Health Analytics: Gaining the Insights to Transform Health Care

Praise for Health Analytics: Gaining the Insights to Transform Health Care "Health care leaders in the next decade must be able to guide their teams in the use of mission-critical health care analytics. Jason Burke has distilled this complex subject to a structured, commonsense framework that is a pleasure to read. His readers will gain significant advantage in the world of provider risk and ACOs, and will be revisiting charts, tables, and entire chapters frequently for sage advice." —Paul Bleicher, MD, PhD, CEO, Optum Labs "Health care is among the largest and most complicated industries on the planet, such that one would expect to encounter advanced practices. However, health care has yet to encounter its own industrial revolution, one in which data-driven organizations disrupt the status quo to deliver ever better results and greater value. In his seminal book, Jason Burke helps us understand how to 'paint a picture of a different future' for health care, using data to define activities, prioritize responses and interventions, and optimize scarce resources, all to drive to a better 'new normal.'" —Don McDaniel, President and CEO, Sage Growth Partners "Passionate, connected, and wonderfully insightful—Jason offers a pragmatic framework to create meaningful value through health care analytics. He has an uncanny knack for demystifying the modern health care ecosystem comprising patients, providers, payers, policymakers, and pharmaceutical organizations—and describing the role of health care analytics as the connective tissue that will transform medicine." —Richard Thomas, CIO, Quintiles "There are several unimpeachable statements that one can make regarding the future of health care: 1) despite wishes of many stakeholders to the contrary, our 'system' of health care delivery and financing will radically change; 2) quality, patient satisfaction, efficiency, integration, coordination, and cost-effectiveness will replace volume as the drivers of medicine; 3) there will be winners and, most assuredly, losers; and 4) essential to winning will be measurement and the use of real-time information to guide decisions. If those engaged in health care delivery (or health policy) wish to be among the future winners, those who successfully reconstruct the health care system, they need to read Jason Burke's Health Analytics . Far more than a lucid explanation of the difference between data and information (and how to ensure that the latter is an integral driver of operations), this book is a strategic map to the future. Filled with wisdom and yet incredibly engagingly written, Health Analytics promises considerable return on investment for anyone interested in the health of individuals or organizations (i.e., virtually everyone)." —David R. Rubinow, MD, Meymandi Professor and Chair, Department of Psychiatry and Director of Innovation and Healthcare System Transformation, School of Medicine, University of North Carolina at Chapel Hill

Foreword xi Preface xv Acknowledgements xix Chapter 1 A Changing Business for a Changing Science 1 The Gathering 1 How Can Medicine Become Smarter? 3 Complexity Exceeding Cognition 4 Learning from Other Industries 6 Nancy 7 Characterizing Health Analytics 8 The Gathering Revisited 10 Chapter 2 Convergence and the Capability Map 11 Nice Job, But . . . 11 Fifty Flashlights 12 Convergence Defined 13 Is Convergence Really Required? 14 The Rush to Health It 17 The Capability Map 18 Putting the Capability Map to Use 21 Health Analytics as a Discipline 23 Notes 25 Chapter 3 The Four Enterprise Disciplines of Health Analytics 27 Heresy 27 Health Analytics for the Nonanalytical 29 Information Management 30 Statistics 36 Information Delivery 39 High–Performance Computing 41 Maturation and Scale 42 Enterprise–Class Analytics: Putting it All Together 44 Chapter 4 Dealing with Data 47 Callimachus 47 Not a Drop to Drink 48 Defining Data 48 Big Data 49 Growth in Data Provisioning 52 The Excuses Every Leader Needs to Know 54 Building for Tomorrow 58 Conclusion 60 Chapter 5 BEST Care, First Time, Every Time 63 By Dr. Graham Hughes Chief Medical Officer, SAS Center for Health Analytics and Insights Medicine: Art, Science, or Both? 63 Leveraging Evidence to Deliver Improved Outcomes 66 What are Clinical Outcomes? 68 Supplementing the Unaided Human Mind 72 Health Care’s Dark Fiber 74 Identifying Hidden Patterns 75 Chapter 6 Financial Performance and Reimbursement 79 Goals 79 Structures and Models 80 Many Names, Common Attributes 83 What is Needed 86 Surviving and Thriving 91 Chapter 7 Health Outcomes Analysis 95 No Leeches Necessary 95 Orientation 96 The Big Seven þ One 97 Timing is Everything 98 Groupers 100 The Population–Patient Pivot 101 Patients Like this One 104 One Model, Many Beneficiaries 107 The Role of Rules Engines 109 Challenges in Health Outcomes Analytics 110 Health Outcomes Analytics in Practice 113 The Marvelous Leech 114 Note 115 Chapter 8 Health Value and Cost 117 An Asymmetrical Industry 117 Kaplan and Porter’s Stand 120 The Elusive Health Value 121 Dissecting Value 123 Linking Costs to Risk 132 Value Innovation 133 Note 134 Chapter 9 The New Behavioral Health 135 Dangerous Portals 135 The Health–Mindedness Gene Experiment 136 Engel’s Model 137 The New Evolving Science of Behavioral Health 138 What You Are 140 What You Experience 142 What You Do 143 What You Believe 145 Influencing Change 145 Putting Into Practice 146 Outcomes 148 Notes 149 Chapter 10 Customer Insights 151 The Consumerized Patient 151 Will the Real Customer Please Stand Up? 151 What Are Customer Analytics? 154 A Framework of Customer Analytics 155 Sharing Insights 161 Adherence 163 Beyond Commercial 165 Chapter 11 Risk Management 167 Risky Business 167 Why Are Risks So Hard? 168 Recharacterizing Risk Factors 169 The Example of Customer Segmentation 170 Risk Interdependencies 171 Everybody in the Pool 173 The Catch 175 Risk Adjustment 176 Borrowing from Other Industries 178 Growing Risks 179 Chapter 12 Quality and Safety 181 Defining Quality 181 Not Your Father’s Toyota 184 On Track 185 Avoiding the Obvious 187 We Just Have to Do This 188 The Growing Inventory 189 Strategy and Performance Management 191 Transparency and Benchmarking 192 Setting Quality Targets 195 Drug Safety 197 The Burden of Insight 198 Notes 199 Chapter 13 The New Research and Development 201 Returning to Alexandria 201 The End of Theory 202 Goals of a New Research Model 205 Characteristics of a New Research Paradigm 207 Target Improvement Areas 209 The Data Conundrum 216 The Big Four 219 One That Does What It Should 221 Notes 223 Chapter 14 Conclusions 225 Taking on Research 227 Five Phases of Value–Based Analytical Innovation 230 Phase 0: The Plan 232 Managing Capability Maturity 233 Wisdom and Health 237 About the Author 239 Index 241

JASON BURKE is founder of Burke Advisory Group, an executive consulting firm focused on helping health leaders pursue transformational programs using data, technology, and analytics. He holds an adjunct faculty appointment with the University of North Carolina at Chapel Hill School of Medicine, where he focuses on the development of new health informatics capabilities for health practitioners, researchers, and patients.