team fields to store attributed PCP & Specialists EPT Import • Developed custom import spec to import attributed PCP & Specialist to Hyperspace & populate primary care team fields Patient Matching Determine if incoming patients on a roster or claim currently exists in Epic. Match patient to existing record, if a patient exists. Create a new record if patient does not exist. Cogito Data Warehouse – Patient Matching • Develop custom logic to identify and match records if patient exists in Epic. Send to Identity if patient does not exist Identity – Custom Algorithm for Patient Matching Access • Create new ID types and workflows to add and store unique payer IDs to patient records Leverage external data for CQMs Modify Clinical Quality Measures to incorporate external claims data Smart Data Elements • Built in Chronicles and allow measures to look to external claims data to satisfy measure criteria Datalink Actions • SQL queries that leverage grouper code sets. mine claims data, and return the required value to the SDE

23. THE SOLUTION

24. LESSONS LEARNED  Reality that not all providers (especially non-employed) will move to a single platform  No single solution for interoperability and exchange of necessary information - HIE - Clearing houses - Report writers/sniffer - EMR/PM - Epic Connect - Epic Care everywhere  How do we import external data - Once we import how do we normalize - Once we normalize how do we risk stratify and attribute

25. LESSONS LEARNED  Engage all partners early - We don’t all speak the same language even though we think we do  Enterprise and Executive Leadership Support is necessary but not sufficient - Need buy-in from end users such as clinical team, tech team, analytic team  Defining measures and program prior to developing technology solution - A poorly thought out process is just as poor electronically as it is on paper  Data Governance (examples of issues) - What is the definition of a day? - We know that we should shoot for a glyco hemoglobin of less than 8 (maybe?), but what is a reasonable target of compliance (25th percentile, 50th percentile or 90th percentile?) - Reporting of measures that appear to overlap across different quality programs (PQRS, CMS ACO, MU, etc.)

26. LESSONS LEARNED  Frequent and intense communication within the project team, with end-users, and stakeholders  Creating the technology platform is only the beginning- need to plan for robust downstream training of users  Know your data sources - There is a lack of consistency between payers and within a payer from month to month (Medicaid – ACE data)  External EMR (clinical) data - Remains a challenge because of interoperability issues, but at the same time is the “pot of gold” we need to get to

27. ADDITIONAL EPIC COGITO RESOURCES GUIDE: How to Enable Value-Based Care and Clinical Integration with Epic Cogito - http://bit.ly/CogitoWP CLIENT SUCCESSES: ProHealth Care Case Study - http://bit.ly/ProHealthCS On-Demand Webinar - http://bit.ly/ProHealthWebinar ASSESSMENT: Value-Based Care Readiness and Cogito Implementation Assessment - http://bit.ly/CogitoAssessment

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