Data Driven Transformation for Delivering Value Based Care
Delivering value-based care so vital for healthcare reform will depend on culture as much as new data analytics. A keynote panel at Healthcare IT Connect’s Accountable Care and IT Strategies Summit discussed how these two factors intertwine.
Platforms that associate data are important, but each vendor platform is different, requiring some comparison shopping by providers and healthcare systems, warned Jeremy Orr, Chief Medical Officer of Optum Analytics.
Healthcare systems often have a lot of data on people with advanced disease, but what’s needed are data on people who don’t have advanced disorders and don’t see providers as often. Optum aggregates from EMR databases, claims, and socio-demographic data from public databases, and matches these at the patient level to give patient centric view at all levels of care.
Some of the most valuable data is the hardest to work with, however: the patient history. Narrative patient histories are not structured datastreams, and even structured entries can be wildly wrong. While more than half of data in EMRs is unstructured, it is quite valuable for predictions, benchmarking and other value estimates.
Use data to capture the rotation of money
In the tradition to value-based care, it’s important to collect data not just for your EHR but also your community at large, including emergency room visits and appoints with outside providers, said Shashi Tripathi, CIO for the 28-location Springfield Clinic in Illinois.
For value based care, there’s going to be rotation of money, Tripathi said. For example, 28% of inpatient cost will move somewhere. Why not move it to outpatient care to improve quality and reduce costs? He asked. “The same procedure in an outpatient facility is half the cost of inpatient care,” he said. Analytics point to these cost savings.
Another issue with value based care is complexity. Springfield includes Southern Illinois University’s school of medicine, and the Clinic will host EHRs on the same platform, totaling 900 providers on the same platform. “Eventually, we will get data in real time, even with institutions that arte in competition with each other,” he said.
Focusing on care gaps and hospitalization prevention has also helped prod reluctant providers. “Providers don’t want to move to value based care. Our proposition is that if you fill these care gaps, you’ll get more patients and in the long term your patients will be more healthy,” he said.
The New England perspective
The Dartmouth-Hitchcock Healthcare System has had an online patient portal for a long time, and a data warehouse since 1980, said Barbara Walters, executive director of Dartmouth-Hitchcock and CEO of OneCare Vermont. “But the ACO experience begins our data story. We were part of the CMS Demonstration Project,” she said.
“Data’s fun, but this is really about delivery and execution,” she said. Data can become a source of resistance, as the search for the perfect model and report causes delays. At Dartmouth-Hitchcock, the center:
- Uses the primary care medical home as building block.
- All RNs are care coordinators at this point, instead of triage points.
- Specialists are in charge of appropriateness and unit costs, and should only be taking care of patients who actually need whatever care it is.
- Clinical partners must be willing and ready to participate.
- System administrators are dedicated to giving providers accountable and timely data.
“Our motto is “First do no harm to the doctors” because they need to spend time with patients, establishing relationships and finding out what’s wrong with patients. It takes a laser-like focus to do this,” Walters said.
Taming wild west healthcare in Montana
To meet healthcare IT needs in the Billings Clinic in Montana, “we needed to have a common EMR platform,” said former CMIO Karen Cabell. Their new platform launched in 2004, and the clinic provides to systems in small towns throughout the vast, sparsely populated state.
Using a common EMR platform “means we don’t’ always go with the ‘best in breed,” so we can have an integrated solution on a common platform, she said. The Billing Clinic culture has helped introduce value added care. It has a very heavy physician leadership in the organization that coordinates tightly with the clinic’s administration, including IT. “We’ve had an explicit partnership with IT and quality, and that’s helped us as well.”
At the clinic, all physician and operational data goes into an enterprise data warehouse. But the clinic doesn’t allow anybody to get to data without feeding the data through the clinic’s cloud first, to verify sources and protect data.
Today, nurses get lists of sickest 5% of population. There are a variety of disease specific navigation tools to identify gaps or transitions in care. In addition, a palliative care team uses automated EMR tools to “find” patients and suggest consults. Value-based care and analytics have reduced readmission rates from 30% to high teens, while a pain management team finds patients electronically and arranges consultations. “We even found ways to avoid skilled nursing consultation—one extra day in the hospital saved a lot on post-acute care.”
View the keynote panel from the 2014 Accountable Care And Health IT Strategies Summit, Chicago IL, September 2014, in HD video with accompanying PPT. To subscribe to view the presentation please register here