© 2021 Health Catalyst
2022 and Beyond:
Navigating the Road Ahead,
Don’t Worry It Won’t Be Too Bumpy
January 19, 2022
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101
101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010010101010101010101010101010
10101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101
10101010101010101010101010101010101010101
1010101010101010101010101010101010101
10101010101010101010101010101010101
01010101010101010101010101010101
101010101010101010101010101010
0101010101010101010101010101
1010101010101010101010101
10101010101010101010101
101010101010101010101
101010101010101010
010101010101010
1010101010101
1010101010
01010101
10101
010
0
Stephen Grossbart
PhD, Senior Vice President,
Clinical Quality Analytics
Bobbi Brown
Senior Vice President,
Professional Services
Agenda
© 2021 Health Catalyst. Proprietary and confidential.
1. Review Six Topics
• Health Equity
• Patient Safety
• Staffing
2. Provide Potential Actions for 2022
3. Get Your Feedback on Priorities
• Care Delivery
• COVID-19
• Payment and Payers
2021 vs 2020
4
Not an easy year, NY Times
5
Poll Question
Pick most read NY Times story:
1. There’s a name for what you’re feeling: languishing. April 19
2. Alec Baldwin was told his gun was safe. Oct. 21
3. Mike Pence reached his limit with Donald Trump. Jan. 12
Source: NY Times, The Year’s Most Read, Dec 29, 2021
Most clicked articles for 2021:
1. Coronavirus in the US
2. How vaccinations are going.
3. How safe are you from COVID
Google most searched: HEALING
Poll Question
How Do You Feel About 2022?
6
Tired Not Sure
Complacent Ready to Go Angry
Guess Who?
• Gathered data on every aspect of
medical care
• Diagrammed causes of mortality
• Sent questionnaires to hospital
administrators
• Used statistics to understand how
the world worked
• Produced findings on deaths for
various diseases and recovery times
based on patients’ age and gender
• First woman fellow of the Royal
Statistical Society
7
Source: Smithsonian March 2020, Thou Shalt Not Underestimate Florence Nightingale
Long View for Another Industry
To a future with more cheers.
8
Source: AB InBev 2021 Investor Seminar, Fortune magazine AmBev CEO Michel Doukeris is writing a 10-year strategic plan (and you probably should too)
• New Strategy
• Portfolio that delivers
superior value for customers
• Digital
• Apps to sell direct to
retailers, consumers
• Convenience-ready to
drink packaging
10 Year Plan
• Old Strategy
• Cost mgmt.
• Cash
generation
• M&A
capabilities
Top Brands and Top Companies
9
DATA is Key
Successful organizations that focus on high-value
data recognize that:
• Integrated data unlocks your highest value use cases
• Reusable data multiplies your data value
• Health care expertise should be embedded to save
time and resources
• Transparent data avoids a ‘black box’ distrust of data
• Aggregated data enables benchmarking
• Application data is highly valuable and should be
reusable
• Data quality is foundational to trust and the use of data
– Dan Heinmiller, VP, Data, Health Catalyst
10
Health Equity
Top Priority
11
Burden on Families:
High cost disproportionately affect
uninsured adults, Black and Hispanic adults
% of people who skipped/delayed are due to cost:
• 31% White
Source: IHI Pulse Report 2021
5 critical priorities for the U.S. Healthcare System,
Marc Harrison, HBR, Dec 15, 2021
• 49% Black • 58% Hispanic
Critical Priorities :
1. Focus on improved health
2. Tackle racial disparities
3. Expand telehealth and
in-home hospital services
4. Build integrated system
5. Adopt value-based care
© 2021 Health Catalyst. Proprietary and confidential.
Observations
12
© 2021 Health Catalyst. Proprietary and confidential.
More that 75 Companies Sign Digital Healthcare Equity Pledge
13
Source: Executives for Health Innovation
• Identify and Address
Health Equity Issues
• Accessibility
• Diversity
• Respect
• Public Policy
Health Care Organizations and Payers
In the Final FY 2022 Hospital IPPS Rule for Acute
Care Hospitals CMS published that they were
requesting “comment from stakeholders on ways
we can leverage measures to address gaps in
existing health equity generally as well as comment
on: . . . potential future reporting of a structural
measure to assess the degree of hospital leadership
engagement in health equity performance data.”
Not the Only Ones Talking about Equity
14
Looking Forward
• Start where you are and build
• New Z codes: Food insecurity, housing instability
15
Power
Source: IHI Pulse Report 2021
Getting Data
The Queen’s Medical Center in Hawaii was the site of nearly 60 percent of all
emergency department (ED) visits by people who were experiencing homelessness,
with some of them visiting the ED every day. Knowing that in most cases patients
would receive better care outside the ED—and seeing that inordinate resources
were needed to treat them—The Queen’s Health Systems sought a better
approach. The organization leveraged its analytics platform, payer data, and patient
flow data to refine care management for this vulnerable population, an effort that
led to dramatic improvement in patient outcomes and costs.
Innovative Care Management Program Avoids Nearly $16M in
Costs and Transforms Lives of Super-Utilizers
Challenges & Impact
• Patients experiencing homelessness were
consuming a disproportionate share of ED
resources.
• Existing program for high-utilizers had not managed
to shift ED utilization patterns for this population.
• Impact: The organization wasn’t able to meet the
needs of this unique patient population, deploy care
management effectively, or expend its resources
most effectively.
Results
• Nearly $16M in cost avoidance.
• 68.5% reduction in the number of days patients
spent hospitalized.
• 22.8% reduction in length of stay.
• 43.8% reduction in readmission rate.
Solution
• Developed the Queen’s Care Coalition, an innovative
care management program, to address the needs of
super-utilizers.
• Leveraged the Health Catalyst® Data Operating
System (DOS™) platform for data and analytics and
the Instant Data Entry Application (IDEA).
• Established mechanisms for using payer data, patient
data, and patient flow data for ongoing program
evaluation and data-informed decisions.
A Health Catalyst Success Story
16
© 2021 Health Catalyst. Proprietary and confidential.
Only three percent of adults in
the U.S. can report practicing
all five of the behaviors that
lead to healthier outcomes:
exercising three times weekly,
not smoking, eating adequate
fruits and vegetables, wearing
a seatbelt regularly, and
maintaining body mass index
(BMI) within a healthy range.
Thibodaux Regional Medical Center conducted a community health
needs assessment (CHNA) as part of its vision for a healthier
community. The CHNA reinforced the hospital’s identified need for a
data-driven, medically integrated wellness program designed to
benefit the health of the community. Using its analytics platform and a
robust suite of analytics applications, Thibodaux Regional’s
multidisciplinary medically integrated wellness team developed a
program to support and track healthy behaviors.
16.1% relative improvement between pre-and-post physical PROMIS scores.
8.6% relative improvement between pre-and-post mental PROMIS scores.
16% relative improvement between pre-and-post distances walked.
2.1% relative reduction between pre-and-post weight—
participants lost an average of 5.1 pounds.
Medically Integrated Wellness Program
Reduces Modifiable Risk Factors
17
© 2021 Health Catalyst. Proprietary and confidential.
Actions: Health Equity
18
1. Review your Community Health Needs
Assessment (CHNA)
• Are you meeting the goals set?
• Who are your partners?
2. Evaluate your value-based contracts and
review the measures being tracked.
• Are the measures helping your community?
• Dig deeper on the measures.
3. Track metrics and measures that have impact
on your community.
4. Report the outcomes and learn from mistakes
and successes.
© 2021 Health Catalyst. Proprietary and confidential.
Care Delivery
19
The U.S. healthcare model has been
moving outside the four walls of the
hospital… COVID-19 has accelerated
this trend with increasing adoption of
telehealth, remote patient monitoring
and other ways to access care remotely.
– T.J. Elbert
SVP, General Manager,
Data Health Catalyst
CMS issued Acute Care At Home
waiver in November 2020.175 hospitals
approved as of October 2021.
Site of care shifts over next 5 years
Imaging & lab Already happening
• Surgical Knee = 6.5% → 36%
• Care clinics = 2.8% → 2.5%
• Digital = 20% of visits are virtual
• Home Based = 1% → 30%
Telehealth
Source: Advisory Board
© 2021 Health Catalyst. Proprietary and confidential.
Use Case for Digital Technology
20
Source: Bain Digital Transformation: What matter most in your sector.
© 2021 Health Catalyst. Proprietary and confidential.
Digital Workflow in Healthcare
21
Alerts
Level of Care
Escalation
PROs & Patient
Response Data
RPM Data
Multi-Channel Engagement
1
4
2
3
IVR
Patient Portal
Secure SMS Twistle / 3rd Party App
Personalized Pathways
Person Selection
Automation Analytics Orders Self-Enroll
System of Record
Ex. EHR, CRM, Case Management, Population Health, Clinical Data Repository, Telehealth, etc.
Patient Education
Appt Reminders Video content
Online Consent
Readmission Management Case Study
Post-discharge Surveillance
22
Approach
• Secure messages 24-48 hours after
discharge to confirm:
– Prescriptions filled
– Understand discharge information
– Follow-up appointment scheduled
– Pain managed
Challenge
• Post-discharge follow-up calls were:
– Manual
– Time consuming
– Often ineffective in reaching patients
Decrease in 30-day
readmissions
26%
Increase in the
number of patients
monitored
62%
© 2021 Health Catalyst. Proprietary and confidential.
With the emergence of
COVID-19, Texas Children’s
Hospital was challenged to
make data-informed decisions
that would allow it to continue
offering critically needed
healthcare services, while
ensuring the safety of its
patients, staff, and providers.
Texas Children’s dramatically expanded telehealth capacity, converting
most in-person primary, specialty, and mental healthcare visits to a
phone or video appointment to better meet patient needs. The
organization leveraged the Health Catalyst® Data Operating System
(DOS™) and a virtual health platform to visualize, monitor, and manage
the conversion to virtual health, in addition to managing in-person visit
volume—enabling the effective management of outpatient capacity,
utilization, and financial performance.
Nearly 70X increase in the number of telehealth visits—in just two weeks.
Approximately 11,000 weekly virtual health visits.
64 specialties providing virtual health visits—nearly 2,000 providers have
completed a virtual health appointment.
Successfully maintained pre-COVID-19 visit volumes.
Virtual Visits and Analytics Enable Continued Delivery of
Ambulatory Services During COVID-19 Pandemic
23
Actions: Care Delivery
1. Know your customer engagement strategy.
Asses where you are and where you want to be.
2. How can you excite customers, simplify life
and improve your patients’ health?
3. What are the key metrics to track for
your efforts?
4. How can you drive a better experience?
5. Can you assess the patient’s condition, can
you navigate patients to the right interventions?
6. What investments will help drive better care
at the right site for the care
24
Patients actively engaged in their care—with the
knowledge, skills, and willingness to manage
their own health—have a 21% lower cost of care.
Source: Health Affairs Feb 2013, Patients with lower Activation Associated with Higher Costs
Patient Safety
The impact of coronavirus disease on healthcare-associated infections in 2020:
A summary of data reported to the National Health Safety Network.
25
© 2021 Health Catalyst. Proprietary and confidential.
Impact of COVID-19 on Screenings
26
JAMA Oncology June 2021
Association of Cancer
Screening Deficit in the
United States with the
Covid-19 Pandemic
© 2021 Health Catalyst. Proprietary and confidential.
Note: Health care spending as a percent of GDP. Performance scores are based on standard deviation calculated
from the 10-country average that excludes the US. See How We Conducted This Study for more detail.
Data: Spending data are from OECD for the year 2019 (updated in July 2021).
AUS
CAN
FRA
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
-1.40
-1.20
-1.00
-0.80
-0.60
-0.40
-0.20
0.00
0.20
0.40
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
Health Care System Performance Compared to Spending
EXHIBIT 4
Higher health care spending
Lower health care
spending
Higher health
system
performance
Lower
health
system
performance
Health care spending as a % of GDP
10-country average
Source: Eric C. Schneider et al., Mirror, Mirror 2021 – Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fun, Aug. 2021).
27
Looking Forward
Measure Suppression Policy
• CMS finalized policy to not use data that has been affected by COVID-19 in
calculating hospital performance. This applied to Readmission, Value-Based
Purchasing and Hospital Acquired-Condition Programs.
• CMS new reporting requirement to improve maternal health.
28
The U.S. spends more on healthcare than any other country—and as costs
escalate, healthcare organizations continue to search for ways to improve care
while containing costs. The University of Kansas Health System recognized that
to truly move the needle on cost and quality, its ongoing improvement efforts
needed more robust, systemwide support. By leveraging data and analytics and
an adaptive problem-solving approach, the organization has achieved
impressive improvements in clinical and financial outcomes.
Adaptive Problem-Solving and Analytics Improves Quality and Saves $4.7M
Challenges & Impact
• Lack of organizational alignment around discrete
improvement efforts.
• Little shared understanding of the context and
import of the performance data that was shared in
the organization.
• Clinician incentives not uniformly aligned around
performance or value; improvement efforts
unevenly supported.
• Impact: Without a strategic, data informed approach
to improvement, the organization struggled to
realize or maintain meaningful gains.
Results
• $4.7M in cost savings.
• 0.69 observed/expected (O/E)
mortality rate for patients admitted
to the hospital.
• 0.63 Standardized Infection Ratio
(SIR) for catheter-associated
bloodstream infections.
• 0.83 SIR for hospital-onset
Clostridioides difficile.
Solution
• Leveraged the Health Catalyst® Data Operating System
(DOS™) platform and a robust suite of analytics applications
to identify, analyze, and track improvement opportunities.
• Developed and applied an adaptive approach to problem-
solving, based on iterative Plan-Do-Check-Act cycles.
• Developed a strategic performance improvement system
that helps align improvement efforts with the broader
organizational goals; builds shared understanding of data,
performance, and targets; and drives stakeholder
engagement.
A Health Catalyst Success Story
29
Actions: Patient Safety
1. Reenforce infection prevention practices.
2. Risk identification with AI and predictive models
3. Goal setting renewed with updates needed for new protocols
4. Gathering information and closing gaps
30
“Healthcare leaders are facing an increasing
number of critical decisions with less time to
make them and lower tolerance for error. Moving
forward, more healthcare C-suites will look to
augmented intelligence to inform their decisions.”
– Jason Jones, Chief analytics and
data science officer, Health Catalyst
COVID-19
• The world is permanently shifted.
– PepsiCo CFO
• Waves, variants will continue
• Geisinger out of beds amid COVID-19 surge, practicing “waiting-room” medicine.
– December 2021
• R- words Recovery, reimage, redo
31
The story that unfolded in 2020
and continues today is unlike
anything that has happened in
the past 100 years.
– Health Affairs
Fitch ratings
The Omicron variant should
not have an outsized effect
on not-for-profit hospital
operations and cash flow.
"In my view, this is a new
beginning. To create a new
health system for the future
based on the experience of
the last 15 months.“
– Michael J. Dowling,
CEO Northwell
Observations
32
COVID-19 Impact
Kaufman Hall projects hospitals will lose $54B in net income in 2021
33
Impact of Unvaccinated
Adults on Hospitalization Costs
34
Looking Forward
Source: PWC
Altarum Health Sector Economic Indicators: December 2021
35
Strong merger and
acquisition deals- 25%
higher than 2020.
2022 Will continue
Oracle and Cerner
HCA buys Urgent Care
Intermountain, SCL Health
U.S. healthcare spending
increased 9.7% in 2020.
36% increase in federal
expenditures largely due to
COVID-19.
Operating Margin- Health Systems
Comments: We expect margin will
likely remain at lower levels given the
broader industry headwinds and the
more immediate pandemic-related
issues. However, to the extent the
pandemic has enable faster decision
making and allowed management
teams to pivot and identify new
opportunities for expense base
restructuring and revenue
enhancement.
December update:
2022 outlook negative as labor costs
drive higher expense growth.
Moody’s
36
Results for 2022 1st quarter results:
• Ascension- volumes strong, net patient revenue
up 7% YOY. Operating income $25M compared
to $144M a year earlier.
• CommonSpirit Health-Higher labor and supply costs,
higher volumes. Operating income $34M compared
to $167M same period last year.
Results for 2021 3rd quarter:
• Kaiser Permanente-Operating income of $38M
compared to $456M in qtr. 3 2021. Drive by higher
care delivery expense due to COVID-19.
2021 Operating Margin Median
2.7%
Increase in Adj. Cost Per Case
24.7%
Solution
• Carle leveraged the Health Catalyst® Data Operating System (DOS™)
platform and a robust suite of analytics applications, including a
capacity
planning tool that uses new Healthcare.AI techniques.
• The new Healthcare.AI techniques enabled Carle
to precisely forecast census and related bed, staffing, and supply
needs at the level of patient acuity.
• Carle uses dynamic regional infection spread and market-share data
and augments these assets with the internal clinical, operational,
length of stay, staff, and supply data to anticipate COVID-19 activity.
In hospitals and health systems around the world, COVID-19 has ushered in resource
and capacity demands that have stressed operations and threatened organizations’
care response. To meet this challenge, organizations must be able to accurately predict
COVID-19 requirements. Carle Health System has achieved this critical capability,
leveraging its analytics platform, implementing new Healthcare.AI tools, and using local
data and infection rates to forecast surges and anticipate resource restrictions.
Advanced analytics now allow Carle to better accommodate COVID-19-driven resource
needs—and minimize the impact of the virus on the organization and community.
COVID-19 Capacity Planning Tool Uses New Healthcare.AI™
Tools to Enable Accurate Forecasting
Challenges & Impact
• Increased demand for facility, supply, and human
resources necessary for COVID-19 patient care.
• Inadequacy of national and county-level COVID-19
capacity planning resources to guide operational
decisions.
• Impact: Carle lacked ability to anticipate patient
surges, identify if surges would exhaust its available
resources, and guide plans to balance load and shift
services at an individual hospital and unit level.
Results
• Carle has embraced data science by
implementing and integrating a
COVID-19 capacity planning tool into
daily operations in less than two
months.
• The organization is using advanced
analytics for capacity planning efforts
and to support its leadership team in
making timely decisions, improving
the effectiveness of COVID-19
planning and response.
A Health Catalyst Success Story
37
Actions: COVID-19
1. Basic management, proactive
• Revenue cycle management
• Cost- knowing “true costs” to provide services
2. Forecast on shorter time frame, ability to
do rolling forecasts as environment changes
• Importance of organizational buy-in
• Messaging and communication critical
• Cross-functional work
• Less detail and more focus on KPIs
3. Capital allocation review
4. Combine clinical and financial outcomes
5. Double down on patient safety
38
Source: HFMA presentation OSF Nov 2021
Leveraging Dynamic Planning on the Road to Financial Recovery
We are committing first call capital allocation
to technology- that is a Board mandate for
Banner Health.
- CFO Dennis Laraway, Banner
Staffing
Great Resignation:
• The quits rate increased to 3% in
September, highest rate going back
to 2000. November 4.5M.
• National Agreement Kaiser, Unions
• Wage increases, benefits
• Career development
• Staffing language for patient and
worker safety
• New terms:
– R.T.O. Return to office-many delays
• 41%, back the week after Thanksgiving
– Zoombie
– Show and tell
– Bookcase credibility
• Fifty million US worker (34.5%) are both
frontline and essential workers,
meaning they cannot work from home
and their work is essential to meeting
basic population needs.
39
The healthcare workforce
is crumbling.
- Sri Balasubramanian, MD
© NSI Nursing Solutions, Inc
© 2021 Health Catalyst. Proprietary and confidential.
Looking Forward
40
2 in 5 nurses and 1 in 4
physicians want to leave in
next 2 years
Mayo Clinic Proceedings Study
To improve staffing efficiency, Hawai‘i Pacific Health (HPH) sought to
realign its staffing practices to better predict and manage its labor needs.
Leveraging Health Catalyst’s data platform, analytics tools, and expert
consulting, HPH was able to forecast its workforce needs and effectively
manage staff schedules—changes that led to timely access to data, a
reduction in administrative burden, and significant cost savings.
Data-Driven Labor Management Delivers Financial and
Operational Improvements
Challenges & Impact
• Data systems were not integrated.
• Definitions of volume statistics were not standard.
• Impact: Burdensome manual processes limited
analysis and required leaders to manage labor costs
with retrospective data only.
Results
• $2.2M savings in 16 months, maintaining high
quality and positive clinical outcomes
• 100x faster insight into basic labor details,
taking minutes rather than weeks to identify and
correct trends or errors
• 93% relative reduction in the time required to
access real-time data, empowering proactive
labor management
Solution
• Partnered with Health Catalyst to analyze and target
opportunities.
• Leveraged DOS™ platform and analytics
tools to integrate and explore hours, volume, and
budget data from disparate systems.
• Engaged leaders from all departments to validate data
and address underlying variation.
• Designed and implemented work plans to improve
labor utilization.
A Health Catalyst Success Story
41
Actions: Staffing
1. Listen
2. Data-shared and communicated. Example at
Kaiser vacancy rates, backfill, budget, People
Pulse and service scores will be shared
(Part of KP-Alliance National Agreement)
3. What support do your care teams need?
– Childcare
– Mental health
4. What flexibility can you offer your workforce?
– Schedules
– Roles
– Care models
5. Retention, retention – cost for each RN
turnover is $40K
42
Source: Mayo Clinic, COVID-Related Stress
And Work Intentions in a Sample of US Health Care Workers
Payment and Payers
• HHS to make cover more
accessible and affordable
for millions of Americans
in 2023.
– Press release Dec. 2021
• CMS reviewing models,
new models expected in
2023
• ACA enrollment for 2022
at 13.6M as of Dec 2021
43
State of Alternative Payment Models (APMs)
13.6M Source: Healthcare Payment and Learning
Action Network
CMS Priorities
• Health Affairs blog August 16, 2021
• Medicare and Medicaid: A Vision for
Next Ten Years
• Create a more value-based system that
reduces spending while preserving or
enhancing quality of care
– Advance racial equity
– Justice for underserved communities
• CMMI Whitepaper:
– Health equity in every model
– Reduce complexity
– Ensure lasting care delivery transformation
CMMI Vision and Strategic Objectives
44
Operating Margin- Health Systems
Comments: Stable, Insurers
financially “unscathed” by
COVID-19, but must adapt to
industry evolution.
• Lower medical cost trends,
Push VBC, Acquisitions,
Manage chronic conditions,
Telehealth
Fitch:
Comments: Neutral, lingering
presence of COVID-19, surge in
delayed care, strong full-year
operating performance
Moody’s
45
2021 EBITDA
7.3% → 7.5%
Fitch Projection
Employer sponsored health
insurance rose in 2021
6.3%
$14,542 per employee
Mercer 2021 Survey
© 2021 Health Catalyst. Proprietary and confidential.
Payer
46
Anthem
Humana Value Based Care Report 2021
Price Transparency
Regulations
47
FY 2020 Price Transparency
Requirements for Hospital to Make
Standard Charges Public
Hospital Price Transparency final rule published 11/27/2019. Effective on 1/1/2021
FY 2019 Requirements for
Hospitals to Make Public a List of
Their Standard Charges
Guidance requiring hospitals to post their chargemaster. Effective until 12/31/2020.
No Surprise Billing Protect
Consumer From Unexpected
Out-of-Network Bills
AMA/AHA filed lawsuit in December 2021 challenging.
Effective On
Jan. 2021
1
Effective Until
Dec. 2020
31
Jan. 2022
1
• 51.6% of hospitals did not publish any
negotiated rates.
– PatientRightsAdvocate.org
• (Data published on hospital web sites.)
• Increasing penalties for
non-compliance- bed size
maximum $5,500 per day
Organizations frequently look to care management to help curb the rising cost of
healthcare. For this intervention to succeed, however, systems need to be able to identify
appropriate candidates for care management and efficiently meet patients’ needs across
the care continuum. To effectively meet these challenges, UnityPoint Health leveraged its
analytics platform and augmented intelligence (AI). They were able to identify patients with
chronic health conditions at a higher risk for overutilizing services, ensure data-sharing
across settings, and ultimately decrease spending by millions of dollars.
AI-Enabled Care Management Reduces Healthcare Spending by $32.2M
Challenges & Impact
• Lack of timely insight into care provided across
acute and ambulatory settings.
• Inability to identify patients with high or rising risk
of worsening health conditions, which often result
in on-urgent ED visits or unplanned hospital
admissions.
• Impact: Unless addressed, these data challenges
would prevent UnityPoint Health from optimizing
care management—and realizing the savings and
care improvement they sought.
Results
In 30 months, UnityPoint Health
decreased utilization and the costs
of care for patients who complete
the program. The organization has
reduced spending by more than:
• $32.2M, the result of a 54.4%
relative reduction in hospital
admissions, and a 39% relative
reduction in ED visits.
• Patients gained 11,000+ more days
at home and had nearly 2,000 fewer
ED visits.
Solution
• Leveraged the Health Catalyst® Data Operating System
(DOS™) platform.
• Instituted collaboration between the analytics team and
acute and ambulatory clinicians to develop and enhance
analytics tools.
• Optimized the efficiency and effectiveness of care
management by using data, analytics, and AI—improving the
system’s ability to risk-stratify and prioritize patients,
understand needs, monitor and manage services, and
discover improvement opportunities.
A Health Catalyst Success Story
48
© 2021 Health Catalyst. Proprietary and confidential.
Actions: Payment and Payers
49
1. Alignment of all parties
2. Review of value-based contracts- even if not time for negotiation
3. Work actively with payers
4. Focus on improved health with measures for cost and quality
Focus on increasing connected care and
reducing health inequities.
Impacts 130,000 people
Reduce cost trend by 10% over five years.
Expand care management.
Renew focus on preventative care.
Source: Allina Press Release
© 2021 Health Catalyst. Proprietary and confidential.
2022
50
Pantone Color of the Year: VERY PERI
Blends the faithfulness, consistency of
blue with excitement, energy of red.
Glitter is back!
In 2030 will we
see this sign?
Year of the Gnome,
River City Yarn
2022
• What is highest priority?
• What actions are planned?
• What are your bumps in the road?
Your list for 2022
51
Health
equity
Response to
COVID-19
Staffing Patient Safety
Care Delivery
Payment &
Payers
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010101010101010101010101010101010101010101
101010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010101010101010101
10101010101010101010101010101010010101010101010101010101010
10101010101010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010101010101
1010101010101010101010101010101010101010101010101010
0101010101010101010101010101010101010101010101010
01010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101010
010101010101010101010101010101010101010101
10101010101010101010101010101010101010101
1010101010101010101010101010101010101
10101010101010101010101010101010101
01010101010101010101010101010101
101010101010101010101010101010
0101010101010101010101010101
1010101010101010101010101
10101010101010101010101
101010101010101010101
101010101010101010
010101010101010
1010101010101
1010101010
01010101
10101
010
0
Questions?
Resources:
• Health equity language and IHI Achieving Health Equity: A guide for healthcare
organizations whitepaper.
• Health Catalyst Healthcare.AI™ resources.
• CMS Acute care at home resources.
• McKinsey Nursing in 2021: Retaining the healthcare workforce when we need it most.
• Mayo Clinic article on COVID-related stress and worker intentions.
• Bain Interactive Digital Transformation.
• Price transparency checklist from CMS.
• Humana Value Report for 2020.
• CMS Innovation Center Strategic Objectives.
53

2022 and Beyond: Navigating the Road Ahead in Healthcare: Don’t Worry, It Won’t Be Too Bumpy!

  • 1.
    © 2021 HealthCatalyst 2022 and Beyond: Navigating the Road Ahead, Don’t Worry It Won’t Be Too Bumpy January 19, 2022
  • 2.
    10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101 101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010010101010101010101010101010 10101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101 10101010101010101010101010101010101010101 1010101010101010101010101010101010101 10101010101010101010101010101010101 01010101010101010101010101010101 101010101010101010101010101010 0101010101010101010101010101 1010101010101010101010101 10101010101010101010101 101010101010101010101 101010101010101010 010101010101010 1010101010101 1010101010 01010101 10101 010 0 Stephen Grossbart PhD, SeniorVice President, Clinical Quality Analytics Bobbi Brown Senior Vice President, Professional Services
  • 3.
    Agenda © 2021 HealthCatalyst. Proprietary and confidential. 1. Review Six Topics • Health Equity • Patient Safety • Staffing 2. Provide Potential Actions for 2022 3. Get Your Feedback on Priorities • Care Delivery • COVID-19 • Payment and Payers
  • 4.
  • 5.
    Not an easyyear, NY Times 5 Poll Question Pick most read NY Times story: 1. There’s a name for what you’re feeling: languishing. April 19 2. Alec Baldwin was told his gun was safe. Oct. 21 3. Mike Pence reached his limit with Donald Trump. Jan. 12 Source: NY Times, The Year’s Most Read, Dec 29, 2021 Most clicked articles for 2021: 1. Coronavirus in the US 2. How vaccinations are going. 3. How safe are you from COVID Google most searched: HEALING
  • 6.
    Poll Question How DoYou Feel About 2022? 6 Tired Not Sure Complacent Ready to Go Angry
  • 7.
    Guess Who? • Gathereddata on every aspect of medical care • Diagrammed causes of mortality • Sent questionnaires to hospital administrators • Used statistics to understand how the world worked • Produced findings on deaths for various diseases and recovery times based on patients’ age and gender • First woman fellow of the Royal Statistical Society 7 Source: Smithsonian March 2020, Thou Shalt Not Underestimate Florence Nightingale
  • 8.
    Long View forAnother Industry To a future with more cheers. 8 Source: AB InBev 2021 Investor Seminar, Fortune magazine AmBev CEO Michel Doukeris is writing a 10-year strategic plan (and you probably should too) • New Strategy • Portfolio that delivers superior value for customers • Digital • Apps to sell direct to retailers, consumers • Convenience-ready to drink packaging 10 Year Plan • Old Strategy • Cost mgmt. • Cash generation • M&A capabilities
  • 9.
    Top Brands andTop Companies 9
  • 10.
    DATA is Key Successfulorganizations that focus on high-value data recognize that: • Integrated data unlocks your highest value use cases • Reusable data multiplies your data value • Health care expertise should be embedded to save time and resources • Transparent data avoids a ‘black box’ distrust of data • Aggregated data enables benchmarking • Application data is highly valuable and should be reusable • Data quality is foundational to trust and the use of data – Dan Heinmiller, VP, Data, Health Catalyst 10
  • 11.
    Health Equity Top Priority 11 Burdenon Families: High cost disproportionately affect uninsured adults, Black and Hispanic adults % of people who skipped/delayed are due to cost: • 31% White Source: IHI Pulse Report 2021 5 critical priorities for the U.S. Healthcare System, Marc Harrison, HBR, Dec 15, 2021 • 49% Black • 58% Hispanic Critical Priorities : 1. Focus on improved health 2. Tackle racial disparities 3. Expand telehealth and in-home hospital services 4. Build integrated system 5. Adopt value-based care
  • 12.
    © 2021 HealthCatalyst. Proprietary and confidential. Observations 12
  • 13.
    © 2021 HealthCatalyst. Proprietary and confidential. More that 75 Companies Sign Digital Healthcare Equity Pledge 13 Source: Executives for Health Innovation • Identify and Address Health Equity Issues • Accessibility • Diversity • Respect • Public Policy
  • 14.
    Health Care Organizationsand Payers In the Final FY 2022 Hospital IPPS Rule for Acute Care Hospitals CMS published that they were requesting “comment from stakeholders on ways we can leverage measures to address gaps in existing health equity generally as well as comment on: . . . potential future reporting of a structural measure to assess the degree of hospital leadership engagement in health equity performance data.” Not the Only Ones Talking about Equity 14
  • 15.
    Looking Forward • Startwhere you are and build • New Z codes: Food insecurity, housing instability 15 Power Source: IHI Pulse Report 2021 Getting Data
  • 16.
    The Queen’s MedicalCenter in Hawaii was the site of nearly 60 percent of all emergency department (ED) visits by people who were experiencing homelessness, with some of them visiting the ED every day. Knowing that in most cases patients would receive better care outside the ED—and seeing that inordinate resources were needed to treat them—The Queen’s Health Systems sought a better approach. The organization leveraged its analytics platform, payer data, and patient flow data to refine care management for this vulnerable population, an effort that led to dramatic improvement in patient outcomes and costs. Innovative Care Management Program Avoids Nearly $16M in Costs and Transforms Lives of Super-Utilizers Challenges & Impact • Patients experiencing homelessness were consuming a disproportionate share of ED resources. • Existing program for high-utilizers had not managed to shift ED utilization patterns for this population. • Impact: The organization wasn’t able to meet the needs of this unique patient population, deploy care management effectively, or expend its resources most effectively. Results • Nearly $16M in cost avoidance. • 68.5% reduction in the number of days patients spent hospitalized. • 22.8% reduction in length of stay. • 43.8% reduction in readmission rate. Solution • Developed the Queen’s Care Coalition, an innovative care management program, to address the needs of super-utilizers. • Leveraged the Health Catalyst® Data Operating System (DOS™) platform for data and analytics and the Instant Data Entry Application (IDEA). • Established mechanisms for using payer data, patient data, and patient flow data for ongoing program evaluation and data-informed decisions. A Health Catalyst Success Story 16
  • 17.
    © 2021 HealthCatalyst. Proprietary and confidential. Only three percent of adults in the U.S. can report practicing all five of the behaviors that lead to healthier outcomes: exercising three times weekly, not smoking, eating adequate fruits and vegetables, wearing a seatbelt regularly, and maintaining body mass index (BMI) within a healthy range. Thibodaux Regional Medical Center conducted a community health needs assessment (CHNA) as part of its vision for a healthier community. The CHNA reinforced the hospital’s identified need for a data-driven, medically integrated wellness program designed to benefit the health of the community. Using its analytics platform and a robust suite of analytics applications, Thibodaux Regional’s multidisciplinary medically integrated wellness team developed a program to support and track healthy behaviors. 16.1% relative improvement between pre-and-post physical PROMIS scores. 8.6% relative improvement between pre-and-post mental PROMIS scores. 16% relative improvement between pre-and-post distances walked. 2.1% relative reduction between pre-and-post weight— participants lost an average of 5.1 pounds. Medically Integrated Wellness Program Reduces Modifiable Risk Factors 17
  • 18.
    © 2021 HealthCatalyst. Proprietary and confidential. Actions: Health Equity 18 1. Review your Community Health Needs Assessment (CHNA) • Are you meeting the goals set? • Who are your partners? 2. Evaluate your value-based contracts and review the measures being tracked. • Are the measures helping your community? • Dig deeper on the measures. 3. Track metrics and measures that have impact on your community. 4. Report the outcomes and learn from mistakes and successes.
  • 19.
    © 2021 HealthCatalyst. Proprietary and confidential. Care Delivery 19 The U.S. healthcare model has been moving outside the four walls of the hospital… COVID-19 has accelerated this trend with increasing adoption of telehealth, remote patient monitoring and other ways to access care remotely. – T.J. Elbert SVP, General Manager, Data Health Catalyst CMS issued Acute Care At Home waiver in November 2020.175 hospitals approved as of October 2021. Site of care shifts over next 5 years Imaging & lab Already happening • Surgical Knee = 6.5% → 36% • Care clinics = 2.8% → 2.5% • Digital = 20% of visits are virtual • Home Based = 1% → 30% Telehealth Source: Advisory Board
  • 20.
    © 2021 HealthCatalyst. Proprietary and confidential. Use Case for Digital Technology 20 Source: Bain Digital Transformation: What matter most in your sector.
  • 21.
    © 2021 HealthCatalyst. Proprietary and confidential. Digital Workflow in Healthcare 21 Alerts Level of Care Escalation PROs & Patient Response Data RPM Data Multi-Channel Engagement 1 4 2 3 IVR Patient Portal Secure SMS Twistle / 3rd Party App Personalized Pathways Person Selection Automation Analytics Orders Self-Enroll System of Record Ex. EHR, CRM, Case Management, Population Health, Clinical Data Repository, Telehealth, etc. Patient Education Appt Reminders Video content Online Consent
  • 22.
    Readmission Management CaseStudy Post-discharge Surveillance 22 Approach • Secure messages 24-48 hours after discharge to confirm: – Prescriptions filled – Understand discharge information – Follow-up appointment scheduled – Pain managed Challenge • Post-discharge follow-up calls were: – Manual – Time consuming – Often ineffective in reaching patients Decrease in 30-day readmissions 26% Increase in the number of patients monitored 62%
  • 23.
    © 2021 HealthCatalyst. Proprietary and confidential. With the emergence of COVID-19, Texas Children’s Hospital was challenged to make data-informed decisions that would allow it to continue offering critically needed healthcare services, while ensuring the safety of its patients, staff, and providers. Texas Children’s dramatically expanded telehealth capacity, converting most in-person primary, specialty, and mental healthcare visits to a phone or video appointment to better meet patient needs. The organization leveraged the Health Catalyst® Data Operating System (DOS™) and a virtual health platform to visualize, monitor, and manage the conversion to virtual health, in addition to managing in-person visit volume—enabling the effective management of outpatient capacity, utilization, and financial performance. Nearly 70X increase in the number of telehealth visits—in just two weeks. Approximately 11,000 weekly virtual health visits. 64 specialties providing virtual health visits—nearly 2,000 providers have completed a virtual health appointment. Successfully maintained pre-COVID-19 visit volumes. Virtual Visits and Analytics Enable Continued Delivery of Ambulatory Services During COVID-19 Pandemic 23
  • 24.
    Actions: Care Delivery 1.Know your customer engagement strategy. Asses where you are and where you want to be. 2. How can you excite customers, simplify life and improve your patients’ health? 3. What are the key metrics to track for your efforts? 4. How can you drive a better experience? 5. Can you assess the patient’s condition, can you navigate patients to the right interventions? 6. What investments will help drive better care at the right site for the care 24 Patients actively engaged in their care—with the knowledge, skills, and willingness to manage their own health—have a 21% lower cost of care. Source: Health Affairs Feb 2013, Patients with lower Activation Associated with Higher Costs
  • 25.
    Patient Safety The impactof coronavirus disease on healthcare-associated infections in 2020: A summary of data reported to the National Health Safety Network. 25
  • 26.
    © 2021 HealthCatalyst. Proprietary and confidential. Impact of COVID-19 on Screenings 26 JAMA Oncology June 2021 Association of Cancer Screening Deficit in the United States with the Covid-19 Pandemic
  • 27.
    © 2021 HealthCatalyst. Proprietary and confidential. Note: Health care spending as a percent of GDP. Performance scores are based on standard deviation calculated from the 10-country average that excludes the US. See How We Conducted This Study for more detail. Data: Spending data are from OECD for the year 2019 (updated in July 2021). AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US -1.40 -1.20 -1.00 -0.80 -0.60 -0.40 -0.20 0.00 0.20 0.40 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Health Care System Performance Compared to Spending EXHIBIT 4 Higher health care spending Lower health care spending Higher health system performance Lower health system performance Health care spending as a % of GDP 10-country average Source: Eric C. Schneider et al., Mirror, Mirror 2021 – Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fun, Aug. 2021). 27
  • 28.
    Looking Forward Measure SuppressionPolicy • CMS finalized policy to not use data that has been affected by COVID-19 in calculating hospital performance. This applied to Readmission, Value-Based Purchasing and Hospital Acquired-Condition Programs. • CMS new reporting requirement to improve maternal health. 28
  • 29.
    The U.S. spendsmore on healthcare than any other country—and as costs escalate, healthcare organizations continue to search for ways to improve care while containing costs. The University of Kansas Health System recognized that to truly move the needle on cost and quality, its ongoing improvement efforts needed more robust, systemwide support. By leveraging data and analytics and an adaptive problem-solving approach, the organization has achieved impressive improvements in clinical and financial outcomes. Adaptive Problem-Solving and Analytics Improves Quality and Saves $4.7M Challenges & Impact • Lack of organizational alignment around discrete improvement efforts. • Little shared understanding of the context and import of the performance data that was shared in the organization. • Clinician incentives not uniformly aligned around performance or value; improvement efforts unevenly supported. • Impact: Without a strategic, data informed approach to improvement, the organization struggled to realize or maintain meaningful gains. Results • $4.7M in cost savings. • 0.69 observed/expected (O/E) mortality rate for patients admitted to the hospital. • 0.63 Standardized Infection Ratio (SIR) for catheter-associated bloodstream infections. • 0.83 SIR for hospital-onset Clostridioides difficile. Solution • Leveraged the Health Catalyst® Data Operating System (DOS™) platform and a robust suite of analytics applications to identify, analyze, and track improvement opportunities. • Developed and applied an adaptive approach to problem- solving, based on iterative Plan-Do-Check-Act cycles. • Developed a strategic performance improvement system that helps align improvement efforts with the broader organizational goals; builds shared understanding of data, performance, and targets; and drives stakeholder engagement. A Health Catalyst Success Story 29
  • 30.
    Actions: Patient Safety 1.Reenforce infection prevention practices. 2. Risk identification with AI and predictive models 3. Goal setting renewed with updates needed for new protocols 4. Gathering information and closing gaps 30 “Healthcare leaders are facing an increasing number of critical decisions with less time to make them and lower tolerance for error. Moving forward, more healthcare C-suites will look to augmented intelligence to inform their decisions.” – Jason Jones, Chief analytics and data science officer, Health Catalyst
  • 31.
    COVID-19 • The worldis permanently shifted. – PepsiCo CFO • Waves, variants will continue • Geisinger out of beds amid COVID-19 surge, practicing “waiting-room” medicine. – December 2021 • R- words Recovery, reimage, redo 31 The story that unfolded in 2020 and continues today is unlike anything that has happened in the past 100 years. – Health Affairs Fitch ratings The Omicron variant should not have an outsized effect on not-for-profit hospital operations and cash flow. "In my view, this is a new beginning. To create a new health system for the future based on the experience of the last 15 months.“ – Michael J. Dowling, CEO Northwell
  • 32.
  • 33.
    COVID-19 Impact Kaufman Hallprojects hospitals will lose $54B in net income in 2021 33
  • 34.
    Impact of Unvaccinated Adultson Hospitalization Costs 34
  • 35.
    Looking Forward Source: PWC AltarumHealth Sector Economic Indicators: December 2021 35 Strong merger and acquisition deals- 25% higher than 2020. 2022 Will continue Oracle and Cerner HCA buys Urgent Care Intermountain, SCL Health U.S. healthcare spending increased 9.7% in 2020. 36% increase in federal expenditures largely due to COVID-19.
  • 36.
    Operating Margin- HealthSystems Comments: We expect margin will likely remain at lower levels given the broader industry headwinds and the more immediate pandemic-related issues. However, to the extent the pandemic has enable faster decision making and allowed management teams to pivot and identify new opportunities for expense base restructuring and revenue enhancement. December update: 2022 outlook negative as labor costs drive higher expense growth. Moody’s 36 Results for 2022 1st quarter results: • Ascension- volumes strong, net patient revenue up 7% YOY. Operating income $25M compared to $144M a year earlier. • CommonSpirit Health-Higher labor and supply costs, higher volumes. Operating income $34M compared to $167M same period last year. Results for 2021 3rd quarter: • Kaiser Permanente-Operating income of $38M compared to $456M in qtr. 3 2021. Drive by higher care delivery expense due to COVID-19. 2021 Operating Margin Median 2.7% Increase in Adj. Cost Per Case 24.7%
  • 37.
    Solution • Carle leveragedthe Health Catalyst® Data Operating System (DOS™) platform and a robust suite of analytics applications, including a capacity planning tool that uses new Healthcare.AI techniques. • The new Healthcare.AI techniques enabled Carle to precisely forecast census and related bed, staffing, and supply needs at the level of patient acuity. • Carle uses dynamic regional infection spread and market-share data and augments these assets with the internal clinical, operational, length of stay, staff, and supply data to anticipate COVID-19 activity. In hospitals and health systems around the world, COVID-19 has ushered in resource and capacity demands that have stressed operations and threatened organizations’ care response. To meet this challenge, organizations must be able to accurately predict COVID-19 requirements. Carle Health System has achieved this critical capability, leveraging its analytics platform, implementing new Healthcare.AI tools, and using local data and infection rates to forecast surges and anticipate resource restrictions. Advanced analytics now allow Carle to better accommodate COVID-19-driven resource needs—and minimize the impact of the virus on the organization and community. COVID-19 Capacity Planning Tool Uses New Healthcare.AI™ Tools to Enable Accurate Forecasting Challenges & Impact • Increased demand for facility, supply, and human resources necessary for COVID-19 patient care. • Inadequacy of national and county-level COVID-19 capacity planning resources to guide operational decisions. • Impact: Carle lacked ability to anticipate patient surges, identify if surges would exhaust its available resources, and guide plans to balance load and shift services at an individual hospital and unit level. Results • Carle has embraced data science by implementing and integrating a COVID-19 capacity planning tool into daily operations in less than two months. • The organization is using advanced analytics for capacity planning efforts and to support its leadership team in making timely decisions, improving the effectiveness of COVID-19 planning and response. A Health Catalyst Success Story 37
  • 38.
    Actions: COVID-19 1. Basicmanagement, proactive • Revenue cycle management • Cost- knowing “true costs” to provide services 2. Forecast on shorter time frame, ability to do rolling forecasts as environment changes • Importance of organizational buy-in • Messaging and communication critical • Cross-functional work • Less detail and more focus on KPIs 3. Capital allocation review 4. Combine clinical and financial outcomes 5. Double down on patient safety 38 Source: HFMA presentation OSF Nov 2021 Leveraging Dynamic Planning on the Road to Financial Recovery We are committing first call capital allocation to technology- that is a Board mandate for Banner Health. - CFO Dennis Laraway, Banner
  • 39.
    Staffing Great Resignation: • Thequits rate increased to 3% in September, highest rate going back to 2000. November 4.5M. • National Agreement Kaiser, Unions • Wage increases, benefits • Career development • Staffing language for patient and worker safety • New terms: – R.T.O. Return to office-many delays • 41%, back the week after Thanksgiving – Zoombie – Show and tell – Bookcase credibility • Fifty million US worker (34.5%) are both frontline and essential workers, meaning they cannot work from home and their work is essential to meeting basic population needs. 39 The healthcare workforce is crumbling. - Sri Balasubramanian, MD © NSI Nursing Solutions, Inc
  • 40.
    © 2021 HealthCatalyst. Proprietary and confidential. Looking Forward 40 2 in 5 nurses and 1 in 4 physicians want to leave in next 2 years Mayo Clinic Proceedings Study
  • 41.
    To improve staffingefficiency, Hawai‘i Pacific Health (HPH) sought to realign its staffing practices to better predict and manage its labor needs. Leveraging Health Catalyst’s data platform, analytics tools, and expert consulting, HPH was able to forecast its workforce needs and effectively manage staff schedules—changes that led to timely access to data, a reduction in administrative burden, and significant cost savings. Data-Driven Labor Management Delivers Financial and Operational Improvements Challenges & Impact • Data systems were not integrated. • Definitions of volume statistics were not standard. • Impact: Burdensome manual processes limited analysis and required leaders to manage labor costs with retrospective data only. Results • $2.2M savings in 16 months, maintaining high quality and positive clinical outcomes • 100x faster insight into basic labor details, taking minutes rather than weeks to identify and correct trends or errors • 93% relative reduction in the time required to access real-time data, empowering proactive labor management Solution • Partnered with Health Catalyst to analyze and target opportunities. • Leveraged DOS™ platform and analytics tools to integrate and explore hours, volume, and budget data from disparate systems. • Engaged leaders from all departments to validate data and address underlying variation. • Designed and implemented work plans to improve labor utilization. A Health Catalyst Success Story 41
  • 42.
    Actions: Staffing 1. Listen 2.Data-shared and communicated. Example at Kaiser vacancy rates, backfill, budget, People Pulse and service scores will be shared (Part of KP-Alliance National Agreement) 3. What support do your care teams need? – Childcare – Mental health 4. What flexibility can you offer your workforce? – Schedules – Roles – Care models 5. Retention, retention – cost for each RN turnover is $40K 42 Source: Mayo Clinic, COVID-Related Stress And Work Intentions in a Sample of US Health Care Workers
  • 43.
    Payment and Payers •HHS to make cover more accessible and affordable for millions of Americans in 2023. – Press release Dec. 2021 • CMS reviewing models, new models expected in 2023 • ACA enrollment for 2022 at 13.6M as of Dec 2021 43 State of Alternative Payment Models (APMs) 13.6M Source: Healthcare Payment and Learning Action Network
  • 44.
    CMS Priorities • HealthAffairs blog August 16, 2021 • Medicare and Medicaid: A Vision for Next Ten Years • Create a more value-based system that reduces spending while preserving or enhancing quality of care – Advance racial equity – Justice for underserved communities • CMMI Whitepaper: – Health equity in every model – Reduce complexity – Ensure lasting care delivery transformation CMMI Vision and Strategic Objectives 44
  • 45.
    Operating Margin- HealthSystems Comments: Stable, Insurers financially “unscathed” by COVID-19, but must adapt to industry evolution. • Lower medical cost trends, Push VBC, Acquisitions, Manage chronic conditions, Telehealth Fitch: Comments: Neutral, lingering presence of COVID-19, surge in delayed care, strong full-year operating performance Moody’s 45 2021 EBITDA 7.3% → 7.5% Fitch Projection Employer sponsored health insurance rose in 2021 6.3% $14,542 per employee Mercer 2021 Survey
  • 46.
    © 2021 HealthCatalyst. Proprietary and confidential. Payer 46 Anthem Humana Value Based Care Report 2021
  • 47.
    Price Transparency Regulations 47 FY 2020Price Transparency Requirements for Hospital to Make Standard Charges Public Hospital Price Transparency final rule published 11/27/2019. Effective on 1/1/2021 FY 2019 Requirements for Hospitals to Make Public a List of Their Standard Charges Guidance requiring hospitals to post their chargemaster. Effective until 12/31/2020. No Surprise Billing Protect Consumer From Unexpected Out-of-Network Bills AMA/AHA filed lawsuit in December 2021 challenging. Effective On Jan. 2021 1 Effective Until Dec. 2020 31 Jan. 2022 1 • 51.6% of hospitals did not publish any negotiated rates. – PatientRightsAdvocate.org • (Data published on hospital web sites.) • Increasing penalties for non-compliance- bed size maximum $5,500 per day
  • 48.
    Organizations frequently lookto care management to help curb the rising cost of healthcare. For this intervention to succeed, however, systems need to be able to identify appropriate candidates for care management and efficiently meet patients’ needs across the care continuum. To effectively meet these challenges, UnityPoint Health leveraged its analytics platform and augmented intelligence (AI). They were able to identify patients with chronic health conditions at a higher risk for overutilizing services, ensure data-sharing across settings, and ultimately decrease spending by millions of dollars. AI-Enabled Care Management Reduces Healthcare Spending by $32.2M Challenges & Impact • Lack of timely insight into care provided across acute and ambulatory settings. • Inability to identify patients with high or rising risk of worsening health conditions, which often result in on-urgent ED visits or unplanned hospital admissions. • Impact: Unless addressed, these data challenges would prevent UnityPoint Health from optimizing care management—and realizing the savings and care improvement they sought. Results In 30 months, UnityPoint Health decreased utilization and the costs of care for patients who complete the program. The organization has reduced spending by more than: • $32.2M, the result of a 54.4% relative reduction in hospital admissions, and a 39% relative reduction in ED visits. • Patients gained 11,000+ more days at home and had nearly 2,000 fewer ED visits. Solution • Leveraged the Health Catalyst® Data Operating System (DOS™) platform. • Instituted collaboration between the analytics team and acute and ambulatory clinicians to develop and enhance analytics tools. • Optimized the efficiency and effectiveness of care management by using data, analytics, and AI—improving the system’s ability to risk-stratify and prioritize patients, understand needs, monitor and manage services, and discover improvement opportunities. A Health Catalyst Success Story 48
  • 49.
    © 2021 HealthCatalyst. Proprietary and confidential. Actions: Payment and Payers 49 1. Alignment of all parties 2. Review of value-based contracts- even if not time for negotiation 3. Work actively with payers 4. Focus on improved health with measures for cost and quality Focus on increasing connected care and reducing health inequities. Impacts 130,000 people Reduce cost trend by 10% over five years. Expand care management. Renew focus on preventative care. Source: Allina Press Release
  • 50.
    © 2021 HealthCatalyst. Proprietary and confidential. 2022 50 Pantone Color of the Year: VERY PERI Blends the faithfulness, consistency of blue with excitement, energy of red. Glitter is back! In 2030 will we see this sign? Year of the Gnome, River City Yarn
  • 51.
    2022 • What ishighest priority? • What actions are planned? • What are your bumps in the road? Your list for 2022 51 Health equity Response to COVID-19 Staffing Patient Safety Care Delivery Payment & Payers
  • 52.
    10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010101010101010101010101010101010101010101 101010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010101010101010101 10101010101010101010101010101010010101010101010101010101010 10101010101010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010101010101 1010101010101010101010101010101010101010101010101010 0101010101010101010101010101010101010101010101010 01010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101010 010101010101010101010101010101010101010101 10101010101010101010101010101010101010101 1010101010101010101010101010101010101 10101010101010101010101010101010101 01010101010101010101010101010101 101010101010101010101010101010 0101010101010101010101010101 1010101010101010101010101 10101010101010101010101 101010101010101010101 101010101010101010 010101010101010 1010101010101 1010101010 01010101 10101 010 0 Questions?
  • 53.
    Resources: • Health equitylanguage and IHI Achieving Health Equity: A guide for healthcare organizations whitepaper. • Health Catalyst Healthcare.AI™ resources. • CMS Acute care at home resources. • McKinsey Nursing in 2021: Retaining the healthcare workforce when we need it most. • Mayo Clinic article on COVID-related stress and worker intentions. • Bain Interactive Digital Transformation. • Price transparency checklist from CMS. • Humana Value Report for 2020. • CMS Innovation Center Strategic Objectives. 53