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A Medical Group CMO Explains Her Participation in HHS’ New Healthcare Payment Learning and Action Network

March 28, 2015
by Mark Hagland
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Westchester Health’s CMO Nancy Beran, M.D. explains why she and her colleagues are participating in the Health Care Payment Learning and Action Network

On March 25, President Barack Obama hosted an event to launch a new program being sponsored by the Department of Health and Human Services (HHS)—the new Healthcare Payment Learning and Action Network.

President Obama looks on as Nancy Beran, M.D. speaks at the White House on March 25

As the website for the Centers for Medicare & Medicaid Services (CMS) explains it, “To help achieve better care, smarter spending, and healthier people, the Department of Health and Human Services (HHS) is working in concert with our partners in the private, public, and non-profit sectors to transform the nation’s health system to emphasize value over volume. HHS,” the description notes, “has set a goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50 percent by 2018. HHS has also set a goal of tying 85 percent of all Medicare fee-for-service to quality or value by 2016 and 90 percent by 2018. To support these efforts, HHS has launched the Health Care Payment Learning and Action Network to help advance the work being done across sectors to increase the adoption of value-based payments and alternative payment models.”

According to the U.S. News report on the event, Sylvia Mathews Burwell, Secretary of Health and Human Services, said, “We want to hear about your success and misses. What metrics do you use? How do you define and measure quality? What data can you share? How have you improved the patient experience?” And President Obama said that the project wasn’t about “reinventing the wheel.” “You’re already finding out how to reduce infections and meet needs,” U.S. News quoted him as saying.

Among the healthcare leaders participating in the White House event on Wednesday was Nancy Beran, M.D., the chief medical officer of the Katonah, N.Y.-based Westchester Health, a multispecialty group practice that encompasses 120 physicians practicing at 50 sites across Westchester County in New York. Six of the Westchester Health practice sites have been involved in the Comprehensive Primary Care Initiative, a four-year, multi-payer initiative launched in October 2012 by the Innovation Center at CMS, and designed to strengthen primary care.

Dr. Beran shared her perspectives on her and her colleagues’ participation in the Health Care Payment Learning and Action Network with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

What brought you and your colleagues into this new initiative?

We have been part of the Comprehensive Primary Care Initiative, with six of our primary care sites participating in that initiative. We’re somewhat unique, with small practice sites, and six sites are in the CPCI; we have about 50 sites. We have a lot of small practice sites. We really brought together existing practices. Our largest site has seven physicians. Some subspecialty sites with maybe 10 people, that’s the most.

When did those six practice sites become involved in the CPCI program?

Those six sites—representing ten physicians—joined the CPCI when it launched in October 2012. All were early patient-centered medical homes, early EMR implementers, and early meaningful use attesters, which is why they were chosen to be part of CPCI.

How broad is the CPCI program?

There are over 70 practices in CPCI in New York. That’s the New York region. There are six different regions with CPCI initiatives across the country. One of the initiatives from CMMI. Looking at alternative payment models, they developed ACOs [accountable care organizations], bundled payments, and this CPCI. They were really trying to take some of these advanced practices that weren’t big enough to be an ACO that were advanced, and give them a way to transform earlier, and built the CPCI for that purpose.

We used the CPCI not just for those six sites, but actually took that model and used it to transform all of our sites. So we use the same technology and workflow in all our primary care sites that we use in the CPCI. So we have 21 PCMHs. In the IT department, what we built for the CPCI, we use in all our sites. We’re a NextGen user, but most of what we needed was not built by NextGen or ready for us in NextGen, when we began this work

One example is population health reports. We’re doing early population health, and we’re a small group, so I don’t have an overlay of big technology. I’m doing it with custom reports. For example, one of our conditions we manage very aggressively is diabetes. So we have reports that allow us to dissect our diabetic population in many different ways.

With regard to our diabetic population, the data points include the date of last visit, date of last hemoglobin a1c, what their LDLs are, because we have integrated lab, so we can analyze how well the diabetic patients are being managed. Those data points are in custom reports, they’re on our SQL server, doctors can run them themselves, and the doctors have dashboards. It’s less for benchmarking, because you can use MU reports somewhat for benchmarking—it’s really for custom reports to see who’s fallen off their radars.