Evolution isn’t just a concept taught to uninterested high school science students. It’s a living, breathing way of life at St. Vincent’s Health Partners Inc. in Bridgeport, Conn.
The organization, the first clinically integrated network to be accredited by the Utilization Review Accreditation Commission (URAC) in the nation, is constantly adapting, explains Michael Hunt, D.O., CIO and CMIO at St. Vincent’s Health Partners.
It started as a physician hospital organization (PHO) with the intent of managing patients through the continuum of care and eventually expanded to include skilled nursing facilities and home health organizations as well. Next up, St. Vincent’s will add pharmacies and durable medical equipment providers to the network. The evolution is also visible in its dealings as an accountable care organization (ACO).
“We started with a commercial ACO product,” says Dr. Hunt. “We then entered into the Medicare Shared Savings program. We are continuing to enhance our capabilities to do medical management under population health.”
The physician-based organization is making these evolutionary changes and achieving its population health management goals through the use of quality-driven analytics tools. Dr. Hunt is one of four panelists who will be discussing the use of analytics to drive quality improvement at the Health IT Summit in New York, to be held September 16-17 at the McGraw-Hill Conference Center. The summit is sponsored by the Institute for Health Technology Transformation, or iHT2. (Since December 2013, iHT2 has been in partnership with Healthcare Informatics through HCI’s parent company, the Vendome Group LLC.) For further information on the Summit, please click here.
Using Analytics for Population Health
To be accredited by URAC is no small achievement. The nonprofit quality accreditation organization worked with the U.S. Department of Justice and the Federal Trade Commission to develop standards on how hospitals and physicians collaborate in an integrated opportunity. This accreditation is all the more impressive when you consider the fact that St. Vincent’s represents both hospital-based and independent physicians. There are 300 physicians within the network in total as well as a flagship hospital.
“If you look at way world is moving, away from fee for service, what we’re doing is we’re trying to empower (our physicians) to be prepared for value-based purchasing and value quality reimbursement. We’ve strategically worked with our organization to lay the foundation for the transition to value-based reimbursement,” says Hunt.
To be successful in this environment, specifically within its various ACO programs, St. Vincent’s has to figure out where there are care gaps within its population and over-utilization of services. The goal is to take care of the right patients at the right location.
The organization has utilized an analytics system to capture data from practice management, claims-based, and electronic health record (EHR) systems. Hunt says that the organization has become adept at taking those data sources, analyzing them internally, and producing monthly data reports for each member.
“Each physician gets complete a data supply of their attribution, of the patients that have high risk, the patients that have been seen multiple times in the emergency department, those who have been admitted to the hospital, those who are seeing a specialist more than expected, those that are using a pharmacy more than being seen in routine office evaluation. We used a multi-varied analysis to really identify those patients with risk and hand that information to the physicians and their staff on a monthly basis,” Hunt says.
This is followed by a meeting from Hunt or another higher up who goes to the physician offices and lets them know where they need to improve. The physicians are evaluated through performance score cards. This is all done to not just help the high risk patients, but for preventative measures as well. “We apply the right level of intervention to each patient who has attributed to the PHO,” Hunt notes.
Technical and Cultural Challenges
Using this data analytics has been successful thus far for St. Vincent’s. The organization has reduced unnecessary utilization of their flagship hospital by 25 percent as well as reduced preventative and chronic care caps.
St. Vincent’s, like many other organizations that have gone down this path, has endured both technical and cultural difficulties. From a technical perspective, St. Vincent’s has to deal with 12 different EHR systems and 13 different practice management systems, as well as laboratory and claims systems. Hunt says it takes a certain amount of finesse to hook up to the varying data sources to the analytics platform for the different practices.
Furthermore, independent physicians are not prone to giving up their data easily. Many are reluctant to relinquish practice management and EHR data. As CMIO, Hunt acts as a translator to the physicians in an attempt to get them on board with the idea of aggressive population health management.
“One of the barriers we’ve had to overcome is getting them to play in the sandbox, even though they want to remain independent and not owned,” Hunt says. “We’ve really had to educate that technology isn’t just a turn on. There are so many myths and mythologies on information technology. Most people don’t appreciate the expertise and time required to make technology work.”