Skip to content Skip to navigation

In Ohio, Value-Based Care Takes Center Stage

January 9, 2015
by Rajiv Leventhal
| Reprints
Mercy Health CIO says that in a shifting healthcare landscape, “it’s all about the data”

When the Cincinnati-based Mercy Health—the largest  health  system  in  Ohio  and one of  the largest in the U.S.—partnered  with the Cleveland-based  Explorys in 2011 for its cloud-based  platform, the idea was to manage  populations,  engage  patients,  and  meet  patient-centered medical home (PCMH) and accountable care organization (ACO) goals. 

At the time, no one could deny the need for this type of IT platform, considering Mercy’s wide-reaching span of facilities, and all of the value-based contracting programs that the health system was in: the Medicare Shared Savings Program (MSSP) ACO in its southwest Ohio market; several commercial ACOs, Medicare Advantage programs, the employee health plan, and HealthSpan integrated care (HealthSpan serves most of Ohio’s major metro areas, with health plans for individuals and families, companies, and Medicare and Medicaid members).

Since then, Mercy has deployed the company’s cloud-based, big data analytics platform to all of its markets, including more than 50 care coordinators, to identify and close gaps in care for the populations it serves. According to the health system’s officials, the Explorys platform has helped support Mercy Health’s PCMH accreditation process and rapid-cycle improvement in PCMH practices, as well as enabling population management and performance measurement for its MSSP program, including supporting a successful submission of the MSSP performance results through the group practice reporting option (GPRO) reporting process in 2012 and 2013.

To that end, Mercy Health’s first and most time-sensitive challenge was to transition its primary care practices to a PCMH model. As a part of this initiative, it was vital that Mercy Health develop an efficient way to manage its clinical quality measures to meet certification requirements defined by the National Committee for Quality Assurance (NCQA) within a 15-month timeline. Within this aggressive timeframe, Mercy had to implement an electronic health record (EHR), develop ambulatory quality measures, and show significant improvements in outcomes. Full system integration was key to Mercy Health’s goals, says Rebecca Sykes, Mercy’s senior vice president, resource management, and CIO. Today, 27 of Mercy’s physician offices are Level 3 PCMH certified.

Big Data Expanded

Just recently, Mercy has announced that it has expanded its relationship with Explorys, signing a multi-year contract with the company. According to J.D. Whitlock, vice president of clinical and business intelligence at Mercy, the big data platform has already allowed Mercy to leverage innovative approaches that enable value-based care analytics and operations using a more longitudinal data set that includes both claims and clinical data as well as integrated clinical and actuarial risk models.

“The ability to provide a registry with daily updates that contains pertinent data elements to perform care coordination for our ACO populations has contributed to the streamlining of workflows for the care coordination team,” Whitlock says. “It has also contributed to a decrease in the number of hours spent manually updating current excel-based patient registries, and an increase in the touches to patients on the registry.” He adds that the team is in initial planning stages to understand how to build key performance indicators on use of this registry and its relationship to closing gaps in care as well.

Whitlock goes on to note that the improvements in patient care have been significant. “[We now have] a quick way to identify patients who need outreach based on time since last outreach, clinical indicators such as elevated lab values, recent ER encounter, and risk score,” he says. What’s more, he adds, the platform helps guide the focus of the outreach, as the registry readily shows if depression screening is due, for example, or if the patient activation measure is due, and if are there care gaps to close. “[There is] true integration of clinical and (post-adjudicated) claims data,” he says. “Risk scores are calculated from clinical and claims data (for populations that have post-adjudicated claims), and clinical data only (for populations that do not). This in turn enables care coordinators to identify patients requiring the most attention.”

According to Sykes, the system has also helped changed physician behavior, which is necessary in a value-based world. They now can identify which  patients were  adherent to a quality  measure, such as diabetes or coronary  artery  disease, and this allows care coordinators to set specific, individual  measures and notifications to reveal trends, notify  at-risk patient,  benchmark  clinical  performance,  and  improve outcomes, she notes. “They can compare themselves to their peers and work on capturing more of the population health analytics that are required,” Sykes says. “No one wants to be at the bottom, and it ultimately helps the patient change his or her health and lifestyle. Doctors respond to data—they always have and they always will. And with this platform, it’s all about the data.”