Q&A with Bob Gladden of CareSource - A Speaker at IIR's Healthcare Data Insights

This June at IIR’s Healthcare Data Insights, Bob Gladden, Vice President for Decision Support and Informatics at CareSource will speak on a session titled “Taking a Persona-Centric, Not a Disease-Centric, Approach to Care Management & Engagement”.

Session Info:
The typical member management program entails profiling members based on their disease states without taking into account the patient as a whole. Beginning in the Fall of 2013, CareSource started using claims and enrollment data to segment their members into a specific persona, then began services to members based upon the persona in which they were identified. Learn how they build data driven personas and understand the results they’ve seen to date.


Q&A:

1. What does data driven decision-making mean to you?

To me it means that when possible, we eliminate the guess work component of decision-making.  There will always be a component to decision making that is not quantitative, but that should be by choice, not because the data isn’t available in a format that can be incorporated into the decision-making process.
2. How do data sets (EHR data, claims data, member feedback, etc.) to inform your business strategy?

As a Medicaid managed care organization, we use claims data extensively to help shape everything from care programs to business strategy.  Ongoing, our strategy continues to be to augment the claims data view of our membership with other data sets that can enrich our view of our members, and help us to identify their needs at the earliest possible moment.  As one example, we are currently working on a partnership with a state Health Department and a major university that will expand our view beyond claims data to include social/economic data. 

3. In general, how difficult is it to get internal buy-in to build out programming that’s based on data?

Actually, at CareSource the difficulty has been to build out the data to support and enhance programs fast enough to keep up with the requests.  Senior leadership here has for some time been asking for more data support to build all of their efforts.  Having leadership asking for this support goes a long way toward the success of having an organization focus decision making on fact and less on hunches.

4. How do you see your use of data evolving in the upcoming year? Are there new opportunities to use data to create more effective, innovative programming?

There are a number of changes that are coming. The most notable in health care is the provider base moving to electronic medical records. Many of these systems were first stood up just to meet requirements for enhanced reimbursement, but now the effort is to fully incorporate this information in work-flow and use it in a meaningful way.  To that end, there are more changes coming that could even eliminate traditional claims as we know them today. It is all part of many exciting developments that will change how we all do business to deliver far more effective and higher quality care.


To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago.

Register now and save an additional $100 off the current rate when using the code: XP1902BLOG

Online Exclusive - IIR Healthcare Events Memorial Day Flash Sale! How can you save 26% off the Full Access Pass? Details here!

To celebrate Memorial Day, we're throwing a healthcare sale!

For the next three days, we're offering you a chance to attend a select number of our healthcare events for 26% off the standard full access pass rates*!

What events are included?



Gross-to-Net Accounting Forum | June 17-18, 2014 | Philadelphia | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1911MDAY* to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• Registrants will receive 26% off the standard registration rates
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Healthcare Data Insights | June 23-25, 2014 | Chicago | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1902MDAY to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• This offer is only available for the Full Access (All 3 Days)
• This offer is not eligible for Main Conference Only (June 23-25)
• Registrants will receive 26% off the standard registration rate.
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Annual Summit for Oncology Management | July 21-23, 2014 | Philadelphia | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1914MDAY to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• This offer is only available for the Full Access (All 3 Days)
• This offer is not eligible for Main Conference Only (July 21-23)
• Registrants will receive 26% off the standard registration rate.
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Specialty Pharmacy Collaboration Summit | September 15-17, 2014 | Boston | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1968MDAY* to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• Registrants will receive 26% off the standard registration rates
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.

HDI Podcast Series with Bob Gladden of CareSource

Healthcare Data Insights Podcast Series

 Below is a teaser from our podcast series with Bob Gladden, VP for Decision Support & Informatics, CareSource

Download the complete podcast and transcript here.

How do you make data-driven decisions across the organization?
Bob: It’s been an interesting journey that we’ve been on. I think we’ve been on this like a number of other companies. I’ve heard some references to how companies are dealing with this today in terms of how decisions are made. Are they made based on individuals having data and pouring through that and coming up with a solid answer? Or is it based on what they call in the industry “HIPPOs”, which simply translates into ‘highest paid person’s opinion’. Now, we have to be careful about calling people HIPPOs. That doesn’t tend to go over well. But, we are working towards certainly the value that those highest-paid individuals have – a lot of energy and a lot of experience that they bring to the table. But, we are trying to shift a little bit so that data becomes more involved and more a part of the decision processes and use the folks that typically in the past were the highest paid person in the room just making the decision.

We’ve now focused that a little differently and we are now using them to help us identify where we need to look and put some energy into changing things. We are actually right now in the process of redesigning our entire care management process in the organization. Within that, we are actually using a very data-driven approach to even design the program, which is certainly a step forward from where we’ve been in the past. It is allowing us to step away from some of the more traditional ways that you might design a care management program.

To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago. Register with the code XP1902BLOG and save $100 off the current rate. That is $300 in total savings if you register by this Friday, 5/23. REGISTER HERE!

FLASH SALE! Healthcare Data Insights - Buy One Pass & Get One Free (Offer Only Valid Through 5/13)

Buy one pass and get one free when you register for IIR’s Healthcare Data Insights (HDI) by the end of Tuesday 5/13!

Be empowered to do more with all of the data you already have at your fingertips. Regardless of what your role is—medical, sales/marketing, financial—data-driven decision-making will help put together smarter, better informed strategies. Attend HDI to learn how to implement data-informed programming. 

HDI’s expert speaking faculty includes companies like Intermountain, CareSource, Steward Health Care Network, Molina and MDwise who are already deemed pioneers and masters of data-driven healthcare strategies, and will present case studies on how you can become a master as well!

Register by calling (888) 670-8200 to join us and mention code XP1902SAVE to buy one pass and get one free!

Healthcare Data Insights will take place in Chicago on June 23-25 at the Hilton Garden Inn Chicago Downtown. See you there.

Have any questions? Email Ryan Geswell.

Note: This promotion is valid only through 5/13 and cannot be combined with any other discounts.

Decode Big Data to Drive Decisions | Register for HDI by Friday to Save $500!

 According to PricewaterhouseCoopers, big data and predictive analytics help companies better understand their audiences and how to engage them.

We're not talking to the "data guy". We're talking to YOU-the person making informed decisions based on data that is material to your business (claims data, member feedback, clinical data, etc.) By translating this information into actionable insights, you have the power to make more efficient and effective business decisions.

Don't fall behind as more and more companies grow increasingly data-driven and are more willing to apply analytics-derived insights to key business operations. Join us in Chicago this June 23-25 at IIR's all-new Healthcare Data Insights, where you will hear from speakers who successful implement big data analytics into their business strategy.

Discover how to make the best data-driven decisions for your company with speakers including:
•    Elizabeth Benz, Associate VP of Community Outreach & Engagement, Molina Healthcare of Wisconsin   
•    Greg Poulsen, Senior Vice President, Chief Strategy Officer, Intermountain Healthcare   
•    Bob Gladden, Vice President of Decision, Support & Informatics, CareSource   
•    Dan Munro, Contributor of Healthcare IT, Innovation and Policy, Forbes

Register by Friday 4/25 to save $400! Plus take an extra $100 off when registering with the code: XP1902BLOG

That is $500 in total savings, register today!

Learn more about Healthcare Data Insights here.

HDI Podcast Series with Steward Health Care Network

Healthcare Data Insights Podcast Series

 Below is a teaser from our podcast series. Thank you to our participants...

John Donlan, Chief Operating Officer

&

Dominique Morgan-Solomon, Vice President, Population Health
Steward Health Care Network

Download the full podcast & transcript here.

What are some of the challenges you faced when implementing data-driven strategies and how did you overcome them?

Dominique: We are a very heterogeneous network, we have over 2700 providers. With that we are on over – I want to say at least 30, but there are more than that – EMRs. They all look different and the data coming out of them is different. So, our challenge over the last two years has been about how do we integrate or aggregate the data that’s coming out of those EHRs such that we can use it and use it in a much more real-time fashion because that’s really what’s meaningful. That’s one of the larger challenges.

We also have the challenge of while we sit on the Network – and I’m glad that John described the larger system – we are part of a larger hospital-based system and so how do we integrate information that is coming out of those EMRs, along with the information that is coming from the ambulatory-based provider’s EMRs to be able to get to the clinical data that is necessary for us to be able to identify the population. As well as from a performance perspective, be able to articulate who are the people who fall into various populations, like our diabetic and our heart failure patients. A lot of that information is defined based off of clinical measures and not claims-based measures. So, getting access to that data is one of the larger challenges that we face.

One other challenge that is tied into that is getting information in a real-time manner. One of the interesting challenges of being part of a pioneering ACO is that the population turns over on an annual basis. While we retain a significant proportion of the population year-over-year, when January 1st comes along, we have either an influx of new patients or potentially an out flux of old patients based off the methodology that CMI uses to do attribution. Because of that, in order for us to effectively impact that population in a real-time manner, we have to be able to pull data out of systems and use real-time information so that we can quickly stratify, identify and engage that population within a less than 12 month period in order to make an impact in that performance year. So, timeliness of data, I would say, is a huge challenge in the integration of the heterogeneous system that we have within our Network are two of the biggest challenges that we’ve had with data.

Now, how do we go about overcoming them? We’ve engaged some partners who have helped other organizations resolve this problem and who have some background and experience in being able to access various EMR data sets and integrate and aggregate that data. Certainly, it’s a challenge that I wouldn’t say today that we’ve overcome it, but we have a plan to overcome it and we’re moving forward on it. But, I would also say the other quick and dirty, so to speak, are boots-on-the ground way of overcoming, which is what I said before which is we have to spend a lot more time engaging providers and members themselves to get to some of the information that is more actionable in a real-time basis.

As John mentioned, we have a very robust governance structure, but underlying that governance structure is an operational structure where we have field operations teams that are aligned to a local chapter and aligned to our local provider groups so that they can be much more in the practices and much more engaged with the providers so that they can glean a lot of that information, like Mrs. Jones who has financial issues and that’s why she’s not filling her medications, which won’t be apparent in an EMR or we don’t have access to that information in the EMR quickly.

So, we’ve chosen in the interim – as well as really trying to leverage the medical home kind of model – we leverage our field operations team being much more embedded in our local chapters. The folks who make up those teams are both clinical, as well as operational in nature. So, our performance improvement advisors are really working on workflow enhancement and work hand-in-hand with a nurse care manager and social workers and pharmacists who are also working with the providers to best identify and manage the populations for which they serve.


To hear more from Steward Health Care Network, join us June 23rd through 25th in Chicago for IIR’s Healthcare Data Insights Conference.

Download Gorman Health Group’s expert summary of the 2015 Final Rate Announcement from CMS

John Gorman predicted that -- if the rate announcement was enacted as outlined in the draft call letter -- it would be "just about a worst-case scenario for flabby, distracted, uncommitted health plans in Medicare."  John declared "there is no question that the 2015 call letter is an evolutionary event and some inferior species will be eliminated."

Now that the Final Rate Announcement has been released we can finally get some concrete answers. Gorman Health Group's renowned financial and policy experts Bill MacBain and Jean LeMasurier are teaming up to provide a detailed analysis and summary of the final regulation.

While Jean and Bill are finalizing the Summary of the Final Call Letter, you can request a copy and we will notify you as soon as it is ready.  But while you wait, enjoy access to some additional resources.  Request a copy of the Summary here.

As an added bonus, Bill and Jean will also be hosting a complimentary webinar today from 2:00PM – 3:30PM to offer insight on the Final Rate Announcement from CMS. You will walk away from this session with critical to-do items and issues to tackle in order to ensure your success in 2015 and beyond. Register now. 

                                                                                              

Reminder – Don’t miss IIR’s Healthcare Data Insights taking place June 23-25 in Chicago. Register by Friday 4/25 to save $400 on the standard conference rate.  For more information, click here.