Swieskowski adds that he in “no way happy” with the data systems to measure and track what the ACO is doing. “It’s not anywhere near what I think we could be doing. By this I mean with our data warehouse, we’re getting the billing information well, but we’re not getting clinical information, such as ‘Is your blood pressure or blood sugar controlled?’ We just are not getting the data in the way we wish we were. If we were, we’d be able to feed it back to the physicians and offices, and make an impact on performance improvement. If you don’t have the metrics to see if you’re making any progress, it’s hard to make progress,” he says.
As such, Mercy has built disease registries. It has a data warehouse where clinical data from EMRs and billing data are married together in one database to try to understand clinical quality and cost for the patients the ACO is taking care of, Swieskowski explains . “The warehouse is used to measure ourselves and improve quality. We probably have 15 EMRs across our ACO, so we get an electronic feed from those, and we then standardize them so we all have a standard measurement across the entire ACO. So we use that for our quality improvement, not the meaningful use reports that come out of the EMRs.”
Another challenge that leaders at Mercy face is engaging physicians to engage patients. Swieskowski says that when a patient comes in the office, it’s easy for a physician to literally walk him or her three down to the health coach. While that can be a powerful approach, some clinicians remain hesitant still, he says.
“Not everyone wants to buy in. But we tracked the data on the physicians, and we found that those who utilize health coaches had better quality outcomes and higher productivity. There were also increased revenues in the practice because you are doing all these ancillary tests and medically-necessary tests that don’t get done. Due to the way offices are designed, you can’t address them in a 10-minute visit,” Swieskowski says, adding that the increased revenue came out to more than $600,000 per coach per year that is generated in the office setting when you have a coach in there. “Quality scores also got better, so based on that physicians have accepted this strategy, and are even paying for the coaches out of their pockets.”
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