Atrius Health, a non-profit alliance of six community-based medical groups in Massachusetts, encompasses more than 1,000 physicians and more than 2,100 other staffers, in six separate medical groups, based in Newton, Massachusetts, that are taking care of 35,000 Medicare beneficiaries in the Pioneer ACO program, sponsored by the federal Centers for Medicare & Medicaid Services (CMS).
Like all those involved in the Pioneer ACO Program, the leaders of Atrius Health have been slogging through a broad range of issues, from working through patient attribution issues to achieving patient/plan member engagement, and from achieving outcomes goals to meeting financial savings targets set by CMS.
In that context, Emily Brower, the executive director of accountable care programs at Atrius, was one of several medical group executives who spoke with Editor-in-Chief Mark Hagland for his October cover story for HCI.
As noted in that article, for all the challenges facing Pioneer ACO and regular MSSP program participants, some leaders of larger medical groups participating in those programs are feeling confident these days; and most of all, they are using the opportunity to participate in one of the two Medicare programs in order to engage in conscious learning. A great example in that regard is Atrius Health, a non-profit alliance of six community-based medical groups in Massachusetts. With more than 1,000 physicians and more than 2,100 other staffers, the six medical groups, based in Newton, Massachusetts, are taking care of 35,000 Medicare beneficiaries in the Pioneer program.
In joining along with the other 31 Pioneer organizations in January 2012, “We had very specific goals when we started,” says Brower. “One goal was to move towards a population-based approach, and a single model of care for the Medicare population, which was population-based, as opposed to thinking about patients being in different service models. What being in the Pioneer ACO did for us was to help us think about the entire Medicare population in the same way clinically—we take an approach that serves that entire population.”
The other goals, Brower says, had to do with aligning all clinicians to work together, Atrius-wide, on care delivery improvement. “We want to think of ourselves as a system of care where we can share best practices, and to replicate, wherever we can find it, across all of Atrius Health, to create systems of care,” Brower says, and working within the Pioneer program is giving her and her colleagues the opportunity to do just that. “That’s been incredibly rewarding. We have a team of about 50 people who are working on our population health strategy, testing [strategies]; we call it our ACO team. It includes our Pioneer population, our Medicare Advantage population, another 30,000-40,000, and our dual-eligible population of about 5,000.”
Still, despite that enthusiasm, Brower concedes that there have been challenges along the way, particularly “a couple of challenges around the way the Pioneer model is structured that’s very different, in terms of how accountability is measured,” Brower says. “Just the fact that it’s different from the way things are structured with a regular health plan,” has been challenging, she says. “The way that financial accountability is set and measured is very different from within the Medicare Advantage program or certain health plans. We’re working within it, but something that is very different is always a bit hard. We’re a very data-driven organization,” she emphasizes. “We’re used to tracking things ourselves, but in this situation, we have to rely much more on Medicare.”
What have been the biggest IT-related challenges involved? “One of our core competencies is around data management and delivery for clinical information and transformation,” Brower says. “We have a fully integrated data warehouse with the full set of claims data from our payers, that works with our Epic EHR-provided data. That helps us understand clinical and performance gaps. It helps us to reach out and manage the population, as well as to help us understand how we’re performing; that’s been a real challenge for us. Medicare, the data is a bit different, so we had to do a bunch of work within our data warehouse to take that data and make sure it’s presented in the way we see it with our other payers. Medicare presents the data on inpatient stays differently. They do send us the full data set, so there are two gaps. One is that patients have the option of sharing their data with the ACO; the other is that Medicare does not share substance abuse data.” Fortunately, fewer than 5 percent of attributed patients refuse to allow their data to be shared. “Otherwise, it would be incredibly difficult” to make the analytics and reporting work, she notes.
Also fortunately, Brower and her colleagues have already been using the data warehouse for several years, and that fact has been very helpful in moving forward. What’s more, she reports, Atrius Health has a CIO, a medical director of health analytics, and a director of informatics (three separate people), and, she says, “We have great IT leadership. And we work really closely with both the medical informatics and data analytics teams.”
What has been learned so far, and what will success mean over time with the ACO model? “One of the things that the Pioneer ACO, or really, any PPO population, because Medicare really is our country’s largest PPO, brings,” Brower says, “is that it really brings you face to face with the fragmentation of care. This is a population with high needs, and are using a lot of services, and are getting them from a very broad network of providers, hospitals, specialists, etc., so when we started to look at the data, we really stepped back and said, wow, if there ever was a population that needed coordinated care, this was it; and for those patients, it’s really all about providing a great experience,” she says, “because if patients have a great experience, they will look to Atrius for care. Because a good, strong, trusting relationship will lead to a patient calling on their providers for care, and if you think about a Medicare patient with multiple chronic conditions and on multiple medications, if we can do this with one EHR and one medication list, it can be safer for patients.”
With regard to the analytics supporting all of this, Brower says, “Everyone always wants more analytics. They’ll always want more, because it’s so helpful and foundational to our work. So we’re very lucky that we have a very good analytics shop, and a good electronic health record platform. I feel very fortunate in this program, the ACO program, to have all those resources; I certainly hear about the difficulty that some of my colleagues have. And we would love to get patient experience data built into our data warehouse; that’s the piece that sort of sits a bit aside. And when we talk about the Triple Aim, we’d really like to bring that in, we talk about meeting the needs of the patient. We’ll be able to do that someday, I think that will be really exciting.”
What kind of advice would Brower offer to healthcare IT leaders around the country? “I think that where things are moving in the new healthcare is that data analytics and HIT and HIE, HIM”—health IT, health information exchange, and health information management—“and all of those pieces are no longer service areas, those kinds of areas are actually the gateway through which we do our work,” Brower says. “They’re so fundamental for delivering efficient, value-based care, closing gaps. All that new healthcare requires a really robust and sophisticated data analytics team and data architecture, all those things. This is the time. There are so many meetings I go where people say, we need more analytics, more people to help us with this. It’s just such an exciting time in health informatics.”