The DuPage Medical Group, a multispecialty medical group with 425 physicians and 60 locations, with 3,200 employees and about $490 million in annual revenues, is based in the western Chicago suburb of Downers Grove. It serves patients in both DuPage County, and also beyond it, in Kane, Will, and Cook counties. The organization’s doctors admit to several local hospitals, and the medical group has formal affiliations with Advocate Good Samaritan Hospital, Central DuPage Hospital, Edward Hospital, and Elmhurst Hospital (Edward and Elmhurst recently came together in a merger). The medical group’s closest affiliation is with Edward-Elmhurst; indeed, DuPage Medical Group shares the same instance of the Epic electronic health record (EHR) solution with Edward-Elmhurst. DMG has had Epic’s practice management system since 1997 and its EHR since 2006. The organization has also become intensively involved in accountable care organization (ACO) development, both through the Medicare Shared Savings Program and in the private insurance sector, as well as in value-based purchasing development.
Recently, Krishna Ramachandran sat down with HCI Editor-in-Chief Mark Hagland in DMG’s administrative offices in Downers Grove, and talked about a wide range of initiatives and advances taking place at the medical group. Ramachandran joined the organization in June 2010, and in May 2012, was promoted to his current position of chief information and transformation officer. Below are excerpts from that interview.
You’ve been involved in clinical transformation along a number of dimensions. Tell me a bit about the most recent developments taking place at DuPage Medical Group.
Certainly. In 2011, we formed a joint venture with Edward Hospital called Illinois Health Partners—a joint contracting partnership, encompassing ACO and other contracts. It was mostly a capitated patient contracting entity, while consolidating some management and billing services. So Epic, Edward, and DMG are all partnered together in that. And the contract that Epic had with Edward was extended. We had Epic first. They started their Epic conversion with their medical group. And the Edward medical group started with our DMG workflows, and made tweaks. The three-way contract was done end of January 2012, and they were live by May. So that really gave them speed. And there were about 150 Edward doctors going live.
And they were using our training, and it was a shared system; so it was a huge joint effort. That was the summer 2013; and in April 2013, the hospital went live. That has been a joint effort for us. And if something goes wrong, it will impact all of the groups. So my team was sitting side by side with them in the command center, so it was a true partnership. And Bobbie is great. And last week, the Elmhurst Clinic and Affiliated Doctors went live; they’re affiliated with Elmhurst Hospital. About 130 doctors. And they’re now live on Epic also. So every year, we’ve had some massive go-lives. But it’s all gone well.
How big is your IT team?
We’ve got 50 FTEs.
You’re also pushing ahead full-bore into accountable care, correct?
Yes. We’ve been a core founding organization, along with Edward Hospital, of Illinois Health Partners, which started out as a joint contracting entity, and which in January of this year, became an ACO under the Medicare Shared Savings Program. In addition, as of July, we’ve become an ACO in a private arrangement with Illinois Blue Cross Blue Shield. It started off as an HMO. But through the same business entity, we also provide billing services, as Midwest Physician Advisory Services (MPAS). MPAS, as a wholly owned subsidiary of DuPage Medical Group, provides managed care services and billing services for the Edward doctors, the Elmhurst doctors, and of course the DuPage doctors as well, via a staff of 250.
With all this progress and activity, what are the biggest challenges and opportunities you and your IT team face these days?
Two things. One is, most EHRs, as they’ve started, have been expensive ways from moving paper to electronic; they’re been data repositories, and have done a good job with electronic data collection. In terms of initiatives like ACOs and quality initiatives we’re doing, they’ve really challenged us to make data actionable. We have tons of data; but how do we make that data actionable to our physicians?
One example is our creation of dashboards. We first introduced them back in 2010; and we provide the doctors with unblended data down the individual doctor level, how they’re performing, including in terms of their clinical outcomes. The PCP ones speak to diabetic care, asthma management, blood pressure scores. And everyone can see how everyone else is doing. I was really nervous about the level of transparency; but honestly, the doctors would rather embrace something like this themselves, rather than waiting for the government to do it. And that’s a mark of how forward-looking they are. So converting data into actionable stuff. And we’ve used the dashboards for many other things—meaningful use, payer quality projects—for example, asthma, diabetes, genetic utilization.
The physicians really have embraced and internalized dashboard use in the past four years?
Yes, for sure. And dashboard use is part of physician bonus structures and other phenomena.
What’s the key to flipping the doctors culturally on the use of dashboards? Do you talk to those lagging behind in their performance?