As the accountable care phenomenon continues to be embraced by patient care organizations across the U.S., it is flourishing strongly through a wide variety of different organizational arrangements. One of the very forward-thinking of these has been created by the St. Louis-based Ascension Health, the largest not-for-profit health system in the U.S. The leaders at Ascension Health have chosen to create Mission Point Health Partners, a Medicare MSSP ACO caring for more than 100,000 members across middle Tennessee, led by Jason Dinger, president and CEO of the Nashville-based Mission Point Health Partners. The focus there has been ramping up quickly around data analytics to identify the accountable care organization (ACO) members in need of the most intensive medical interventions and care coordination.
At Mission Point, Dinger and his colleagues have been working with the Washington, D.C.-based Advisory Board Company in that area, leveraging a solution from that organization’s Crimson Analytics suite, one of the many analytics solutions options available on the market now. Speaking of the need to plunge into that area, Dinger says, “One of the most important things we’ve done is that we’ve made significant investments in data analytics and data mining tools, with the express interest in understanding our population and some of their unique needs. The technology really allows us to find the most people in need, and to discern what kinds of services they need.”
Mr. Dinger was one of a number of healthcare leaders interviewed by HCI Editor-in-Chief Mark Hagland for the magazine’s July-August cover story. Below are excerpts from his interview with Hagland this spring.
Tell me about your organization?
Mission Point Health Partners is, by the traditional definition, an ACO, meaning, we manage the healthcare needs for large populations. We are a subsidiary of Ascension Health; they are our parent organization. And we were created in order to do work on four issues: we wanted to improve the health outcomes of individuals, wanted to lower their healthcare costs, wanted to improve their satisfaction with the health system, and wanted to improve the satisfaction of providers. We’re based in Nashville; we manage more than 100,000 members across multiple populations, and our network involves more than 1,600 physicians and nine hospitals, in middle Tennessee.
How many staff do you have?
We are approaching 100 employees.
When were you incorporated?
We were founded in 2011 and started working with our first member in January 2012.
Are you a Medicare MSSP?
Yes, we’re participating in the Medicare Shared Savings Program; we started in July 2012 with that program. And then we also manage populations that are self-insured; an exchange population; and Medicaid members.
You’re managing the care of members coming to you via a health insurance exchange set up through the Affordable Care Act?
Yes, we have a contract with Blue Cross Blue Shield of Tennessee, to manage a large exchange population.
What are some of the core things you’re doing?
To start, we have made significant investments in data analytics and data mining tools, really with the express interest in understanding our population and some of their unique needs. The technology really allows us to find the most people in need, and to discern what kinds of services they need.
Do you have a data warehouse?
Our principal partner that we used to get started was Crimson Analytics, from The Advisory Board Company. We use a whole suite of tools that they provide. One initial tool we used is their population risk management tool, which allows us to understand the historical claims that each member has.
It takes insurance claims data and helps you analyze it?
Yes, and then we use what had been called Care Team Connect, and which they call it Crimson Care Management. It is an electronic health record [EHR] that tracks interactions; so when somebody does a home visit for a member, someone would track that. It’s separate from the hospital and physician EHRs, but interfaces with them. And then we use Crimson Care Registry, which aggregates discrete data elements across the population, so we can know how many people have gotten a flu shot or mammogram, and allows us to identify gaps. Both the Crimson Care Management and Crimson Care Registry interface with EHRs. And the Crimson tool aggregates into a master member index.
And then Crimson Analytics helps you analyze all the data?
When did you go live with the tools?
We had been working with CareTeam Connect; they were a separate company at the time, but were later acquired by The Advisory Board Company. We deployed most of the tools in the middle of 2012.
When you started applying the tools, what did you learn?
We learned several things. The first thing we learned is that good analytics help you stay focused as an organization. They also help you understand where to focus your energy at any specific time and place, and that improves outcomes and lowers cost. The second thing we learned is that we found that non-clinical indicators are often as important or more than, clinical indicators. Here’s an example: we knew that a number of people were presenting to the ED but had filled their asthma prescriptions, and we wanted to find out why they were presenting in the ED. Well, it turns out that the little plastic spacer, the tube that the inhaler medication goes into—for a lot of people, that spacer cost more than the medicine, so they were buying the medicine, but not the spacer. So they were trying to administer their medication without it, and it wasn’t working.
We also know that the stress you associate with getting to the doctor’s office can be more predictive than what your issue is. We also know that if you use a step stool to get into your bed, that you’re significantly more at risk for a fall. So once you start developing an analytics tool, and an analytics environment, you get smarter; but then you also end up aggregating new sets of data, and you learn how those new sets of data impact your environment.
What has been the hardest thing so far in all this work?
I think the hardest thing is really getting everything to work in concert with every other thing. One of the real challenges of our healthcare system is just how fractured it is. So as an accountable care organization, your sole mission is to reduce gaps in care and improve outcomes, but you’re trying to do that in a system that is essentially fractured, so getting everyone to work in concert is the hardest thing to do.
IT-wise, what’s been hardest?
Attribution and identification. You’ve got lots of different systems with unique identifiers. And so how do you create an IT infrastructure that links all the various data elements?
How far along are you on mastering those two challenges?
I think that we feel good about where we are; on the clinical and claims data, I think the next frontier is really non-clinical data, in order to be able to intervene to help patients, based on data that is not at all clinical, but that can provide great insight into how to care-manage patients/members. For example, does a patient own a car? What is that patient’s transportation capability? Because what you find is that a primary care physician might refer a patient to a specialist who’s nowhere near a bus route, and the simple fact of the inability to access transportation can strongly impact the clinical outcomes involved in a situation.
How do you resolve issues like that?
We have an infrastructure called Health Partners; they are RNs and social workers; and they’re charged with those duties. We have well over 30 RNs and probably five social workers. They’re solving those kinds of issues every day.
Will some of this come down to things like buying people bus passes?
Yes. I think we’ll find that the barriers are not significant, but they are persistent. And transportation affects every element. Do you live in a food desert? These aren’t big healthcare infrastructure investment issues; but if you’re a diabetic and you don’t have any place to get fresh fruits and vegetables, it’s going to be hard for you. So it’s going to be some of those elements that will improve the health status of our patients and members.
Do you have a CIO for your ACO?
We don’t; we have an IT affinity group with people from all across the organization; and they identify use cases and prioritize them on a quarterly basis. So someone inside Mission Point will take these things on. We actually only have one internal IT person; Crimson is a complete turnkey solution for this; our IT functions are all outsourced.
What would you advise people whose organizations have not chosen to outsource their IT capabilities, with regard to the IT issues involved in all this work?
I think you first have to identify your most important use cases to solve for; then you have to deploy your solutions, which will be largely dependent on your use cases. So a data warehouse, analytics engine, and EHR interfaces, all your standard fare, are going to be essential.
What kinds of clinical informatics issues come up?
I think that one of the big issues in the clinical informatics arena is discrete data and unstructured data. It’s very hard if you’re dealing with a lot of unstructured data. Let’s say you’re a small provider group, participating as an ACO. If all of your real, critical data is in unstructured notes, it’s going to be very difficult to report on your quality outcomes indicators for CMS [the Centers for Medicare & Medicaid Services]. Second, if you don’t have a master patient index, you’re not going to get your full credit, because somebody somewhere else may have given a patient a flu shot, but you’re going to have to say that you didn’t. And the third is, what is the technology going to be that you’re going to use to interact with your patient? Are you making full use of your patient portal or set up a separate portal? How are you going to interact with your patient?
Do you have dashboards for the physicians, in order to help them track their performance and their patient panels?
Yes, all of our applications have custom dashboards, depending on the use case and the user.
And, with regard to your physicians, what percentage are employed versus independent?
Eighty percent are independent, which is a lot.
How do you get all those independent physicians to buy into the concept?
Our physicians are committed to the same frames that we are, so I think we align philosophically in most cases; and we’re here to help them with their patients. So the work they do every day is of great value to them and their patients.
Are there any broad lessons learned that you’d like to share?
My overarching comment would be, there are no magic bullets; this is pick and shovel work. So anybody who’s going to get involved in managing the needs of a population will have to get involved in the day-to-day commitment to do that; there’s no quote-unquote-easy solution.
Somehow, all this brings to mind my reading about the early history of the development of the passenger car, how so much at the beginning was built totally custom, and how it took decades to begin to standardize auto manufacturing processes.
I feel like that every day! But I think you’ll find that the ACO movement will continue to grow; but smaller players will begin to come together, because of the high fixed costs involved. So you’ll see some merging and consolidation, but the overall work will only continue to grow and expand.