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New England Innovation: Collaborative IT Foundations for Accountable Care

January 18, 2013
by Mark Hagland
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Dr. David Wennberg shares his perspectives on the gains he and his colleagues are making in jointly laying the IT foundations for accountable care

David Wennberg, M.D., M.P.H., is CEO of the Northern New England Accountable Care Collaborative, a Portland, Maine-based collaborative organization founded by four hospital-based organizations in New England: Eastern Maine Medical Center (Bangor, Me.), MaineHealth (Portland, Me.), the Dartmouth-Hitchcock healthcare system (Lebanon, N.H.), and Fletcher Allen Health Care (Burlington, Vt.). Of those organizations, Eastern Maine and Dartmouth-Hitchcock are  Pioneer ACOs [accountable care organizations] under the Medicare Shared Savings Program, while Maine Health is a participant in the regular Medicare Shared Savings Program for ACOs; and the executives at Fletcher Allen Health Care are considering participation in one of those programs.

Wennberg spoke recently with HCI Editor-in-Chief Mark Hagland about the creation and development of the Northern New England Accountable Care Collaborative (NEACC), and about the IT foundations needed to facilitate accountable care. Below are excerpts from that interview.

Tell me about your organization?

Our owners are four health systems, and they’ve created what is essentially a shared services organization with a products suite and a services suite. And the products suite provides an intelligent infrastructure to support accountable care, but it also works for bundled payment and patient-centered medical home models.

David Wennberg, M.D., M.P.H.

How and when did your founding organizations come together to share services to support accountable care?

The conversation started about a year and a half ago, and we were officially incorporated in March. So essentially, the setting was that the Affordable Care Act had been published, including this concept of shared savings, but neither the regular nor the pioneer regulations had yet been published. But general information was out there, and there was enough interest in it in Maine. They thought they should save money on the initial investment, and could also learn from each other about how to do things better. They’re using the same data model and applications; their care models are all different. But all have the same basic financing model. The differences between the pioneer and regular shared savings model aren’t that great.

What are some of the mechanics behind the collaboration?

We integrate claims data from ADT [admissions/discharge/transfer] information, including, interestingly enough, via HealthInfoNet [Maine’s statewide health information exchange], whose leaders we’ve been working with. So we get access to ADT data statewide; and we get select data from EMR vendors, from Epic, from Cerner, from GE Centricity; and soon, we’ll get data from others as well. And we get laboratory data. We will be getting patient reporting measures later this year; and the data are integrated into a longitudinal, patient-centric data model.

Where do the analytics tools come into this process?

We use SAS a lot, developing new IT and predictive analytics models. And we use Crystal Reports for our presentation; and Business Objects as a hosted, cloud-based design; and we have applications for care coordinators, physicians, and administrators, that sit on top of the predictive models, and the Business Objects tools are used primarily by super-users who are accessing their own data warehouse. There’s a virtual data warehouse for each of the four systems. It’s a private cloud, actually sitting at Dartmouth College. And we do all the management, predictive models, and risk models, and it’s all served over the web, via web-based applications.

When did you go live with sharing of data or using data?

We went live earlier this month [January]. The first version of this solution is being used by care coordinators—some call them health coordinators or care managers; but it’s basically a patient list with clinical risk scores, recent events like admissions and transfers, admission or readmission risk, etc. And it has some areas for notation and planning, outreach calls, etc. So essentially, it’s a workflow tool. Initially, we’ve got about 75 care coordinators across three sites, about 25 care managers at each of the sites, using this; and the fourth site will eventually be determined. That’s for the first application.

Application two will be the physician view. Using that application, physicians will be able to use dashboards to compare the cost and quality of their care for their patient panel to those of their physician peers. And it will provide us all with regional benchmarking across all four participating health systems. In an ideal world, you could say, I’d like to find all my heart failure patients with a moderate or high risk of readmission whom we haven’t seen in the past three or four weeks; and you could instantly see where your opportunities for improving population health might be.

That approach would be similar to how some of the Beacon Communities are approaching population health, correct?

Exactly. And, when successful, a solution like that should be able to communicate to itself; you could say, I’d like to have the following 15 people seen, so it will essentially communicate within the system what needs to happen.

And application three will be the administrator application, which will provides the clinical and financial data.

And that’s where the heavier analytics stuff comes in?

Yes, some of the heavier business intelligence tools come in there, and we’re using SAP for those. Those tools will be rolling out over the next three to four months; the data model is already done. What needs to be done is creating the data marts; the basic data mart model is done, it’s just a matter of serving up the configurations, and a few additional applications as well.

What do you hope will happen over the next year or two?

Our hopes are really to build out the full information suites so that these healthcare systems, which really are in a very new environment, that they become successful, and that we can be a true component in their success. So there are a lot of technical issues, but the most difficult ones are cultural and organizational. We physicians are smart and organized to work in the environment we’re in, and that happens to be primarily fee-for-service. And the entire way that the healthcare system is organized is optimized for the fee-for-service environment. So recognizing that you’ll actually have to keep people out of your office, and coordinating care, all those things are challenging.

What advice might you want to share with hospital, medical group, and health system CIOs and CMIOs?

I think one piece of advice is, be somewhat humble about what you can get done in a short period of time, both technically and culturally. Second, this is going to become a much larger proportion of their time and energy, and it’s time to start investing in it now, because there’s going to be rapid change in healthcare, and they don’t want to get left behind.

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