Saturday, 3 October 2015
The centrality of health IT to ACO success
Modern Healthcare recently hosted a webinar that featured a leadership panel willing to share their views on the importance of health IT systems, the challenges associated with implementation and their advice for other accountable care organizations.
Modern Healthcare New York Bureau Chief Melanie Evans moderated a discussion with Jason Dinger, CEO of MissionPoint Health Partners, a Nashville-based subsidiary of Ascension that focuses on accountable care; Kim Kauffman, vice president of value-based care at Summit Medical Group, a 220-physician group based in Knoxville, Tenn.; and Katie White, assistant professor of health policy and management at the University of Minnesota School of Public Health. This is an edited transcript of that discussion.
Kim Kauffman, vice president ofvalue-based care, Summit Medical Group
In our study of the ACOs in the Medicare Shared Savings Program and the CMS Innovation Center’s Pioneer ACO program, we found that more advanced information technology and data analytics did not necessarily ensure success. For example, we had an integrated delivery system with a single electronic health-record system, sophisticated value-analytics capabilities, with years of performance in risk-based managed-care contracting that could not achieve shared savings.
On the other hand, we had a sizable physician group partnered with a hospital system with little risk-based or performance-based contracting experience that had multiple EHR systems but achieved shared savings in the first year with little IT support. They tracked patients with Excel spreadsheet-based registries and did extensive health coaching and care coordination throughout their practices.
The bottom line seems to be that truly adding value in health IT will come from developing the ability to analyze big data, to understand patterns in those data, and to act on trends where it matters most. We are just beginning to understand what exactly fully functioning health IT for value-based payment systems means.
Modern Healthcare: What are the key lessons you identified as you looked at the role of IT among Medicare Shared Savings ACOs?
White: When you enter programs like this, you come in with a set of situations and a context and you try to adapt based on whatever you have today and whatever your experience is. Some of these ACOs, frankly, were just pretty lucky. They’ve been on this journey for some period of time. Other ACOs found that they weren’t prepared and they couldn’t achieve those savings. Much of that had to do with not having the data at their fingertips to make really good decisions to put them into the right trajectory so that they could succeed.
Kim Kauffman: Summit Medical Group formed 20 years ago and is currently home to 220 physicians and about 140 advanced practitioners. It’s physician-owned and primary-care driven, and 99.9% of our eligible sites have achieved Patient-Centered Medical Home Level 3 recognition. A full 35% of our patients are under a value-based contract, including one Medicare Advantage contract with upside and downside risk and contracts with our two largest commercial health plans.
Our strategy includes aligned incentives, full transparency and various tracking tools. We also use dashboards and side-by-side reports to demonstrate the provider’s progress on quality measures, expense management measures and other key performance indicators such as admissions per thousand, emergency department visits per thousand, generic prescribing rates and readmission rates.MH: For organizations that are new to data analytics, what do you see as the first steps?
Kauffman: A low-cost way to begin—and most organizations have the capability to do this in-house—is to start with a simple creation of disease registries and look for those historically high-utilizing, high-cost patients, or those patients who have problems but perhaps haven’t seen their primary-care physician in the year to date, and engage those patients.
Then there’s the opportunity to move on to hindsight. Again, it’s the easiest information to wrap your hands around. That is the historically high-cost utilization. This presumes that past behavior is the best indication of future behavior. And then as your organization matures, endeavor to identify your rising-risk patients.
MH: It sounds as if transparency really played a role in achieving the outcomes you were seeking. How did you approach communication with physicians?
Kauffman: Years ago, when we first started down this path and multiple payers were approaching us with a list of 24 and 36 and 47 different quality measures they wanted us to track, we decided that we needed to pick a finite number of measures, develop workflows and processes and point-of-care reminder tools within the EHR for a subset of those measures and focus on those measures. And now, instead of a health plan approaching us with a myriad of measures, we approach them and say, “These are the measures we are prepared to knock out of the ballpark. Let’s focus our work around these, and then we’ll add a couple more next year and a couple more the year after that.”
The dashboard is fully transparent. Any of our providers can go on to our Internet site and look at their aggregate stars on these Healthcare Effectiveness Data and Information Set measures. Similarly, on a quarterly basis we send out a side-by-side report that shows each individual primary-care physician the number of patients they have in a particular contract, their medical-expense ratio, their risk score and their key performance indicators.
The newest addition to that stable of transparency tools relates to the distribution of bonus or pay-as-you-go performance dollars. Any time any of those dollars are distributed, every provider sees the same report with the provider name right there and the amount and the reason for which they were receiving incentive dollars.
Jason Dinger: Mission Point Health Partners started with 10,000 members in 2012. We’re now managing the needs of over 250,000 members, and we’ve clinically integrated with more than 7,200 providers. We’ve learned a lot by being in different geographies and seeing quite a bit of variation.
The first step is getting a historical view of your population. As you know, a small percentage of people generate most of the cost, and that’s one of the big challenges for ACOs. We have found, as we go on our IT journey, is that being able to stratify patients to make sure we’re allocating the right amount of time to each person and engaging them in the right setting to really help them and their families is so important.
We are starting to do a lot of work around predictive modeling and machine learning, putting more and more data into kind of our data repository and letting that data get smarter and smarter about which interventions are working and which ones aren’t. For example, recently we were looking at some data and found that our second call with the member is by far the most predictive of improving outcomes and lowering costs.
MH: Could you give us an example of how data stratification allows you to allocate resources efficiently and in an appropriate setting?
Dinger: The one that comes to mind is depression. Historically, we would have looked at folks with depression as asthma patients or active cancer patients and relate to them as such. But we now know that unless we can really help them through their depression, all the other conversations are just not going to have the same impact. By doing some scoring directly with members and working through our providers, we can get a little bit closer to the root cause.
MH: What would you recommend as first steps for organizations that are new to data analytics?
Dinger: I would find a partner to just help clean and standardize your data. There are a number of lower-cost solutions now on the market, and finding a partner can take a whole bunch of things off your plate as well as kind of reduce the number of potential errors. Then I’d listen and watch that data and really kind of soak yourself in what it can tell you about the people you’re serving. And then I’d customize and slowly add to that data set and just let it get richer and richer for you and your partnering providers.
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Friday, 2 October 2015
Comparison Tool Allows Californians To Check Medical Costs, Insurance Premiums
California has launched a $3.9 million federally-funded platform, California Healthcare Compare, allowing consumers to access healthcare price and quality rating information at the touch of a button. The comparison tool can be used to compare the price of common medical procedures, estimate how much insurance will pay, and what out-of-pocket expenses will cost. This will enable them to make better decisions about where to seek medical care.
Price information for the site was provided by Truven Health Analytics, which gathered data from 10 million claims between 2010 and 2013.
California State Insurance Commission Dave Jones explains, “The time for greater transparency for healthcare costs is long overdue. Consumers have been in the dark about the price of medical services from one medical provider and facility to the next and certainly haven’t had cost information paired with quality measures to help them determine where they will get the best value.
“Purchasing healthcare now is like shopping with a bag over your head. The Healthcare Compare website makes it possible for Californians to search for common medical procedures, to get average and a range of prices in their area, and to compare medical providers based on quality measures-before making the important decision about where to seek medical care. This is also a first step toward convincing doctors, hospitals, insurers and legislators of the benefits of sharing more detailed price information to allow consumers faced with high deductible plans to make better decisions about how to spend their scarce dollars.”
According to Healthcare Dive, Colorado and Maine have engaged in similar efforts at price transparency but concerns remain regarding the level of data available and whether consumers can use it effectively. Additionally, some experts question whether consumers will use a third-party website to compare prices.
“This website would not be possible in most states, because the information simply isn’t available,” said R. Adams Dudley, MD, Director of UCSF’s Center for Healthcare Value. “Because of the advocacy of California consumer and business groups and the vision of California’s insurers and providers, we have much more information about quality of care than most states. Therefore, we can, for instance, tell a pregnant woman not only about the C-section rate at a hospital and whether she’ll be allowed to try for a vaginal delivery if she’s had a C-section before, but also what percent of women at that hospital learn to breast feed before going home and how often complications happen.”
As long as funding remains available, Dudley told Kaiser Health News the platform will continue to evolve and grow with the potential to add quality and cost data for more conditions and cost data for individual hospitals and physicians’ groups.
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Diagnostic Errors Persist In Healthcare
Getting the proper diagnosis is an essential part of establishing the proper treatment in healthcare, but an Institute of Medicine report has found diagnostic errors persist across all healthcare settings, placing patients at risk.
The report, Improving Diagnosis in Health Care: Quality Chasm Series, is a continuation of IOM’s Quality Chasm Series and finds these errors harm “an unacceptable number of patients. Getting the right diagnosis is a key aspect of healthcare. It provides an explanation of a patient’s health problem and informs subsequent healthcare decisions.”
The report authors argue the occurrence of diagnostic errors has been largely ignored in the battle to improve the quality and safety of healthcare. This has had devastating results, and the report underscores that “urgent change is warranted to address this challenge. Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.”
Improving diagnosis and reducing errors requires more effective teamwork among healthcare professionals, patients, and families; enhanced training for healthcare professionals; more emphasis on identifying and learning from diagnostic errors and near misses in clinical practice; a payment and care delivery environment that supports the diagnostic process; and a dedicated focus on new research, according to the study.
“This problem is significant and serious [yet] we don’t know for sure how often it occurs, how serious it is or how much it costs,” Dr. John Ball, of the American College of Physicians, chair of the committee that carried out the analysis told U.S. News and World Reports. He said the lack of evidence was one of the committee’s most “surprising” and distressing findings and more research is necessary into this pervasive problem.
Furthermore, as greater emphasis is placed on the ICD-10 transition, implementation of EHRs, and interoperability, healthcare providers need to collaborate to bring the issue of proper diagnosis to the forefront.
“It’s huge that diagnosis is finally getting the attention it deserves,” says Helen Haskell, co-chair of the patient committee at the Society to Improve Diagnosis in Medicine, who reviewed a draft of the report. “There are lots of people who think our failure to tackle this is one reason why patient safety hasn’t progressed farther.”
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RFID, Voice Recognition, Mobile, And Cloud Transform Clinical Documentation
When Disney introduced Magic Bands at its theme parks in 2013, they seemed like a magical device. These RFID-enabled wristbands functioned as tickets to jump to the front of long lines and hotel room keys, and allowed visitors to connect to their accounts. They also store personal information and preferences, giving access to that data to park employees to improve the guest experience.
Now that technology is part of a new solution for healthcare providers combining RFID, voice recognition, and Web-based mobile and cloud technologies to automate EHR documentation, streamline patient check-in and registration, and track the flow of both patients and staff throughout the clinic.
Created by Barcoding, Inc. and Better Day Health, this solution improves the overall patient experience in clinical settings, allowing healthcare organizations and clinics to cut costs and operate more profitably while improving the overall patient experience and physician-patient relationship.
With the new solution, RFID-enabled ID badges are provided to physicians and staff, as well as to patients upon check-in. These badges then trigger hands-free authentication, login, and data collection in the exam room on the provider’s mobile device. The BetterDay App also uses passive voice recognition technology during the exam to recommend potential diagnoses and aid the physician in diagnosis and billing code selection and documentation. It speeds the process, reducing the time required to type in information, allowing physicians to spend more time focused on the patient’s needs.
Peter Ragusa, MD, MPH, CEO and co-founder of Better Day Health, said, “Doctors are the world’s most expensive clerical workers; today, they are using valuable time to fill out EHRs and compile medical histories. Barcoding has provided us with the technology needed to bring our vision to life by partnering with Better Day Health to create an intelligent, automated, hands-free experience in the exam room. In conjunction with Better Day, Barcoding will help doctors have more meaningful interactions with more patients, in less time, and without all of the burdensome data entry.”
The solution also tracks the flow of patients, physicians, and staff charting wait times, staff availability, and patient location. This allows healthcare organizations to adjust and improve to enhance the overall patient experience
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ONC Releases 5-Year HIT Strategic Plan
The ONC has released the final version of its Health IT Strategic Plan for 2015 to 2020. The four main goals cited in the 50-page document include transforming healthcare delivery and community health; enhancing health IT infrastructure; fostering research, scientific knowledge and innovation; and advancing person-centered health and self-management.
“Health IT only achieves its full potential when it seamlessly supports individuals as they strive to take control of their own health,” said National Coordinator for Health IT Karen B. DeSalvo. “Implementing the Federal Health IT Strategic Plan over the next five years drives toward a public-private partnership to achieve interoperability and will help the nation achieve important health outcomes, while remaining flexible to the evolving nature of health care and technology.”
The plan also outlines how the federal government will support the effective use of information and technology to achieve these goals while underscoring the fact IT is merely a tool, not an end goal, of the document. The final Plan reflects the input from more than 400 public comments, collaboration between federal contributors, and recommendations fromthe Health IT Policy Committee.
The plan also requires collaboration from private stakeholders, state and local governments, and all healthcare industry stakeholders as necessary components for advancing the ONC mission. It originated from ONC’s Federal Health IT Advisory Council, which gathered information from 35 entities and departments in the council as well as public comment from about 400 people and organizations.
The document represents an “action plan for federal partners, as they work to expedite high-quality, accurate, secure, and relevant electronic health information for stakeholders across the nation,” wrote DeSalvo in a blog post on the ONC website.
According to Becker’s Hospital Review, industry leaders support the plan. “The incorporation of person-centered health as a core goal of the final Federal Health IT Strategic Plan is a significant and positive step toward the kind of patient- and family-centered healthcare system this country needs,” said Debra Ness, president of the National Partnership for Women & Families, in a statement. We commend ONC for recognizing that patients, families and caregivers must be able to access, understand, use and share health information in order to achieve a healthcare system that delivers better care, better health and better value.
“By laying out the vision, goals and collective efforts that federal agencies will pursue over the next five years in concert with public and private organizations, the Strategic Plan will help sustain momentum in advancing patient access to tools that can help them understand and manage there are, communicate effectively with providers and participate in efforts to enhance coordination of care across settings and providers.”
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