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Developing a Clinically Integrated Network in a Pediatric Setting: Phoenix Children’s Hospital’s Experience

August 9, 2015
by Mark Hagland
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The leaders at Phoenix Children’s Hospital have been busy at work building a clinically integrated network, and an ACO, in a pediatric setting, and they’ve been learning important lessons along the way

The push towards creating true clinical integration across a health system that encompasses a hospital or hospitals, and physicians and physician groups, inevitably requires a great deal of strategizing and a lot of agile executing.  David Higginson, senior vice president and CIO, and Bob Campbell, senior vice president of business development and chief strategy officer, are among those leading their colleagues on a journey towards clinical integration, at Phoenix Children’s Hospital.

Inevitably, developing the first-of-its-kind clinically integrated pediatric care network, has presented somewhat unique challenges, as well as opportunities. But Campbell and Higginson and their colleagues have moved forward confidently on their path. As it stands, the Phoenix Children’s Care Network, which is both a network and an accountable care organization (ACO), encompasses 824 pediatric care providers (physicians and allied health professionals) in the Phoenix metropolitan area, 50 percent of whom are located in Maricopa County, where the city of Phoenix is located (though the network spans five counties in central Arizona), and those providers care for over 750,000 unique patients in active in the network’s population health database. That database is tracking 14 primary care outcomes measures and 34 specialty measures, and providers are accessing its physician portal to work with primary care measures.

Examples of some primary care and utilization measures include Chlamydia screening, diabetes hemoglobin a1c tracking, body mass index assessment, asthma management, immunizations, well-child visits, ED utilization, and hospital readmissions rates.

They and their colleagues have been partnering with the Chicago-based Valence Health, which specializes in clinical integration and population health development, leveraging IT.

Higginson and Campbell spoke recently with HCI Editor-in-Chief Mark Hagland regarding their journey towards clinical integration. Below are excerpts from that interview.

Let’s talk about your organization’s journey towards clinical integration.

David Higginson: Phoenix Children’s started looking at clinical integration a little over two years ago, and obviously, with an accountable care organization initiative moving forward and the need to unify pediatricians in the valley and the attempt to control costs and improve care, we partnered with Valence. That company’s origins were as a claims processor but has leveraged their knowledge into collecting data from many providers and then providing great actuarial tools and other knowledge tools, to make it easy for providers to learn from it.

David Higginson

As you know, one of the greatest challenges in accountable care is in health information exchange. And what Valence came up with and is fairly unique, in my view, is that they really take it upon themselves to connect all the providers. So rather than a large population health tool or HIE [health information exchange] tool where the host organization will be tasked with building all the interfaces and it may take 6 months and $50,000 per connection, they quickly connected 800 providers and began pulling lab and clinical data into the database within a very short time; so six months within signing that contract, we had data flowing into the database. So we were able to show early wins. Also, some of those were members of other ACOs that hadn’t achieved this.

Tell me about your accountable care organization?

The Phoenix Children’s Care Network is a private ACO. It is a non-exclusive (providers can be in other networks) pediatric-focused network with general pediatricians and hospital-based pediatricians, including specialists, including a lot of subspecialists. I last heard we had 60 percent of the pediatric providers in the area in our network; and we have 832 providers submitting their data to the Valence database. We have more providers than that in the ACO, but not everybody’s connected yet. But the database represents 80 percent of the practices submitting their data.

When did you go live with the database?

We signed the contract, and then it took six months to get scheduled and started; and then in quarters two and three of 2014, we implemented and collected the tools. And then with regard to the use of the tools, we began fully rolling it out in the first quarter of this year.

What kinds of data are involved?

What has really transpired at a fairly high level is that, rather than using canned sets of reports or measures, the leaders of the ACO had to agree what their quality measures would be and tightly align those with nationally accepted measures—so, we had to define pediatrically relevant measures. So there was a whole cross-team group—where they agreed on those quality measures.

That was our first-prong, short-term approach, to get up and get going. It’s critical for ACOs to gain credibility by bringing some things live. And now we’re focusing on care coordination and population health management, so we’re beginning to work with valence and other vendors to support that. So we’re now building on those tools, to manage that population.

For children, population health inevitably involves the participation of parents for it to work, right?

Yes, obviously, the child will have little to do with the factors around getting consistent care.

What have the biggest challenges been overall?