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ENTERPRISE VALUE MANAGEMENT Integrating Value Management with Corporate Strategy

Quture introduces Enterprise Value Management (EVM) implemented with the QualOptima Health Informatics Platform (PaaS), using Health Data Science by Value Data Centers.  EVM empowers healthcare providers, their patients and payers to achieve optimal outcomes and valuable personalized care safely. Quture transforms an output- volume-based enterprise into an impact and outcome-driven enterprise.

EVM is Quture’s informatics system for aligning advanced analytics of clinical, operational and financial data in relationships defined by data models with the healthcare organization’s strategic plan.  The goal of EVM is to define “value” in the delivery of health care – the deliverable.  Quture envisions QualOptima as the free-enterprise solution to improving health and healthcare outcomes while reducing costs. Quture is positioned through its disruptive technology to become the foremost global provider of value-based clinical intelligence and knowledge solutions centered in EVM.

By eliminating information silos to organize initiatives around value-delivery, healthcare value-based organizations can become leading-edge, value-based learning organizations that accomplish their vision, missions and strategies to dominate their markets. Quture’s QualOptima Health Informatics Platform eliminates information silos by implementing a common data platform with innovative technologies to measure quality and cost, the essential components of value.  EVM aligns quality and cost measurement with organizational vision and strategy, engages stakeholders at broad levels, and measure customer value as their perception of their outcome.

A Note in this series will consider Quture’s three (3) phase progression to use data and analytics from the QualOptima 2nd generation database or “data lake.”  Rather than jump prematurely to real-time use at point-of-care before scientific reformatting of data for rapid understanding and use, Quture focuses our product and marketing for EVM.  Quture’s strategy begins by using this common data platform and analytics for retrospective development of optimal clinical processes.  Optimal outcomes will ultimately rely upon performance of evolving processes by practitioners who demonstrate current clinical competence in specific diagnostic and treatment modalities.

As always, there will be two (2) kinds of healthcare organizations: those that look to comply with minimal impact on how they work, and those who see the strategic advantages of providing optimal care at the most competitive price, value-based care.  The hospitals in the latter group will often include healthcare systems, who share data for comparative and mutual benefit through a central corporate structure.  This also means that there is centralized purchasing and operations for information technology (IT), which necessitates working primarily with large consulting firms.

Defining “value” is the new challenge in health care as the industry endeavors to recover from its addiction to the perverse fee-for-service payment system.  Consistent with our business strategies, Quture is committed to exceeding compliance with regulations.  When healthcare organizations commit to delivering value as quality care, which inherently balances cost with outcomes, the strategic plan to accomplish that goal creates the urgent need for the QualOptima Health Informatics Platform.  These healthcare organizations are Quture’s ideal customers

Quture’s initial mission remains to transform how healthcare organizations measure, analyze, improve and continuously track those gains in quality.  After 35 years of measuring quality and patient safety as external peer review consultations, we know what is missing and the opportunities to radically change failed quality efforts.  The traditional approach has been to identify suboptimal outcomes and analyze how to improve care.  QualOptima identifies suboptimal outcomes and medical errors based on captured, integrated and aggregated disparate data using the following processes:

  • Performance & outcomes metrics – medical specialty organization and CMS metrics
  • Clinical quality indicators – traditional process to identify cases for peer review
  • HFACS error classification – optimal event and near miss process
  • Electronic triggers with NLP – electronic searching for specific defined terms and phrases in narrative text
  • Computational trigger algorithms – advanced mathematical and computational tools using triggers as signals
  • Unsupervised machine learning – total array of unsupervised and machine learning (a form of artificial intelligence).
  • Patient experience – new technologies replace “patient satisfaction” tools with innovative patient experience methods
  • Mortality & claims data review – traditional morbidity & mortality quality reviews and risk management causation of claims (medical malpractice)

While healthcare providers may use two (2) or more of these methods, this total array of available methods transforms systems we have worked in for over 35+ years.  Rather than isolated initiatives based on anecdotal data, QualOptima delivers a transformative system for rapid change, improvement and outcomes.

Quture’s methods of identifying specific cases and patterns and trends of multiple outcomes dramatically transform how quality is measured, and QualOptima innovations exponentially

QualOptima Data Capture

QualOptima Data Capture

change how quality is analyzed.  These initial changes more than satisfy what the Joint Commission standards require for accreditation, particularly Focused and Ongoing Professional Practice Evaluation (FPPE-OPPE).

The QualOptima advanced analytics engine is designed to:

  • find hidden patterns;
  • understanding relationships;
  • derive meaning from human language by extracting knowledge from documents; and
  • understand relationships and patterns using a method of portraying data in three-dimensional space and as nodes, not rows & columns.

The QualOptima analytics engine incorporates an array of selected technologies common to “big data” analytics to rapidly process the 3 V’s (volume, variety & velocity) including:

  • natural language processing (NLP)
  • machine learning
  • unsupervised learning
  • machine-based algorithms
  • graph analytics
  • Hadoop

Some of these technologies are proprietary to Quture, some are licensed from selected vendors, while others are embedded in the InterSystems HealthShare Platform (e.g. iKnow and DeepSee).

The third element of the QualOptima quality system of strategic data capture and advanced analytics engine adds the ultimate unique power to analyze and deliver quality health care – identifying optimal clinical processes.  QualOptima analyzes quality along a discrete continuous clinical process.

QuOP Analytics

Again, QualOptima is unique as Quture’s sophisticated system of meFactors© calibrate performance measures with risk, fitness, wellness and omics factors.  This precision medicine system personalizes otherwise general clinical processes. A later Note (Enterprise Value Management: Understanding the QualOptima Platform) discusses the logical and scientific advances of empowering customer segments from second generation databases.  The QualOptima Health Informatics Platform anticipates three (3) essential progressions to achieve the potential of these data repositories and technologies. We explain how the meFactors© calibration of performance and outcomes measures become extraordinarily valuable in the second and third phases of this progression.

As previous Notes have detailed, there is intense uncertainty in health care.  After passage of the Affordable Care Act (ACA), there have been seven (7) years of challenges in the Supreme Court, all of which failed.  These have been the years of the chant to “repeal and replace.”  The uncertainty is now intensified.  Politicians are focused on how our federal and state legislation and regulation will address insurance to pay for care with little or no attention to the quality or cost elements of health care.

At the same time, there is intense certainty.  The American economy cannot continue to suffer the impacts of the costs of health and health care.  The American healthcare ecosystem is not a sustainable model.  One of the gross misperceptions of the ACA, “Obamacare,” is that it took remarkable action to reduce the costs of care.  Reducing cost impacts is even tougher than figuring out how individuals secure insurance to pay for those costs.

The next Note focuses on how the federal MACRA legislation and it’s four (4) components of the value-based payment formula that will determine payment incentives for physicians and how these impact Quture and its QualOptima product.

4 Elements of the MACRA Payment Formula

4 Elements of the MACRA Payment Formula

Under the ACA, over three-quarters of hospitals are paid under the Inpatient Prospective Payment System (IPPS), while nearly one quarter are paid based on costs and are called Critical Access Hospitals.  Legislation passed after the ACA, called MACRA (Medicare Access and CHIP Reauthorization Act of 2015), creates a new framework for rewarding physicians for providing higher quality care under the Quality Payment Program (QPP).  There is also significant impact on hospitals, especially those that own physician practices.

ACA and MACRA, with accompanying Final Rules for regulatory actions, are intent on changing the existing perverse payment system for care.  As we frequently comment, fee-for-service is being incrementally replaced by fee-for-value, “value-driven” payment.  Results or outcomes replace simply performing a task, whether clinically indicated and despite whether it benefits the patient.  As Quture endeavors to reduce medical errors using HFACS, it is fundamental to understand that often medical errors result in more revenue (the diagnostic code increases for payment).

Volume strategies are being transformed to become quality and outcomes strategies.   Hospitals and physician groups are now forced to develop new strategies, as payers transition to value-driven payment.  Hospital payment pursuant to the ACA requires a Medicare hospital Value-Based Payment (VBP) program to be established, which began in fiscal year 2013.  The legislation and accompanying CMS regulations require a portion of hospitals’ payment be linked to performance on measures related to common and high-cost conditions.

Most businesses focus on their product; not so in health care.  Health care focus on billing strategies.  These strategies are primarily called “revenue cycle management.”  Measurement strategies were based on “resource use” and “length of stay,” the number of hospitalized days per patient versus the number of days contemplated per DRG billing code.  Diagnostic-Related Groups (DRG) codes are based on the number of days the payer (e.g. CMS/Medicare or Medicaid) calculates it should take for a specific diagnosis to be treated during a hospitalization.  Quality strategies have focused on how much was expended on patient care by physicians within a billing code.

The fundamental power of EVM is to monitor the healthcare organization’s strategic plan using scientifically significant and precise measures – metrics that matter.  Quture since our inception has worked to advance our Quality-Value Proposition.[1]  We began simply focusing our software technologies on the same criteria for overuse, underuse and misuse of medical services that existed in our peer review software.  The cost relationship to quality and optimal outcomes has been essentially ignored and poorly studied.  However, use of existing payment disincentives, such as not reimbursing certain hospital readmissions, Comparative Effectiveness Research and organized medicine initiatives, such as Choose Wisely, are strong additional methods.

Quture’s system of precision calibration of performance and outcomes measures provides the foundation for QualOptima cost analysis.  Scientific metrics along a clinical performance process creates the opportunity to measure cost of specific actions along that optimal clinical process.  Quture has incorporated the cost concepts of Michael E. Porter, PhD, in quality-cost relationships,[2] as well as using his template for aligning costs with performance.

The next Note about MACRA will consider how the federal government is analyzing cost based on billing.  The significance is that using billing codes, even the most recent ICD-10 codes, is seriously flawed to achieve optimal outcomes at the most reasonable cost.

This proprietary system of aligning quality and cost with the strategic initiatives of our customers differentiates Quture in the marketplace and is the substance of EVM.  Quture’s methods of abstracting optimal clinical processes from EMR’s while aligning with precision medicine and evidence-based clinical practice guidelines further distinguish QualOptima from competing products.

Today Quture is proud to introduce and begin to explain Enterprise Value Management.  We are committed to convincing our potential customers and investors that EVM is the future of healthcare quality and cost, therefore VALUE.  Our continued mission to define value in health care and health will ultimately validate the value of our own product and QUTR stock.

[1] Feazell GL and Marren JP, “The Quality-Value Proposition in Health Care,” Journal of Healthcare Finance, pp. 1-29 (Winter 2003).

[2] Porter ME, “Perspective: What Is Value in Health Care,” New England Journal of Medicine, pp.2477-83 (December 23, 2010)