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Drilling Down to the Data, Engaging the Doctors

April 1, 2013
by Mark Hagland
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Mercy Health Partners’ Amy Frankowski, M.D. talks about the opportunities and challenges involved in sharing clinical performance data with physicians

A lot of innovation has been taking place recently within Catholic Health Partners, a Cincinnati-based integrated health system that encompasses 29 hospitals, making it the largest health system in the state of Ohio. As part of a broader strategy aimed at optimizing resource use and improving clinical outcomes, leaders at Mercy Health Partners have been working with the Cleveland-based Explorys, a big data-focused analytics vendor. And as at other Catholic Health Partners health systems, the Mercy Health Partners folks are making progress in improving outcomes across entire physician groups.

In January, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed Kenneth Bertka, M.D., president of physician clinical integration for both the seven-hospital Mercy Health Partners, based in Toledo, a division of Catholic Health Partners, and of the entire health system, about the organization’s overall innovation work, as well as its partnership with the Cleveland-based Explorys, a big data-focused analytics vendor. Following that interview, Hagland spoke with his colleague Amy Frankowski, M.D., the senior medical director of clinical integration at Mercy Health Physicians, the physician organization within Mercy Health Partners. Mercy Health Physicians encompasses 300 physicians, evenly divided between primary care physicians and specialists, as well as about 1,000 staff members in 80 locations across the greater Cincinnati area.

Dr. Frankowski has been helping to lead the ongoing development of Mercy Health Select,, a Medicare Shared Savings Program (MSSP) accountable care organization (ACO) chartered in July 2012. Mercy Health Select encompasses, Mercy Health Physicians, as well as local Mercy hospitals. Below are excerpts from that interview.

With regard to your title, senior medical of clinical integration—is that more of a “CMO-ish” title or a “CMIO-ish” role?

It’s more “CMO-ish.” But because of the need for a common data platform and all the need for information technology, I’m intimately involved with all of our IT.

Amy Frankowski, M.D.

Do you have a staff reporting to you?

We have a team within Mercy Health Systems, so there is a director under me who is a doctor, with an IT background. But I don’t personally have a staff under me; we run a lean ship. The roles are evolving. I report to Dr. Dan Roth, the President of MHP. He had previously been CMIO of Catholic Health Partners.

How long have you been in your current position?

I’ve just been in this position since May 2012; before that, I was the medical director of clinical transformation; my role has expanded, because of the development of our clinically integrated network and our ACO. I still practice as an internist; I see patients about 20 percent of the time now.

MHP itself has been a rapidly growing group. There have been a lot of changes; our market had a lot of independent physicians, but the consolidation of physician practices into large groups has really taken off in the past three years, and especially in the past year. So we’ve been bringing in a lot of physicians who hadn’t previously been involved in collaborative efforts like measuring quality.

That’s always a cultural challenge, correct?

Yes, I would say the cultural change is the biggest challenge, followed by the IT challenge. Many of the doctors were independent business owners who by choice or because of economic factors became employed physicians, and for many of them, it was the first time they were on an EHR; and all of our ambulatory doctors are live on Epic. And we have about 400 affiliated doctors, and we’re trying to bring up most of the primary care doctors on Epic in the next year; most specialists are on something. Our goal is to get them all live within the next year. And we require all physicians to move towards being on an IT platform.

Have you attested to Stage 1 of meaningful use for your employed physicians?

Yes, in spring 2012. But we did decide that any new primary care doctors need to get onto Epic [the core electronic health record system from the Verona, Wis-based Epic Systems].

What core elements are you measuring right now?

One of our core elements is patient satisfaction; we’re also measuring our employed physicians on quality incentives, on the outpatient side. On the inpatient side, we’re tracking all the traditional HEDIS [Health Effectiveness Data and Information Set] measures [from the National Committee for Quality Assurance, or NCQA] as well as Joint Commission factors, the readmission rate, etc. For the outpatient group, we initially decided to track patient satisfaction and quality measures.

Which quality outcomes are you measuring right now on the ambulatory side?

We started here in southwestern Ohio looking at preventive measures, diabetic measures, and coronary disease. On the preventive side, the same elements that Dr. Bertka mentioned. And in our region, we started a couple of years ago with those. And then in our region, Aligning Forces for Quality is a National Quality Forum initiative—funded by RWJF [the Robert Wood Johnson Foundation]—and we publicly collect and report what are called the D5 measures. So we publicly report the D5 and the C4 measures—coronary measures, and colonoscopy rates.