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A Surge Towards Population Health Management in the Upstate of South Carolina

May 14, 2015
by Rajiv Leventhal
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In the upstate westernmost region of South Carolina lies Greenville County, home of Greenville Health System (GHS), among the largest healthcare networks in the Southeast—a $2.3 billion dollar organization with 1,358 beds, 14 medical residency and fellowship programs, and the state’s largest number of active clinical trials. It is also home to one of the nation’s newest medical schools—University of South Carolina School of Medicine-Greenville.

When it comes to delivering care in the upstate region, GHS strongly believes in managing populations, says Angelo Sinopoli, M.D., the health system’s chief medical officer. “We believe that population health is the future. Also, we realized that as big as we are, we are not geographically dispersed appropriately to manage certain populations that we’d be required to manage,” Sinopoli says, referring first to the various manufacturing companies in the upstate that are the largest in South Carolina with plants scattered throughout the region. GHS also has Medicaid contracts that span 11 counties, a Medicaid Shared Savings Program (MSSP) accountable care organization (ACO) that’s one of the largest MSSPs in the country with approximately 58,000 Medicare participants throughout the state, Sinopoli notes. “We realized that we would have to partner with practices that weren’t all Epic, and also other hospital systems that are not in our electronic medical record (EMR) system. We felt that we would need a rapid turnover of data and report cards to drive outcomes,” Sinopoli says.

Enter Santa Monica, Calif.-based population health management company Orion Health, with a solution that supports clinically integrated networks and ACOs by aggregating both claims and clinical data from various care settings and systems throughout the community and making that information readily available via a longitudinal patient record. With this longitudinal record, providers are able to make better-informed decisions at the point of care, says Mark Wess, M.D., chief medical information officer (CMIO), Greenville Health System.“As we prepare to start taking on more risk in an ACO model of care, we need an integration technology partner that is able to aggregate data from disparate data sources, including our Epic EMR system, and a vendor that can blend the longitudinal medical record into the clinician’s workflow to support our population health management goals,” Wess says. “Like any other thing in the nation, patients receive their care from multiple clinical entities for very good reasons, and when you want to see what happens across those systems, some of the EMRs can talk to each other, but many cannot pull that information together, especially because the medical record numbers are different across those systems,” Wess adds. “We can now see a continuum of care regardless of where a patient was seen. Bringing in data in a consistent format and being able to normalize it for the analytics is the other big component,” he says.

Indeed, for Sinopoli, aggregating the data is the key. “That’s what it’s about for me, aggregating the data so we could perform analytics on it but also so we can feed a real-time care management workflow tool. It takes both of those to be most effective,” he says. At GHS, Sinopoli says analytics are being used to look at two major buckets: first is claims analysis, so claims can be downloaded from insurance carriers and health plans that the organization is managing, we and analytics can be done in terms of utilization rates such as hemoglobin A1c being orders. The second bucket is integrating the clinical data through the Orion health information exchange (HIE) from EMRs and other sources into a data warehouse where GHS can look at gaps of care and opportunities, and do clinical analytics on that, Sinopoli says.

Another element to support GHS’ population health move is its MSSP ACO, MyHealth First Network, a network that is led by a 12-member board of managers that provides leadership and oversight, as well as a number of subcommittees that feed into the larger group. Nearly 2,000 healthcare providers across 10 counties in the upstate region of the state, including Greenville, currently participate in the network; the ACO was one of the 89 new ones introduced to the program last December by the Centers for Medicare & Medicaid Services (CMS).

Physician engagement has certainly been a top priority for the ACO, says Sinopoli. “We’re looking to engage those physicians in a single care model with a single set of standards so they’re all getting a single report card that has been approved by the entire network with benchmarks and goals for everyone,” he says. He adds that there has been very little difficulty in terms of getting people signed up and engaged. “They come to all the meetings and have been very vocal and active in getting into the discussions, giving input with care models and metrics,” he says. “We’re just getting to the point where we’re developing an infrastructure in which they will really need to actually change the way they practice medicine. They are very open to that; clearly they need the data to learn how to work with care managers, and they need models of care to help them with their workflow. We’re in those last stages now. They have to see the data, and then it will become more evident, that it’s time to do something differently.”