Health Intelligence in the Era of Reform: Strategies for Improvement

Date: 09.27.2013 | Zach Urbina">Zach Urbina

Miles Snowden, CMO, Optum

Jeremy Orr, Physician Director, Humedica Provider Solutions

Chester J. Kunnappilly, MD, CMO, San Mateo Medical Center

Dr William Ellert, Chief Medical Officer of Arizona Care Network

Analytics to predict future medical costs of individuals and populations are limited by the varying characteristics of the available data: abstracted data, clinical data, and claims data. By combining and analyzing all three types of data, predictive modeling promises the best opportunity for success in a physician-centric model—where reimbursement arrangements shift accountability and opportunity to physicians. The technical, administrative, and regulatory challenges associated with this aggregation are significant. However, as more population health management initiatives migrate from payers to providers, advancements should occur in the ability to predict and mitigate future medical events.

Miles Snowden opened the keynote panel session by sharing a brief history of accountable care, which in his medical experience began in 1982.

“We’re through talking about what we’re beginning to do and moving on to talk about what we’re doing, and what we’re getting done,” he said.

Snowden expressed light frustration with the reporting on the Pioneer ACO program, but also looked forward to the tangible measures of success in the ACO experience down the road.

Miles Snowden then introduced the panel, starting with CJ Kunnappilly, Chief Medical Officer of San Mateo Medical Center, “One of the 1st public hospitals in California to put in an ambulatory EHR.” Kunnappilly also reported on San Mateo’s efforts to implement an inpatient EHR beginning in 2013.

Kunnappilly stressed the importance to working with good data. “You can’t improve what you can’t measure.”

The San Mateo mission includes a pay-for-performance model and a Medical 1115 waiver demonstration project. Kunnappilly underscored that the 2010 Affordable Care Act was a strong driver behind San Mateo’s efforts, and stressed the need for robust decision making processes.

“Having data for performance improvement is incredibly important to our organization.”

The biggest core effort at San Mateo currently concerns getting the data back to the enterprise warehouse into a single location, breaking down silos and instituting an enterprise wide business intelligence strategy. Central development with local empowerment means getting clinical staff the data they need at the push of a button.

Kunnappilly highlighted the effort to develop systems that support both the management of individuals and the population being served. “Keeping up” with the industry became a major goal for San Mateo, as they found the organization to be data rich, but information poor, the ultimate goal being to turn data into actionable information.

Miles Snowden next introduced Bill Ellert, Chief Medical Officer of the Arizona Care Network (ACN).

ACN is a clinically integrated care network owned by two health systems with over 1,500 physicians, governed by a physician majority board. Their goal remains to improve quality of care throughout the network.  ACN is physician led and physician driven.

The organizational goals align with the triple aim of ACOs with a side goal of renegotiating with payers, as a physician group, for enhanced leverage.

“How do you bring together a group of care providers?” asked Ellert. Data becomes the central importance, meeting the patients where their needs are.

“If your goal is to care for a community, how do you assure that the members have adequate coverage throughout the community,” asked Ellert. Geographic distribution of clinical and claims data remain a high priority.

Ellert reported on the ACN health information exchange (HIE) serving data from their electronic medical records(EMR). Predictive modeling becomes an eventual goal. Managing chronic diseases is also a high priority.

“How do we engage some of our community partners (i.e. the YMCA) to help with issues like obesity,” asked Ellert.

Dr. Jeremy Orr was next introduced by Miles Snowden.  Dr. Orr began his presentation with a brief history of his work with mathematics and data, including an early interest in epidemiology. He shared his experience with data tools and how the work the used to take months is now achievable in a few minutes, using EHR data and the changes brought into play via HITECH and more widespread EHR implementation.

Claims data is great, reported Orr, but clinical data is a mess. Dr. Orr related the initial ideal of establishing a narrative between a patient and a physician, to now bringing data points from that narrative and normalizing the collected data for enhaced interoperability.

Orr then jokingly described the process of accountable care as being asked to “Change our helicopter to a jumbo jet while flying it. Structuring and un-siloing data becomes a challenge. Realistically, clinical informaticists are going to be working in their data pool alone. Insights come from larger, normalized data sets. It’s unbelievable what lives in your EMR,” said Orr.

Claims data, financial data, and clinical data should all come together to achieve population health management, said Orr. Only 70% of patients with diabetes were coded. 30% was gleaned via clinical data.  The point Orr made was that unless you use all clinical data, you’re going to underestimate your population by about 25 – 30%.

Orr noted that by simply scheduling appointments, a simple medical intervention, Humedica was able to bring down uncontrolled diabetics to 17%.

Predictive analytics was next discussed, as a mean of intercepting risks by working hard to mature EMR data, tying it to claim and demographics data. Eventually accountable care begins to materialize with appropriate fee-for-service remaining in place.

Miles Snowden then opened up the panel to questions from conference attendees.

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