Increasing the Value of Care through Integrated

Diagnostic Image Analysis Services

Mitchell Goldburgh, Cloud Solutions for Enterprise Imaging and Analytics

Charlotte Hovet, MD, MMM, Medical Director for Provider Solutions

Naomi McMillen, RN, MPH Clinical Consultant for Provider Solutions

Sponsored By:

Thursday – December 7, 2016

Noon – 1:30 Pacific / 1:00 – 2:30 Mountain / 2:00 – 3:30 Central / 3:00-4:30 PM Eastern

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Charlotte Hovet, MD, MMM, Medical Director is a strategic, experienced, contemporary physician leader with a passion for transforming healthcare and optimizing the health and well-being of all people. She is a board-certified family physician and clinical informatics specialist, with expertise in mentoring and motivating colleagues to embrace innovative and effective solutions to support excellence in patient care.

Mitchell Goldburgh, Global Solutions Manager – Enterprise Imaging and Analytics who has over 30 years in healthcare imaging and information technology and has had the opportunity to introduce cutting edge technology in digital imaging such as computed radiography and deliver large scale projects involving data governance, cross enterprise data sharing and telemedicine.

Naomi McMillen RN, MPH, Senior Principle Consultant, Global Healthcare Solutions and Consulting is a Registered Nurse, has a master’s degree in public health, and was CIO of an Integrated Delivery System in Seattle, Washington. Over the past 8 years she has been involved as program/project manager in many EMR implementations in large, complex integrated systems to critical rural Hospitals. Specifically over the past 2 years Naomi has been working with NTT Data (formerly Dell Services) Population Health Solutions, including: analytics, risk stratification, predictive analytics, coordinated care, telemedicine, and imaged based analytics. Her main focus is on improving outcomes through organizational change management and clinical adoption of technology innovations.

PRESENTERS

NTT DATA welcomed Dell Services into the family in November of 2016. Together, they

offer one of the industry’s most comprehensive services portfolios designed to

modernize business and technology to deliver the outcomes that matter most to our

clients. NTT DATA Services is committed to improving patient outcomes by connecting

the healthcare ecosystem. A recognized leader in the healthcare space, they deliver

targeted segment solutions including patient engagement, predictive analytics,

healthcare cloud hosting, integration and interoperability, clinical and claims application

implementation, revenue cycle management and policy administration, in addition to

core managed infrastructure, application and business process services. The clients

they serve include more than 1,800 hospitals, 2,200 long-term care facilities, 225

acute care facilities, 43,000 clinicians, 1,000 physician practices and 50 insurance

providers in support of 65 million policy holders.

NTT DATA formerly Dell

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Insights into healthcare costs and medical imaging

Imaging analytics integrated into

clinical care

Today’s Discussion

Impact of data-driven care

management

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A Myriad of Challenges

• 2016 - From the effects of high-

deductible health plans to how to remain

profitable in the future

• ‘It's not just the fact that we're going to

get paid less for what we're doing. We're

also seeing a shift in business..’

• ‘We're trying to evaluate all of the

different services we have and evaluate

how they will fit into what we believe is

the future of healthcare.’

• 2015 - From the transition to ICD-10 to

mergers and acquisitions, hospital and

health system.

• Both the actual cost of the ICD-10

transition and indirect costs of the ICD-10

transition as well.

• Inpatient Prospective Payment System,

drive pre-determined rates to serve

Medicare patients and adjusts IPPS

payments based on quality of care.

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http://www.beckershospitalreview.co

m/finance/hospital-cfos-top-

concerns-for-2016.html

http://www.beckershospitalreview.com/fina

nce/hospital-cfos-top-concerns-for-

2015.html

2017 - Maintaining financial performance amidst regulatory uncertainty is a key

challenge hospital for CFOs. Panelists identified six challenges in Chicago this

November.

• Combat volume leakage. "Competitors in the area are fighting for our patients. Our strategies in 2017 revolve

around driving volume to our hospital as reimbursement declines," CFO at Lane Regional Medical Center.

• Smart expansion. Mergers, acquisitions and affiliations have become important tools in a hospital's strategic

wheelhouse

• Clinical documentation improvement. Hospital leaders are both financially and clinically motivated to improve the

quality and specificity of their clinical documentation data.

• Build fundamentals of managing risk. Healthcare organizations will need to make risk management a core

competency moving forward. But unlike insurers, hospital systems have little to no experience taking on risk.

• Paradigm shift in reimbursement. Value-based programs require a different financial skill set and different financial

management tools driving strategic and capital investments at a time when hospital resources are increasingly limited.

• Improve point-of-service collection rates. Improving point-of-service collections is still a challenge for many

hospital systems.

A Myriad of Challenges Ahead

6http://www.beckershospitalreview.com/finance/cfos-name-top-6-challenges-in-2017.html

Investment in Information Technology must support, not hinder, the

agility needed to respond to these challenges

• Accountable care organization (ACO) models focus on

improving population health however understanding the

role of diagnostic imaging is lost and the role of radiology

is changing and the changes are not necessarily

considered.

– According to CMS, the typical Medicare Shared Savings Program

(MSSP) spends $10,000 annually per patient. However, diagnostic

imaging accounts for only $300 of that yearly total.1

Impact of ACO on Medical Imaging

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1 Jackson, Whitney L., Radiology in the Value-based ACO Model, http://www.diagnosticimaging.com/rsna-2016

2 Zhang, Hui · Wenz, Christian · Hughes, Danny R., Modeling and designing health care payment innovations for

medical imaging, Health Care Manag Sci DOI 10.1007/s10729-016-9377-z

• Recent published analysis regarding specifically use of CT

imaging shows the importance of balancing rewards and

incentives with Medicare Shared Savings Program

(MSSP), specifically when setting a cost benchmark.2

– The researchers found that provider participation in ACOs occurs at

very different cost benchmarks and physician provider shares vary

according to the cost benchmarks set between payers and ACOs.

– The current practice of ACOs negotiating for a more lenient cost

benchmark may lead to higher costs and worse health outcomes.

– However, a too stringent cost benchmark can result in too low CT

testing thresholds, and further may jeopardize the willingness of

ACOs to participate.

Impact of ACO on Medical Imaging

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• Medicare payments will be reduced by 20% for providers submitting claims for

analog x-ray studies starting in 2017 under a provision in the Consolidated

Appropriations Act of 2016, which was enacted into law in December 2015.

Starting in 2018, payments for imaging studies performed on CR

equipment would be reduced by 7% for the next five years, and 10% after

that.

• While the law's provisions on analog x-ray are expected to have a minor

impact due to the small number of traditional systems still in operation in the

U.S., the reductions in CR payments could have a much broader effect: More

than 8,000 CR units are still in service in the U.S. All of these systems must

be replaced or imaging facilities will experience payment reductions.

Continued Focus on Technology vs Outcomes

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Casey, Brian, Medicare to cut analog x-ray payments starting in 2017, AuntMinnie.com

Change in Delivery Model: Value-based Healthcare

Value Cost

Triple aim

Better care

OutcomesQuality + Patient experience + Safety

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Impact of Data-driven Care Management

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The Value in Clinical Imaging

Clinical imaging is a critical tool in

identifying disease pathology– Presence of disease – health

screening

– Progression of pathology

– Spatial reference for care decisions

Payers are focused on clinical imaging

for cost control– Reduction of duplication

– Appropriateness of procedures

– Clinical decision systems

But there is more that can be done with

clinical imaging than primary diagnosisUnderstanding what is in an image? Is it

just finding who is from out of town?

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The Value in Clinical Imaging

Clinical imaging is a critical tool in

identifying disease pathology– Presence of disease – health

screening

– Progression of pathology

– Spatial reference for care

decisions

Payers are focused on clinical

imaging for cost control– Reduction of duplication

– Appropriateness of procedures

– Clinical decision systems

But there is more that can be done

with clinical imaging than primary

diagnosisIdentifying who is out of town and when, where, and what they bought as incidental findings

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Imaging Analytics: Uncovering Hidden Risks

Source: Imaging Performance Partnership interviews & analysis

Why focus imaging?

A standard of care in diagnostic process

Event to baseline patients’ health beyond

the prescribed reason for exam

Opportunity for comparison with previous

images to track change

Advances in imaging technology have

made incidental findings available

Diagnostic imaging identify incidental findings,

analytics makes them more consistent and meaningful

Why incidental findings ?

Lowest cost of identifying disease

Profiles patients’ at risk

High value expense reducing cost of

care and increase safety (incident

avoidance and dose reporting)

Improve patient outcomes

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• 3D visualization is an important tool but it

is not machine vision

• Machine vision is the ability to automate

and identify anatomy and measure its

characteristics

• Artificial Intelligence takes one or more

measurements and relates them to

disease states based on learned patterns

• Proper application of these technologies

create actionable insights impacting

patient care

– Not just more data points but

recommendations on clinical

pathways and patient risk

Advances in Machine Vision and Artificial

Intelligence in Medical Imaging

(applied to medical imaging)

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Coronary calcium scoring

Pulmonary hypertension**

Emphysema

Fatty liver

Imaging Analytics Impacts Revenue, Cost and Patient Care

• An ordered imaging study is filtered by patient

criteria to be run through imaging analytics for

incidental findings

• Incidental findings are delivered to appropriate

care solution(s)

Brain Mapping**

Lung Elasticity

Breast**

** Algorithm not available for sale in the US, Pending FDA

Osteoporosis

Algorithms from Zebra Medical Vision, Ltd,

AnatomyWorks,LLC , Imbio,LLC and growing

Organizational clinical transformation to integrate

tools/results into existing pathway or care paths

program make it actionable for additional testing,

prevention programs, etc.

The value: early detection improves outcomes

from increased insights leveraging existing studies

(lower cost to detect)

New revenue from new diagnostic tests and

applicable preventative care programs as well as

new risk profile for improved coding

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Primary and

Incidental Finding

Report Published

Radiologist Reports with Prepopulated

Template

Automated Imaging Analysis

Delivers Measurements

based on Anatomic Specific

Algorithms to Reporting Tool

Integrating Imaging Analytics into Diagnostic Imaging

Automated quantification for aiding diagnostic reading

Patient Presents

for Primary

Diagnostic Study

Study Completed and

Diagnostic Images set

Read

Primary Care Team

Foreseen Value:

• Easier detection of asymptomatic disease from existing studies (incidental finding)

• Interpretation and productivity enhancement for radiology, cardiology, and future areas of imaging

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Alternate Integration of Imaging Analytics into Care Delivery

Options for initiating automated screening of patient studies

Population health consumption

stratification using ordered studies

Patient eligibility by health

profile and imaging study type

Primary care selection of screening

with principle diagnostic request

Automated

Imaging

Analysis

Patient Disease Screening Result(s)

Primary Care Team for recommended actionable follow-up

H

ig

h

L

ow

R

is

k Hig

h util

izers

Hidden

opportunity

Cri

tical

Rel

ativel

y he

alt

hy H

ig

h

L

ow

Cost

(PMPM)

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• Capitated Reimbursement Environment– Savings from early detection and avoidance of costly incidents of care

– New revenue from multipliers on capitated rates based on patient risk

stratification (HCC)

• Services optimization

– Increased study throughput with physician resources focused on more

complex cases

– Preventative care early on reduces long-term care costs

ROI from Imaging Analytics

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Focus on “Value” – delivers ROI

Components In Healthcare Informatics Strategy - Imaging

Intelligent archiving

Application neutral access

Image sharing and exchange

Beyond Diagnostic

EHR integration

Real-time data collection

KPI dashboards and reports

Cross platform / enterprise analysis

Vendor independent FHIR repository

Close loop on Incidental findings

Machine vision and learning for automated image incident findings

Dose / protocol monitoring across modalities

Operational Intelligence

(Business Intelligence)

Clinical Intelligence

(Enterprise Imaging)

Imaging Insight(Imaging Analytics)

Unified Clinical Archive (UCA) Portfolio

Tools for Agile Care Delivery

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Value Proposition with Increased Reporting from Analytics

0%-10%

25%-50%

10%-25%

25%-50%Next Generation

Radiology

Efficiencies in

Reporting

Begin to Emerge

Initial Domain

Specific Coverage

Population Health

Risk Management

● Screening for early detection from existing studies

● Improved documentation & coding for reimbursement

● Increased billings from follow-up incidential findings

● Early adopters

● Automated QA

● Improved accuracy & consistency

● Clinical systems integration

● Higher volume and throughput

● Lower costs

● Clinical systems integration

● Automated screening and alerts

● Tighter clinical systems integration

● Higher quantification of disease descriptions

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The Benefits of Imaging Analytics

• Early identification of diseases – increase patient engagement

in making healthy choices before an event occurs, thereby,

avoiding costs and enhancing the quality of a patient’s life.

• Better health outcomes – improve the quality of care by

identifying patients at risk before they are symptomatic

• Cost Management – support incremental billings based on

CPT/HCC coding while using existing studies for quality, care

management and clinical assistance

Clinical Cloud

Analytics Platform

Clinical data sets

ProviderClinical insights

Pre-screening

Preliminary diagnosis

Population health

Preventative care

Risk management

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• It’s very important for CFOs to have meaningful data

coming in from all areas to make important decisions

about provided care.

• CEO Bird Blitch, of Patientco says “That is the no

brainer statement of the year, but it deserves attention

because so many people are handcuffed..”.

• Leveraging analytics – clinical and operational is key -

Anything less and it’s the difference between Amazon and

the old Sears catalogue. And we all know how that story

ended.

You can’t manage what you can’t or don’t measure*.

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* https://en.wikipedia.org/wiki/W._Edwards_Deming

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To Complete the Program Evaluation

The URL below will take you to HFMA on-line evaluation form.

You will need to enter your member I.D. # (can be found in your confirmation

email when you registered)

Enter this Meeting Code: 16AT60

URL: http://www.hfma.org/awc/evaluation.htm

Your comments are very important and enables us to bring you

the highest quality programs!

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