Increasing Analytical Capabilities for Utilization Management
Northwestern Medicine Physician Partners
BACKGROUND
To remain at the leading edge of healthcare, Northwestern Medicine is exploring new ways to collaborate across the health system enterprise to increase efficiency and elevate the quality of care. Northwestern Medicine Physician Partners (NMPP) is a population health management program built on the foundation of a shared physician-hospital platform, and designed to meet the future demands of healthcare through collaboration and leadership.
WHY KEENA HEALTH
Keena Health brought the technical knowledge to be able to develop an SQL Server Analysis Cube as well as the industry expertise to work effectively with health care data.
THE CHALLENGE
Health care providers generate and collect an enormous amount of data. One of the biggest challenges is being able to aggregate all this information in a useable way that will inform treatment decisions and ensure the highest quality of care for patients.
NMPP is looking to gain deeper insights from their data, which comes unorganized from a number of disparate sources and not in the form they need in order to transform it into actionable information. NMPP approached Keena Healthcare to build an SQL Server Analysis Cube to help them normalize, curate and key up targeted information so they can improve their data analysis capabilities.
THE SOLUTION
Keena implemented a comprehensive financial claims data management solution as highlighted below:
- Extract, transform, load and normalize financial claims data from: Medicare SSP, BCBS Exchange Products, ACO Cigna and BCBS ACO.
- Continuously monitor the health and quality of data and identify any issues that arise.
- Developed an SQL Server Analysis Cube to facilitate analysis of cost and utilization data.
GOALS
- Gain greater confidence that patient data is standardized and reliable.
- Enable NMPP to pull analytics and reports to improve their business intelligence.
- Identify patient trends; know where patients are going for their care and how they are spending their health care dollars.
- Increase patient engagement; create new analytical tools that better target communications and health care reminders.
- Leverage the cube to help evaluate the effectiveness and completeness of their utilization management program.
- Address shortfalls in service needs and identify opportunities to grow revenue and control costs through access to resource utilization reporting.
- Track ACO quality agreement metrics.
THE RESULTS
- NMPP quickly put their new data analysis capabilities to work and completed an in-depth analysis of their emergency room utilization and spend. By identifying ER “frequent flyers” and patients with ambulatory sensitive conditions they have been able to funnel patients back into their primary care and urgent care facilities. In addition, care managers can track patients with chronic conditions and help them stay connected to their primary care physicians, arrange appointments and if necessary send social workers to do in-home visits. By harnessing new data capabilities NMPP is improving patient outcomes while cutting down on costly emergency room visits.
- NMPP has identified payer data issues that will allow them to fine tune payer contract negotiations.
- Standardized data formats now enable shorter implementation times when signing new payer organizations.
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Director Value Base Care Analytics, Northwestern Memorial HealthCare
THE RESULTS
- NMPP has identified payer data issues that will allow them to fine tune payer contract negotiations.
- Standardized data formats now enable shorter implementation times when signing new payer organizations.
- NMPP quickly put their new data analysis capabilities to work and completed an in-depth analysis of their emergency room utilization and spend. By identifying ER “frequent flyers” and patients with ambulatory sensitive conditions they have been able to funnel patients back into their primary care and urgent care facilities. In addition, care managers can track patients with chronic conditions and help them stay connected to their primary care physicians, arrange appointments and if necessary send social workers to do in-home visits. By harnessing new data capabilities NMPP is improving patient outcomes while cutting down on costly emergency room visits.
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