In an industry full of incredibly busy executives, Chuck Podesta must surely count as one of the busiest. Podesta has for years been senior vice president and CIO of Fletcher Allen Health Care, a Burlington, Vermont-based health system encompassing one academic medical center and numerous ambulatory sites and physician practices. But there’s so much more to it than that. To begin with, in January 2012, Fletcher Allen created a corporate umbrella, Fletcher Allen Partners, which brought into the network Elizabethtown Hospital, a critical-access hospital in Elizabethtown, New York; and then in January 2013, Central Vermont Medical Center, a 100-bed community hospital in Berlin, Vermont, and 250-bed Champlain Valley Physicians Hospital in Plattsburgh, New York.
But wait—there’s much more. First, the leaders at Fletcher Allen launched their Medicare Shared Savings Program accountable care organization (ACO), OneCare ACO, in January 2013; that ACO encompasses all 14 hospitals in the state of Vermont, as well as Dartmouth-Hitchcock Medical Center, located over the border in Lebanon, New Hampshire (Dartmouth-Hitchcock cares for numerous residents of eastern Vermont). According to Podesta, with its current estimate of 52,000 patients involved, OneCare ACO is the fourth-largest in the country. What’s more, Podesta notes, the state of Vermont, based on the healthcare reform law it passed in 2011, is requiring that all individuals signing up for health insurance using the state’s health insurance exchange, be enrolled in OneCare ACO. At the same time, Podesta and his colleagues are awaiting word that the state of Vermont will include Medicaid and commercial health plan enrollees in OneCare as well. The resulting total could reach upwards of 150,000, in a state with a population of 600,000.
Indeed, one explicit strategy of Green Mountain Care, Vermont’s healthcare reform law, passed in 2011, is to get 90 percent of Vermonters into risk-based health insurance plans as possible, in order to promote value-based purchasing and improve care delivery.
And yet there’s still more. The Fletcher Allen organization has been involved from the start with VITL, Vermont Information Technology Leaders, the statewide, 850-provider-strong health information exchange (HIE). One advantage for all those involved in VITL is a state requirement that all providers in Vermont connect to VITL.
Podesta spoke recently with HCI Editor-in-Chief Mark Hagland regarding his involvement in all these activities, and the broad implications of all this work. This is Part 1 of a two-part article.
You have so much going on, it’s amazing. Tell me a bit about your HIE activity of late?
On the HIE side, we’re contracting with VITL, our state-sanctioned HIE. The state passed a law that all the providers in the state are required to connect to VITL, which has been very helpful. And OneCare is working very closely with VITL to move the EHR [electronic health record] portion of what we need into the strategy. So you get the CMS claims data and load that in, but to do predictive analytics, you need to add in the lab data and biometrics data from the patient, and you need that from the EHR. And we have over 20 different EHR vendors involved in OneCare. And the only mechanism is to pull that into there through Medicity, which is providing the interface engine to pull the data into VITL. And then on our big data strategy, we’re in a consortium with Dartmouth-Hitchcock, Maine Health, and Eastern Maine Health System, and that’s called the Northern New England Accountable Care Collaborative (NNEACC).
That’s a learning collaborative?
It’s more than that; it’s the collaborative that is creating the ACO dashboard and is consuming Medicare data.
You’re sharing data in order to benchmark performance, then?
Yes, basically, the bigger the denominator of patients, the better the analytics you’ll get. And certainly while our PHI from the organizations is all segmented, we can do deidentified queries across 2 million patients instead of 700,000. So you’re going to get better results with 100,000 diabetics, say, versus 25,000 diabetics. So the larger the number of these patients in the high-cost chronic diseases that you’re trying to control, the better off you’re going to be. And two of the four—Dartmouth-Hitchcock and Eastern Maine—are pioneer ACOs. And being able to learn from that is important. And the nice thing is, it’s a single data repository, it’s a data warehouse, so we don’t have four separate warehouses involved. And Recombinant, owned by Deloitte now, has created the applications—the predictive analytics portion, the care management portion, etc.