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Moving Forward on Population Health in the Granite State

April 2, 2015
by Rajiv Leventhal
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The increase of data from the digitization of patient records has undoubtedly sparked a big data revolution within the healthcare industry. However, there remains a significant challenge of turning that data into knowledge that improves patient quality of care and reduces costs. When this happens, and the data becomes actionable, healthcare organizations can then work on expanding their care to patient populations.

To this end, leaders at Granite Health Network (GHN), a five-hospital healthcare network based in Concord, N.H., have set ambitious goals regarding big data and population health management. In fact, according to Bob Kay, director of population health at GHN, the network’s board of chief medical officers (CMOs) has set the objective for GHN to be the premier health system in the state within five years.

“Successfully managing data and moving forward with population health management is a key to that,” says Kay, who will be part the Health IT Summit in Boston, hosted by the Institute for Health Technology (iHT2 – a sister organization to Healthcare Informatics under the corporate parent, the Vendome Group LLC), on May 19-20, 2015 to discuss the big data revolution. Serving as a preview to that panel discussion, Kay recently spoke with HCI Associate Editor Rajiv Leventhal on how GHN is progressing with population health management, and how the health network is leveraging data for better value-based care. Below are excerpts from that interview.

Which value-based programs are GHN currently a part of?

We are a venture of five different independent health systems in New Hampshire, having started that process about three years ago. We have our employees, an accountable care organization (ACO)-type arrangement with Cigna (CAC, collaborative accountable care), and four of the five health systems are also involved in the Medicare Shared Savings Program (MSSP) So we have about 85,000 lives at risk at the moment. With the MSSP, I would say there has been mixed results—the quality has been really good, but it’s been hard to meet the savings targets. We haven’t been losing money though, at least as far as I’m aware.

Bob Kay

How are your providers taking to this shifting way of delivering care?

Honestly, I think they’ve all described it as a great learning experience, as it’s been a way to crystallize all the learning that needs to get done and make it data-driven as well. Being data-driven has really been a huge help. All of the health systems have had an electronic medical record (EMR) for a decade or more, so they’re used to looking at data and managing it. When we started with the population health initiatives, it was a natural fit for what a lot of them have already been exposed to anyway, so that was very helpful. Our board set the goal to be the premier health system in the state within five years, and in order to do that, we have to show that we’re meeting benchmarks. There is also the physician “ I don’t want to be last” aspect to it as well.

You mention being data-driven. Can you expand on that?

Taking data out of silos, well that’s hard at the moment, I don’t know if we have what you’d call “big data” right now. We use claims data, publicly reported data, and right now we are just starting to move clinical data into our data vendor. Once the clinical data is in, we’ll have more of what’s considered “big data” to work with. But we have been using the claims data to look at variations and to drive clinical initiatives where we’ve seen some of that variation come out to be true. We have had four clinical initiatives across GHN from which there have been recommended practice guidelines derived from that.

Right now we have claims data, and that’s adequate I would say. Claims has a breadth of services that you don’t get in clinical data, but not the depth of clinical information that you would need for it to be really actionable. So we use the claims data more directionally, and then we work with experts in the health system to say, “We found something in the claims data, do you see this in your own health system in your own EMRs, and can you verify this for us?”

Can you elaborate on these four clinical initiatives?

They are asthma, low back pain, depression screening, and ED throughput. Expert panels drove those initiatives. We looked at data for asthma, for instance, and we saw some high rates of drug utilization that some of our CMO group didn’t think was appropriate. Then a panel of experts across GHN started to go though the data, using NHLBI (National Institutes of Health) guidelines as recommendations to start from, and then planned from that. At GHN, the five independent health systems all operate a little differently, so that’s why we call them recommendations so the health systems can implement them to fit their own structure.  For asthma, we found that all chronic persistent asthmatics should be having a spirometry once a year rather than peak flow meters.

For low back pain, we found high rates of narcotic use for some of the patients. Also one of the elements that was missing was early treatment with physical therapy, and no one was using that in the other guidelines that we found. One of our health systems piloted that, with good results, so that was rolled out across the network.