At Texas Health Physicians Group (THPG), the physician organization integrated into the Arlington, Texas-based, 21-hospital Texas Health Resources, Shawn Parsley, D.O., president of THPG, and Barbara Adams, vice president, innovative technology solutions, for THPG, and Texas Health Resources, are deeply involved in forward-focused efforts around accountable care organization (ACO) development and population health management work.
Texas Health Physicians Group encompasses 829 providers, including physicians, physician assistants, and nurse practitioners. THPG is participating both in the Medicare Shared Savings Program for ACOs (MSSP program), in concert with the UT-Southwestern Medical School in Dallas, in which it is covering 64,000 lives altogether (46,000 from THPG and 19,000 from UT), and in several commercial shared-savings ACO contracts with commercial health insurers—Aetna, Cigna, and Blue Cross Blue Shield of Texas, covering an additional 60,000 lives.
Dr. Parsley and Barbara Adams were among the healthcare leaders interviewed by Healthcare Informatics Editor-in-Chief Mark Hagland for the magazine’s September-October cover story. Below are excerpts from the interview they gave to HCI this summer in the preparation of that cover story.
Tell me about the issues and opportunities around leveraging data analytics to support your ACO and population health work at THPG.
Shawn Parsley, D.O.: Clearly, having analytics makes up a major portion of your ability to actively do anything with these contracts. There’s a period of time where we’re standing with a proverbial foot in the boat and foot in the dock, in terms of the fee-for-service world and the fee-for-value world. What we took on first was a quality incentive program for the docs that was really payer-agnostic, and designed to represent the entire panel a physician had, with incentives. We really want our physicians to think about how they take care of all their patients. So the first step was to develop a quality analytics dashboard that would have the capacity to look into the EMR data, without regard to which EMR is involved, and extract the information and compile it in a centralized database.
Shawn Parsley, D.O.
When did you go live with that architecture?
Barbara Adams: We went live at the beginning of 2014. It was there in 2014, but we were still validating and testing the data, so that by January 1, 2015, the measures would show directly in the dashboard So the physicians have a performance incentive in 2015, and one of the gates is simply using the dashboard.
What are some of the core data elements involved?
Parsley: Among them are tobacco cessation counseling, colorectal cancer screening, breast cancer screening, hemoglobin a1c management, and hypertension management. For the hemoglobin a1c management measure, we use the National Quality Foundation measure on having a hemoglobin a1c test within the last 12 months.
What kinds of data are you providing, and are physicians looking at?
Parsley: What we do is that we attribute a patient to a provider based on which provider has seen the patient the most often. And let’s say that our target for hemoglobin a1c management is that 70 percent of patients need to be compliant with a1c management; we’re giving the dashboard that shows the doctor where their patients are. If for example, 65 percent of the doctor’s panel of patients are compliant, they can drill down in the dashboard and find out who’s not compliant, and their care manager will call them and intervene telephonically or in person. And that provides a discrete list of patients with gaps in care.
What results have you seen so far?
Parsley: We can’t really say what our results are in the MSSP yet; but one of the things we have noted very clearly is that the physicians who access the dashboard, and we can tell when they log in—the more often they access the dashboard, the higher the probably that they will be meeting the measures, and conversely, those who access the dashboard least frequently tend to be lower; so in other words, they’re starting to act on the measures. About 50 percent of the physicians are accessing the dashboard pretty regularly. The other 50 percent aren’t doing so regularly yet; but this is the first year where we have payment tied to this, and the payments go out in December.
What development and governance processes have been involved?
We have a group called the Key Council. It’s mostly tied to our Medicare Advantage program, with a mentor/mentee program, with each mentor having three to five mentees.
And who are the mentors in that program?
They’re doctors who have performed really well. Right now, that’s in the Medicare Advantage program, but we’re going to roll out that same structure with the MSSP program and ACO programs.
Barbara, what have been the main challenges from the IT leadership standpoint?