Accountable care organization (ACO) work continues to move forward at the Springfield, Massachusetts-based Baystate Health, a six-hospital health system serving large swaths of western Massachusetts. Anchored by flagship facility Baystate Medical Center in Springfield, the health system encompasses six hospitals, 80 medical groups, and its own health plan, Health New England, which has 200,000 members. Baystate Health serves 900,000 patients across four counties.
Meanwhile, Baystate Health joined the Medicare Shared Savings Program for ACOs in 2012, with its Pioneer Valley Accountable Care organization, or PVAC, which encompasses 90,000 lives. Joel Vengco, vice president and CIO at Baystate Health, spoke recently with HCI Editor-in-Chief Mark Hagland regarding his organization’s experiences to date with accountable care-driven care delivery. In the first part of his two-part interview, Vengco shared his insights on the early phases of ACO development. In this second part, he discussed issues around aligning his organization’s health plan and ACO, and the implications of the learnings taking place at Baystate Health, for CIOs of other organizations.
Do you feel that the ACO and health plan in your enterprise are organizationally aligned?
There's a little bit of a tension there between the objectives of the health plan, which is looking to be efficient and save, and that of the ACO, which is looking for revenue, obviously, but also to achieve shared savings. But ultimately, we have folks from the health plan who sit on the board of the ACO, and vice versa, so there is an aspiration to be aligned. Ultimately, they still have the same goals in mind—the Triple Aim, more efficient care and greater value. So those are the same broad goals overall; they have some different fiscal and financial differences and goals. But in terms of care management, it’s very much aligned.
I often think about how difficult it was to build the Transcontinental Railroad, where people literally had to break rocks and other hard ground to build that important railroad. You’re breaking new ground. In what you’re doing. In that regard, what should CIOs know about this kind of work?
You need to be aware of the relationships around the community. If there is a formal ACO, make sure you know who all the leaders are. They all have different needs and systems. So you need to be aware of who those leaders are and what kinds of levels of technology sophistication each of their groups has. Second, you need to figure out ways to connect these disparate providers to each other, whether through data connection or collaboration. We pushed out a secure texting app, so that clinicians, doctors and nurses, and office staff, can securely text across the region. For example they could text the pulmonologist or orthopod they’ve referred to. And we offer that through our accountable care organization.
And the third thing is having an understanding of what systems you as the CIO—since you have the largest IT footprint—what you as a CIO should be offering to the region to help continue the collaboration. Is there a single system you might have folks converge on for data exchange? Do you want to offer them views of your enterprise EHR or somebody else’s EHR is there a care management program you can converge on? But the care management programs themselves are still nascent, still in their embryonic phase, and really, not even infancy yet! And CIOs need to make sure they keep an eye out for the analytic needs of the ACO, and identify how you can best help provide reports and analytics for managing shared savings, global payments, and so on. And a lot of that is still nascent. A lot of firms will say, we can do this for you. But if you don’t have the data, you can’t manage the analytics.
And the other thing I would say is that we CIOs are in an interesting time in our industry. There are so many innovations there and there are so many learnings and technologies from other industries that we could benefit from. Think of the analytics coming from the stock market. You could use those kinds of algorithms to sift through signal data. And think about technologies like OpenTable and Uber, which could manage populations. OpenTable could help provide better access to scheduling. And new innovations are coming into other industries that we should be open to trying out.
At Baystate, we opened a technology innovation center in November 2014, called TechSpring. It’s really what we call an innovation center that opens its doors to crowdsource innovation in healthcare. It gives technology firms, both startups, and large firms, the ability to have access to real, live healthcare data, and the environment, and experts in that environment. It’s creating a space whether they can incubate their solutions or innovations inside a living organization like Baystate Health. So it allows us to partner with these partners to solve some of the most difficult problems we have in healthcare today.
So we’ve got a lot of innovations in the pipeline and have a few things we’ve already released. And tomorrow, Dell is coming down to announce an innovation with us—we’re partnering with them on a couple of major fronts. The first is telemedicine—everything from e-visits, which are still in their infancy, because folks are still trying to figure out reimbursement issues, to teleconsults—how do you keep patients in their community hospitals? How do you provide services to patients who are at a distance to their tertiary care hospital? And the third thing is home monitoring, everything from glucose monitoring to palliative care. And the fourth is things like kiosks for e-visits. So you’d have a pod in a retail store for telemedicine. So we might pilot this at a local airport or university. HealthSpot is the company; Cleveland Clinic is using it as well. We’re a pilot site for them, and we think that’s a great innovation for extending primary care services. Imagine having something like this in a mall; it looks like a photo booth. So that’s really neat.
And, with regard to analytics, Dell has traditionally been known as a vendor for hardware, but they’re really getting into things like stratification and predictive modeling and prescriptive analytics, using their computing power. They’re wanting to use real-life data to use these models they’ve been developing to manage care. So we’re going to talk a little bit about that with them.
CIOs seem to be becoming uber-facilitators at a higher leadership level these days. Am I right?
You are right. I think that traditionally, IT has been seen not as strategic, but as a thing that you plug in. And what I’ve been preaching since I took this role about three years ago is that my role is no longer going to be just about the technology any longer; it’s going to be about information, and the strategic value of information to the organization at large. And I changed our name subtly, from Information Services, to Information & Technology. So we’ve got this ampersand in the middle of our name, because I wanted to highlight that our value is really about information. So yes, as CIOs, we’re now managing everything from the operations of the health system, to ensuring that M&As are successful with integrations; and to new realms that are strategic and that will create new viability for the health system, things like analytics.
And we’ll be diving into new service lines like telemedicine, that our outside traditional means of delivery. So you have to be a strategist, a visionary, a salesperson, you have to create collaboration across multiple lines of services. It’s really more of an extroverted role than in the past, and you’re right, you really have to bind the organization. It’s a challenging role and not for the faint of heart, for sure. One day, you’re the hero, the next day you end up being the enemy. So it’s challenging but exciting.
As a CIO, you’re now at a very high level of visibility. I’m sure you have to present regularly now to boards?
Yes. I go to tour general board, to our quality board; every board we have ahs seen me at least once in the past six months. So you have to be engaging; you have to be able to explain technology in simple words. And you have to be able to help these board members be able to relate to things that in many ways might be beyond their understanding; engineering is complex. But you have to e able to help them understand. For example, our Audit & Compliance Board is one of the boards I’ve been in front of recently; and cybersecurity is a huge concern. And I anticipated that a few years ago. And all these organizations are getting hacked, and these lay board members are imagining we’re getting hacked every day. So you have to help them understand that our perimeters are solid; yes, we need to invest more and should do it ASAP, but here are the things we need to be doing to get to a level of security posture. But you need to be articulate, you need to be able to communicate, and you need to be able to sell it; and if you’re a traditional CIO, you need to step up your game.