The leaders at Lancaster General Health in Lancaster, Pa., which in August became part of the Philadelphia-based Penn Medicine system, have been moving ahead on population health management initiatives recently. Their two main areas of focus have been the organization’s participation as an accountable care organization (ACO) in the Medicare Shared Savings Program (MSSP) for ACOs, and its universalization of the patient-centered medical home (PCMH) model across all of its medical clinic sites. Among those helping to lead the charge in Lancaster General Health are Michael Ripchinski, M.D., the organization’s chief quality and medical information officer, and Douglas Gohn, M.D., its physician executive for population health. With regard to ACO development, LGH is managing the care of 18,000 in the MSSP program and 70,000 in some sort of risk-based contract. LGH is also participating in the Bundled Payment Pilot Initiative out of the Centers for Medicare & Medicaid Services (CMS), doing cardiac stents, bypass surgery, pacemakers, hip and knee joint replacements, and some spine procedures as well, Gohn reports. Gohn is a cardiologist who continues to practice one day a month.
Drs. Ripchinski and Gohn were among the healthcare leaders interviewed this summer by Healthcare Informatics Editor-in-Chief Mark Hagland for the magazine’s September-October cover story. Below are some excerpts from Gohn’s interview with Hagland. Excerpts from Dr. Gohn’s interview appeared in an article published last month.
Do you report to the CMO of your organization?
I report to the CEO, primarily because of having oversight for quality for the organization. We’ve been trying to achieve a high level of profile to the quality—we’re bringing both results and action plans to the board.
Michael Ripchinski, M.D.
What would you like to have happen at Lancaster General health, with regard to population health, in the next year?
We’ve spent the better part of our efforts since early 2013, first getting all of our primary care sites NCQA Level 3 certified [certified as patient-centered medical homes by the National Committee for Quality Assurance]. That has been a monumental undertaking, and we were moving towards HIMSS Level 7 [a Level 7 designation on the seven-level HIMSS Analytics EMRAM EMR Adoption schematic] at the same time. We were the first in Pennsylvania to achieve HIMSS Level 7 at the hospital and clinic level. And so a lot of this was preparatory work to do gainsharing and then eventually risk-based payment to the physicians; we’re still in the gainsharing mode. We’ve taken on gainsharing contracts with private, commercial, and Medicare payers. Our structure for accountable care was built on the PMCH certification and HIMSS Level 7 structures. We needed those infrastructure foundations for this work.
And can you describe the direction of this work, overall?
The future state is the maturation of those tools from that foundation to do population health. The HIMSS 7 work has been one step on the journey. We’ve basically proven that we can engage our medical staff and physicians and our staff in the journey of transformation to electronic health records, and to use those EHRs to improve performance. Now, in the next year to two years, I see the continued maturation of those tools to identify care gaps, transparently present metrics to the physicians, and give them the ability to improve their performance, and as a result, the outcomes of their patients. We do this in a number of ways, including extensive pre-visit planning, including through huddles.
There are numerous process elements in all this, correct?
Yes. There’s the pre-visit piece; there’s also the same-day process element. I’m a family physician by training, and Doug is cardiologist. The pre-visit planning is the work we do before the patient even shows up. One week before a patient has their visit, we make sure they get their hemoglobin a1c and their LDL numbers, and other data, to follow up with Dr. Ripchinski about. With regard to the same-day preparations, I as a family physician sit down with my nurse and look at care gaps every morning before patients come in. We use the patient registries and population health functions within Epic, checking which patients might be missing their colonoscopies, breast cancer screenings, etc. We’re contacting patients just the way a payer would. And the patient portal plays an important role in helping patients with all of these tasks. But it requires multi-factorial efforts to close the gaps; the efforts have to be multi-factorial and multi-tiered.
What has your journey been like around data and analytics?
It’s very difficult to manage both claims data and clinical data. There are companies trying to merge clinical and claims data to create a path forward, but we’re early on that journey. And as part of setting up the MSSP in January 2014, we started to get claims data and began to do typical payer analysis—what’s the pharmacy spend, who are the high ED users, who are the chronic condition patients?