Headquartered in San Francisco, Dignity Health is a large integrated health system operating 39 hospitals, with facilities predominantly in California, Arizona and Nevada. Dignity Health’s network of providers comprises about 1,400 physicians that are either employed by the health system or in its foundation practice models, and an additional 6,000 independent physicians that are aligned with the health system through eight regional clinically integrated networks.
In the past few years, Dignity Health executive leaders have made significant strides toward evolving the organization from a hospital to a care continuum company and a clinically driven enterprise, and physician integration and population health management both play critical roles in this journey. The health system also has increased its focus on new models for healthcare delivery with the aim of improving patient care, quality and lowering costs in its communities.
However, Dignity Health executive leaders faced the challenge of having a fragmented approach to population health across the health system's expansive footprint, which includes eight regional clinically integrated networks, according to Julie Bietsch, Dignity Health’s vice president of population health management. “We divide our market into eight geographic regions, and each region is doing something different. We needed to get agreement from everybody on how we were going to assess the members, what care plans are going to be offered, and then how are we going to measure success. Also, before we implemented a population health technology solution, we were doing care plans on paper, and you can’t do any data analytics when you have paper.”
What’s more, risk stratification was a significant hurdle. “When you look at a population, you need to be able to say who needs wellness intervention, who is a rising risk, and who needs complex interventions. We really had one market that was doing risk stratification, and they were doing it manually,” she says.
She continues, “We also had struggled in each market to declare who is going to be the owner of risk. Now that we have identified every risk member, then who owns this to make sure we’re successful? It’s difficult to get a view on how you are doing from a system perspective because of those fragmentations.”
Health system executive leaders were looking to make large-scale population health management a reality, and began working with Boston-based health IT company athenahealth two years ago to implement its population health management solution.
As part of its robust population health management strategy, Dignity Health wanted to develop an integrated care management platform to help implement standardized care models across its clinically integrated networks, says Bietsch, who has worked at Dignity for three years and partners with the vice president of physician integration to develop population health strategies in all the health system’s markets.
Currently, there are about 1.1 million patients cared for under value-based payment models, according to Bietsch. “Those value-based contracts range anywhere from something as simple as a network design to all the way up the cost continuum to full risk. So, about three-fourths of those 1.1 million members have up and down side risk.”
For the past two years, Bietsch and her team have been focused on building what she calls a strong foundation for the clinically integrated networks.
“We also recognized that we had a problem with out-of-network utilization, once we started looking at the data, and we needed a system to manage our out-of-network information. That’s what we’ve been focusing on for three years—those care plans, analytics, out-of-network management,” Bietsch says. “I see us evolving into things more like looking at tools and solutions around patient engagement opportunities, but right now we need to be strong in the basics.”
Dignity’s Data-Driven Population Health Strategy
Dignity Health’s population health strategy is focused on network development, implementation of payer risk contracts, alignment of clinical solutions and analytics and technology to support the integrated solution. Leveraging the platform, Dignity Health rapidly integrated a wide range of disparate electronic health records (EHRs) and aggregate data from a variety of sources, including hospital data, payer claims, lab results and prescriptions, Bietsch says.
In addition to the above data sources, Bietsch and her team recognized that admission, discharge and transfers (ADT) data was a pertinent piece of the puzzle as well. The platform now includes patient ADT data from all of Dignity Health’s hospitals, and project leaders also worked with state health information exchange (HIE) organizations and competing health systems to integrate ADT data. “We now have 13 hospital systems and two states HIEs that are giving us ADT data,” she says.
Integrating the population health platform with EHR systems was another significant hurdle. “The physicians who are employed by Dignity or are in our foundation are on two EHRs right now. By the end of 2019, we will be on one EHR. We are mapping that EHR data into the platform; we’re not quite there yet,” Bietsch says. “Part of the problem with EHR data is there are things where it’s reportable because data are in certain fields and then there are a lot of things that are just in physician notes. We’re working on things like natural language processing to extract the physician notes.”
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