At AcademyHealth’s Concordium 2015 meeting Sept 22 in Washington, D.C., three physicians leading accountable care organization (ACO) efforts at academic medical centers described the challenges they face, ranging from build-vs.-buy decisions for technology platforms to gaps in their data to a shortage of data scientists.
William Borden, M.D., is associate professor of medicine and the director of healthcare delivery transformation at the George Washington University. In addition to practicing cardiology, Dr. Borden leads GWU’s ACO and other care improvement efforts.
Now in year two of its ACO efforts, GWU’s data challenges are perhaps elevated because it is in the process of switching EHR vendors from Allscripts to Epic, with a go-live of February 2016. But it already has a wealth of claims data in an Epic data warehouse. But speaking to the “build vs. buy” question, he said so far GWU has chosen to build its analytics tools. “The build process has been beneficial because we can customize to our needs the claims analytics and data warehouse,” Borden said. “We have learned form researcher colleagues who have deep experience working with Medicare claims data.”
He added that for organizations new to the ACO realm, it helps to get your feet wet by figuring things out on your own at first. “We are much better consumers than we were a year ago. We are talking to vendors and know what questions to ask because we better understand our operational needs,” Borden said.
Borden identified two data gaps GWU would like to close. One is around patient-reported information. “We have CAHPS [Consumer Assessment of Healthcare Providers and Systems] data, but it is not actionable. I would like to see us get more patient-reported information. The second gap is around, discrete socioeconomic data. For instance, as GWU does transitions of care and discharge for the most vulnerable populations, there is no easy way to identify patients who struggle with homelessness, he said.
Sreekanth Chaguturu, M.D., is vice president for population health management at Partners HealthCare in Boston, and is responsible for Partners’ ACO efforts. He said that although Partners was a pioneer in developing population health analytics tools, it has chosen to sunset those applications and work with vendor Health Catalyst because it wants to focus its efforts on providing care, not being an IT company. Nevertheless, he added, there are lots of gaps in current offerings and you still need a strong IT shop to customize the systems and make them work.
Chaguturu said a key to success has been to create a governance structure. “One of the questions you have to ask is how to organize yourself to make the most of the assets you have,” he said. Partners created a governance structure that reviews, IT, business and clinical priorities. But once Partners analysts began reporting out data, they had to make adjustments because providers and administrators said they were getting overloaded with data, he said. “For instance, we backed off from weekly reports to middle management to monthly ones and then finally quarterly ones with a 12-page narrative explaining the data,” he said. “We were proud of that, but they said that 12 pages was too long. We have to constantly tweak how we present it to make the data actionable by different users.”
One current challenges he is working through is trying to figure out what data and analytics capabilities to centralize vs. having available locally. “What do you keep at the physician level or hospital level, and where do you keep the predictive modeling capabilities?” he asked. There are limits to data self-service, he added. “We have found that clinicians and middle management have challenges looking at it on their own. We now keep regular office hours so people can come in and ask questions.”
Lindsay Jubelt, M.D., is medical director of population health at Mount Sinai Health Partners in New York and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai. She started out her presentation by describing saying Mount Sinai used to be a “feed-the-beast” hospital focused on doing lots of procedures in a fee-for-service model. But since 2013 it has been undergoing a complete transformation to becoming a population health center. “It is an exciting time, but we have never done this before. Population health is new, and there is lots of data we haven’t worked with before,” Jubelt said. "Our first approach was to buy IT platforms because we didn’t have the bandwidth to create things. But we have found no external solution can understand us, so we build on top of those tools.” For instance, they built a registry of patients with chronic kidney disease within Epic that can survey lab data and notes for patients at different stages of kidney disease. “But Epic’s capability ended there,” she said. Mount Sinai fed that registry information into their data warehouse to flag patients that need to see a nephrologist or be contacted by a care coordinator..
Jubelt said Mount Sinai learned it had to better integrate IT and clinical teams. Previously IT and data reporting was a completely separate entity. If you wanted a report, you put in a ticket, and got in a queue. “The problem with that is that it is incredibly inefficient. Often the report would not be what the user wanted. We decided to break down those silos and integrate IT folks. The two groups have become one and they can push data out to front line users, which has led to more innovation at the front line.”