RowdMap's Laura Sandman showcases RowdMap's Risk-Readiness® Benchmarks at Health Datapalooza along side the Aetna Foundation and Xerox. RowdMap's use open health data to profile the low value care vs high value care of providers and what will hinder or drive their success in risk arrangements or pay for value programs.

1. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
Hi, I’m
Laura!

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
RowdMap: Proven Innovation at Scale
Payers and providers are using HHS data to identify, quantify and reduce low-value services as they
move from Fee for Service to Pay for Value arrangements.
Health plans and providers in 48 states and the District of Columbia
use RowdMap and HHS data to reduce the delivery of no-value care.
The clients RowdMap serves collectively cover the lives of
more than 100 million Americans.
Here’s where HHS Data is being used to move from FFS to Value Base Arrangements
(not ‘pilot’ or ‘innovation’ programs) but active operational programs.
Clients using HHS data include National, Regional & Boutique
Payers in Marketplace/Exchange, MA, Medicaid,
Commercial and Government Programs as well as
Providers including PCP & Specialty Groups, CINs & Systems,
ACOs, Bundles & other CMMI Program Participants.

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
Low-Value Services: Why You Should Give a Darn
RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify,
quantify, and reduce delivery of no-value care—a central tenet of successful pay-for-value programs.
Over $9B in
Orange County, CA
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
Institute of Medicine (IOM) report, “Best Care at Lower Cost,” (Sept. 2012) estimates that
the United States lost $750 billion in 2012. (Adjusted in 2013 at $800BB, 2014 at $850BB.)
This is about 3% of GDP.
No-Value
Care (30%)
Necessary Utilization
(70%)
“It’s generally agreed that about
30 percent of what we spend on
health care is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”
-Dr. Elliott Fisher,
Dartmouth Institute for
Health Policy
“Bigger than higher prices,
administrative expenses, and
fraud, however, was the amount
spent on unnecessary health-care
services.” In just a single year,
up to 42% of patients receive
“No Value” Care.
- Dr. Atul Gawande,
Department of Health Policy and
Management at the Harvard
School of Public Health &
Department of Surgery at
Harvard Medical School

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
Low-Value Services: Broad, Increasing Interest
RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify,
quantify, and reduce delivery of no-value care—a central tenet of successful pay-for-value programs.
Research Evaluating
CMS & Private Plan Programs:
“Do they reduce
Low Value care?”
Popular Press Reporting and
Provider Rankings:
“Consumers are/should
avoid Low value care.”
Critique of
Fee for Service:
“FFS has too much
Low Value care.”
RowdMap
Partner
Recommended
evaluation criteria for
value based plans from
payers/providers

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
Low Value Services: Practice Variation
RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify,
quantify, and reduce delivery of no-value care—a central tenet of successful pay-for-value programs.
The estimated 30% of medical expense
that goes to no-value care.
Unnecessary spending drives billing in a
fee-for-serve economic model, but success
in pay-for-value comes from managing and
mitigating these pockets of variation.
Variation: Unwarranted
or Unexplained?
Every physician has a unique fingerprint
Economic Drill Down: Example Utilization Review and Actuarial Unit
Cost Analysis against Care Intensity Curve across Total Basket of Care
Variation across geographies and within practices across physicians.
“Physician-Level Practice Variation: Who You See Is What You Get”
Brian Powers, Sachin Jain, David Cutler, & Ziad Obermeyer Health Affairs, 09.23.15
Definitions, research and geocoding by Hospital Referral Regional
available via the Dartmouth Atlas for Unwarranted Variation:
www.dartmouthatlas.org
NB: Unwarranted variation refers to practice patterns, which hold up across
populations but pricing variation may also be unwarranted and marked fluctuates
across insurance product and lines and geography. “The Price Ain’t Right.”
Cooper, Craig, Gaynor and Van Reenen, 2015.

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
Low Value Services: Identified via Public Data
Medicare DocGraph
Referral file
(Patient flows between
PCPS, specialists, hospitals
and post acute centers)
Dartmouth Atlas of Health Care &
Choosing Wisely
(Decades of research and data on
unwarranted variation by condition
and geography to keep things
apples-to-apples for comparisons)
CMS FFS Data Sets, CDC Data
Sets (MEDPAR, Part B, Part D,
BRFSS)
(Individual providers, groups,
hospitals and post acute centers)
Provider Pattern Intensity Profiles and
Risk Readiness for every provider,
hospital, post acute center in the US.
All preloaded with no IT.
OPEN DATA –
Particularly powerful when pulled together
Affordable Care Act data to determine
Risk-Readiness of Providers / Networks

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HEALTH DATAPALOOZA
RowdMap’s Risk-Readiness® Benchmarks
RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify,
quantify, and reduce delivery of no-value care—a central tenet of successful pay-for-value programs.
Providers in a Market
Groups
Individual Physicians
What is driving a provider’s Risk-Readiness®?
Is it procedures, prescriptions, referrals or visits?
How big is a
provider’s panel?
How ready is a provider
to succeed in risk
compared to peers?
By specialty?
Within a region?
Finger print with
practice patterns
that mitigate
no-value care =
Green Dot
Finger print with
practice patterns
that create
no-value care =
Red Dot
Risk-Readiness® Benchmarks