With provider organizations taking on more risk as they continue to enter into the world of value-based healthcare, business intelligence (BI) and analytics become crucial elements for accountable care success. In Fredericksburg, Virginia, Mary Washington Healthcare (MWHC) is one patient care organization that has recently made the leap into the BI and analytics arena.
In February, MWHC announced that it has adopted a population health solution from the Emeryville, Calif.-based MedeAnalytics with the goal to improve the quality of care and reduce costs for more than 3,000 employees that are part of its self-insured health plan. MWHC officials say that the health system will also leverage MedeAnalytics’ platform for its quality reporting needs, such as HEDIS (healthcare effectiveness data and information set), and will utilize the Johns Hopkins ACG system for risk stratification, and FirstDataBank for advanced pharmacy analytics.
Additionally, the integrated healthcare system recently received certification into the Medicare Shared Savings Program (MSSP) and plans to expand the platform to a broader population as it enters into similar value-based shared savings agreements with commercial payers, its officials say. The Mary Washington Health Alliance accountable care organization (ACO) is a clinically integrated network made up of primary care and specialty physicians, along with Mary Washington Healthcare hospitals and other facilities.
Undoubtedly, it’s been a busy stretch for MWHC, but as the federal government continues the push from volume to value—the feds want 30 percent of fee-for-service Medicare payments to switch over to models such as ACOs and bundled payments by the end of 2016—data will have to become more actionable for providers, says Travis Turner, MWHC’s vice president of clinical integration. As such, the Mary Washington Health Alliance was initially formed as a joint venture between MWHC hospitals and facilitates along with independent physicians pursuing a health information exchange (HIE), which Turner says is the glue that binds the network together to interface across multiple electronic medical records (EMRs), as there is no common platform within the network. “Aside from the HIE, we needed analytics to back up that information platform so we can provide actionable data to the providers,” Turner says. “With the formation of this clinically integrated network, and our MSSP ACO, along with our bundled payment [initiative], we are really getting into that value-based contracting world. And it’s the analytics that drives that actionable data,” he says.
As such, MWHC will use MedeAnalytics’ population health solution to aggregate and normalize disparate claims, digital records and other clinical and financial data—enabling the health system to better manage costs and achieve standard industry quality metrics, says Turner. “A major part of our healthcare quality improvement strategy is to align our care metrics with the physician community that is participating in our clinically integrated network. We can only do that with strong analytics that empower us to self-evaluate, efficiently manage patient populations and proactively identify areas for early clinical interventions,” he says.
Indeed, regarding care metric goals, Turner says that having physicians at the table for discussions has certainly helped. “Right now, it’s difficult for providers to be completely engaged when they’re treating the patient and not the insurance or coverage card. So each carrier or insurer has a different quality perspective on what defines quality, meaning the physician gets confused about what they have to do for each payer, if they can even define it in the first place,” he says. But in an integrated delivery system such as MWHC, it’s crucial to sit down specialty by specialty and define with them what it is they want to be held accountable to and what can be tracked, Turner notes. “What helps determine if he or she is a good provider? We ask them rather than have it dictated to them; we want them to have a seat at the table. We have done that for each specialty, all 37 of them,” he says.
MWHC’s network includes more than 400 physicians, 37 specialties, a Level II trauma center, two other hospitals, and a freestanding emergency department, but when it comes to its MSSP ACO (which has 18,000 lives at risk), despite the vast network, the quality component becomes difficult, says Turner. “One of the trigger points is, does your network represent a whole picture of the specialties that are provided as part of healthcare? In our case it does, but then it gets to be about quality,” he says. Right now, Turner continues, a lot of the payers are primarily focused on the 50/50 shared savings, but what you’re putting at risk in addition to that is a portion of your savings regards to efficiency and quality metrics. “So even though it’s a 50/50 split, you may not necessarily share all 50 percent of your savings that you attained,” he says.
Nonetheless, the ACO was one of the new 89 that joined the MSSP late last year. “For us, it’s another brick in the foundation, Turner says. “We’re adding the government contracts, and we are continuing our negotiations with commercial payers for value-based contracting too,” he says. He adds that commercial payers are beginning to adopt Medicare’s HEDIS quality metrics, so physicians can get comfortable with those 33 metrics, or a subset of them. “We’re looking at several quality components, and as a result I hope we will be achieving shared savings by this time next year.”
For Turner, these steps all represent strides towards the greater goal. When it comes to successful population health management, Turner says that “you can’t put your arms around it,” so MWHC leaders are trying to put guardrails in place. “When you prioritize everything, nothing gets accomplished,” he says. “We’re moving from episodic care to coordinated care and from reactive care to proactive care, and we have deemed our slogan as going from transactional care to population health management. So we’re on that journey, and are focused on population stratification and implementing evidence-based guidelines,” he says.
At the end of the day, Turner understands that these initiatives are the keys to diving into the population health management scene. Some of the big commercial payers, he says, have made the choice to sit back and not be part of the value-based shift right now. As such, they aren’t sharing anything with providers. “But that’s fine for now,” Turner says. “As long as it’s not too onerous and the clinicians embrace it, knowing that the real reward starts with shared savings, I’m okay with some payers sitting on the coat tails of others. As you shift towards that risk-based contracts, capitation or however you define it, that’s where the shift is going. So you do have to get your feet wet at some point.”