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Value-Based Healthcare and IT: HIT Leaders Work Out New Strategies

September 27, 2017
by Mark Hagland
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Experts at leading patient care organizations discuss just how complex the IT challenges in front of them really are

When it comes to the plunge into value-based healthcare of all kinds—participating in value-based programs, both mandatory and voluntary; participating in accountable care organization (ACO) and other risk-based contracting involving population health management; participating in bundled-payment contracting; and all the rest—the leaders of patient care organizations are only beginning to fully realize how complex the strategic IT challenges involved really are.

For the leaders of the eight-hospital Orlando Health, based in Orlando, Florida, participation in accountable care/value-based healthcare has provided welcome opportunities—as well as some very practical strategic IT challenges.

As Jerry Senne, vice president of value-based care and population health, and Brandon Burket, director of value-based and accountable care, note, Orlando Health joined the Medicare Shared Savings Program (MSSP) on January 1, 2013, and, Burket reports, “We’ve been able to generate shared savings every single year. We’ve also generated some of the highest quality scores” in the program, he notes. And their organization, whose physician network encompasses 900 employed and 2,800 affiliated physicians, and a health system staff of over 18,000, continues to move forward in its accountable care/value-based care work.

Senne and Burket and all of their colleagues at Orlando Health have been making tremendous progress on all fronts, but it should surprise no one that data and IT issues have come to the forefront in this work. “At a more granular level,” Burket says, “we’ve had challenges with data, in terms of timeliness, accuracy, and the lag itself. We get the reports only monthly or quarterly with some payers, and often, that’s not often enough to be actionable, or it’s too old; so it’s more using the data as a compass than a roadmap.” Still, he adds, “The benefit from getting the data, even if it’s old—is that it creates a level of transparency and competitiveness among providers.”

Brandon Burket

Indeed, crucially, Burket notes, early on in the process as an MSSP-participating ACO organization, “We quickly developed what we called a data roadshow, and went around to physician practices, asking them which metrics would be useful for them. We developed 15 or 16 measures and developed our own homegrown data dashboard every month, and actually said, ‘Dr. Jones, you’re number 54 of 56 docs on this contract.’ We created a level of transparency that engendered a level of competitiveness that made people want to get better on these measures. And over time, the standard deviation actually got tighter; people were performing at a much higher level, and there was much less variation. That said,” he continued, “a lot of our commercial contracts are more claims-based, so it’s less onerous on the providers to report. But with regard to the MSSP, it’s quite a bear of an endeavor that many organizations struggle with every year. And it takes our care and coordination team quite a bit of time and effort to report on accurately.”

As Senne sees it, the ability to capture “population-based data—payer/claims data, pharmacy data, and to be able to distill that into reports, is important,” while at the same time moving physicians forward “to participate in medical governance and really participate in the journey, that is critical. Second,” he says, “to be able to achieve and maintain actionable data,” is crucial. “In early versions that payers came out with, they would say, your population health performance was ‘78’ on a scale of 1 to100; well, that was meaningless to physicians. On the other hand, if they gave you a list of the diabetics on your panel who were not controlled in their hemoglobin a1c, that was usable.”

Of course, all of these imperatives end up falling into the laps of CIOs and their colleagues in organizations participating in value-based care delivery and contracting. Rick Schooler, who’s been Orlando Health’s CIO for 16 years, sees all this clearly. “There are several must-do’s” for CIOs and other healthcare IT leaders in this venture, he says. “Number one, throughout your healthcare continuum, you’ve got to have integrated information, to the degree possible. And that’s a lot harder to do than to say. As your patients go through the continuum, those who are managing their care have to respond to things that do happen or don’t happen. You’ve got to have an EMR [electronic medical record] platform that’s generating and is capturing data, across that continuum. And you’ve got to have what a lot of people are calling population health platforms. And it’s not so much, ‘Hey, Rick has a lab result,’ but rather, ‘Hey, Rick didn’t get his lab work done.’ So there’s got to be a surveillance element going: are the things that should be happening, happening?”

Rick Schooler

What’s important, Schooler says, is to build the analytics capabilities to determine that “what should be happening is happening, and what shouldn’t be happening, isn’t happening. And you’ve got to understand physician performance: are physicians ‘in protocol’ in terms of managing their patients? You’ve also got to be able to look at claims data. And these are basically descriptive analytics. I don’t think you’ve necessarily got to have predictive analytics, though if you do have those, that’s great. But you have to make sure patients are compliant with their care plan.”

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