In the October 2013 Healthcare Informatics cover story, HCI Editor-in-Chief Mark Hagland interviewed a wide variety of physician group leaders and industry experts regarding the journey toward population health management, which encompasses numerous vehicles and organization structures, including accountable care organization (ACO) development, care management, patient-centered medical home (PCMH) development, and avoidable readmissions reduction work, among other types of initiatives. His story noted that medical group leaders attempting to move forward in the population health management arena face greater resource challenges than do hospital leaders, as well as incentive alignment and strategic IT issues.
Fortunately, many medical group leaders moving forward in the population health/accountable care arena are figuring out quickly where the key gaps, both process-wise and technology-wise, are, and are working to bridge those gaps. Not surprisingly, physician organization leaders are adopting a variety of different strategies in that regard. One of the organizations moving forward into the realm of collaboration with private health plans while not participating in the Medicare Shared Savings Program (MSSP) ACO program is Prevea Health, a 200-physician, 1,500-staff member multispecialty medical group with 18 care sites, based in Green Bay, Wisconsin. Ashok Rai, M.D., president and CEO of Prevea Health, says of the private-payer ACO that he and his colleagues have created in collaboration with three local hospitals, “Probably the largest insight is that there’s a lot of opportunity with the right infrastructure, to change how we traditionally practice medicine, to start to make populations healthier. In a patient-centric rather than provider-centric model, where everyone’s working to the highest level of their license, we find it a much better and more effective model in terms of preventive and primary care,” Rai says. “So we’ve seen a definite bending of the curve upward on the quality side and downward on the cost side. The biggest challenge is that with the majority of our revenue still being fee-for-service—we’ve essentially been financially disincented to make the progress we have; but it’s the right thing to do.”
Rai spoke this summer with HCI Editor-in-Chief Mark Hagland regarding the progress he and his colleagues have made so far in accountable care and population health. Below are additional excerpts from that interview.
Are you doing population health within your group?
We’re not doing the Medicare demonstration project, but we’re partnered with St. Mary’s Hospital and St. Vincent’s Hospital in Green Bay and St. Nicholas Hospital in Sheboygan; and we’ve launched our own health plan, Prevea 360, in partnership with the Dean Health Plan this January. So we are essentially a commercial ACO, where we take risk; and we’ve been involved in population health now for over five years since we started our PCMH pilots, which have rolled out to all of our primary care sites and now two cardiology sites. St. Mary’s and St. Vincent’s own 50 percent of the common stock in Prevea 360, and the doctors own the other 50 percent. We’re partnered at the hip and make strategic decisions together. But we’re not owned by the hospital. Meanwhile, St. Nicholas Hospital is part of Hospital Sisters Health System with the other two, based out of Springfield, Illinois.
Ashok Rai, M.D.
When you look at electronic health records and the other tools of automation available to support your journey into accountable care and population health, what do you see as the biggest challenges right now?
The challenge is in trying to effectively leverage EHRs as population health management tools. If you look at how EHRs were designed, they were designed to interact with the provider, not the patient, number one; and they were designed to document what was going on in the room during a patient visit; they weren’t designed to work on population health proactively. So if you’re changing your processes to say that the patient visit never ends, to care for their health, and changing your processes so that you’re trying to work with patients who haven’t come in, you end up scrambling for tools or jimmying existing tools to give you what you need.” As a result, he and his colleagues are still using manually created and maintained patient registries for the high-risk patients they’re caring for.
One core problem, obviously, is that right now, there are no off-the-shelf tools available to facilitate population health and accountable care, right?
Yes; if you look at how EHRs were designed, they were designed to interact with the provider not the patient, number one; and they were designed to document what was going on in the room during a patient visit; they weren’t designed to work on population health proactively. So if you’re changing your processes to say that the patient visit never ends, to care for their health, and changing your processes so that you’re trying to work with patients who haven’t come in, you end up scrambling for tools or jimmying existing tools to give you what you need.
So what have you and your colleagues done to bridge that tools gap?