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ACO Infrastructure: ‘Building the Plane While Flying It’

March 9, 2016
by David Raths
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Population Health Colloquium panel describes IT challenges of transitioning to value-based care

At the 16th annual Population Health Colloquium in Philadelphia this week, one panel session dealt with the health IT platforms required to support the transition to value-based care. Accountable care organizations have had to ramp up very quickly, and developing the infrastructure is like “building the plane while flying it,” said Jack Price, director of population health informatics and technology for the Delaware Valley ACO in Radnor, Pa.

Delaware Valley ACO is owned by several health systems, including Main Line Health, Jefferson University and Hospitals, Holy Redeemer Health System, Doylestown Health, and Magee Rehab. The ACO acts as a convener, accelerator, and provider of the foundation needed to assist its members to transition from fee for service to a model focused on population health.

“We have to deliver solutions quickly to deal with claims data and attribution methodology,” Price said. Without a big IT shop, the ACO is oriented toward software as a service. “We signed a contract for a population health system in July and were up and running in August,” he said. It allows care coordinators to document in a system, which is better than pen and paper. “We are also putting tons of effort into interoperability, connecting physician practices.” He is working with close to 400 practices on 45 to 50 different EHRs.

Price said that although he is enthusiastic about the promise of FHIR and APIs, he can’t wait for full interoperability to come to fruition. “We have to take the data we have now and try to get ahead of the curve,” he said, adding that he has to take systems based on pure payer or pure provider thinking and bridge them to get the answers he needs at an ACO level. Price said working with a health information exchange, the ACO is getting alerts when patients are admitted or released from the hospital as well as information from skilled nursing and home health agencies. All that data is fed into a dashboard to let providers know what is happening with their patients. “We see IT as an enabler,” he said. “IT is helping to support the business strategy.”

Arumani Manisundaram, the director of the Center for Connected Health at five-hospital Adventist HealthCare in Gaithersburg, Md., said their ACO has 18 EHRs and 34 total data sources. They build some homegrown tools to aggregate data from the EHRs. “The biggest challenge is normalizing all the data,” he said. He said he is busy adding data scientists to the team to use predictive modeling and risk stratification to get more out of that data.

Harm Scherpbier, M.D., M.S., former chief medical information officer at Main Line Health, talked about whether the population health platforms that ACOs need will come from the large EHR vendors or independent solution providers.

“The big players are Epic and Cerner. When we talk about a platform, most CIOs would go there first. But in settings where we deal with 45 EHRs, you can’t solve that with Epic or Cerner. Gartner says 40 percent of population health will be done using an EHR like Epic or Cerner. I think the number may not be that high. The majority will use platforms that span EHRs and are not monolithic.”

All the panelists talked about the difficult culture change involved in the switch to value-based care. “I love the Delaware Valley ACO model,” Scherpbier said. Rather than change each health system from inside, they created an external organization to change it from the outside in. He said he would like to see others try that model.

Within an acute care health system, Scherpbier recommends having the hospitalist team drive change. “They see the patients you are trying to go after. They are part of your organization and on your team. If I were doing culture change from the inside out, I would use hospitalists as the drivers.”




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