“The reality is that most independent physicians have traditionally operated in a data-poor environment. They couldn’t tell you how many of their hypertensive patients have their blood pressure under control. They would have no easy way of finding that out if you asked them.”
That quote is from Carl Couch, M.D., president of the Baylor Quality Alliance (BQA) in Texas, a quality improvement organization that includes approximately 1,400 independent physicians and 600 employed ones. I recently had the chance to talk to Dr. Couch about BQA’s efforts to get physicians out of that data-poor environment.
BQA,a wholly controlled affiliate of Baylor Health Care System,recently announced plans to use Humedica MinedShare to extract and normalize clinical and administrative data and provide detailed analytics.
HealthTexas, BQA’s employed physician group, has used a homegrown analytics tool for several years to pull data from its GE Centricity electronic health record. “But the independent physicians have more than 40 different EHRs,” Couch explained. “Our solution to that is to build our own health information exchange, using AT&T’s Covisint product.”
BQA is loading data into Humedica MinedShare from physician practice EHRs, from the hospitals’ Allscripts EHR, and from claims data from the major payers in the area, Couch said. The multiplicity of sources will provide a robust view of patient experience. “Humedica is a natural for gap analysis,” he said. The plan is for health professionals at BQA to identify people at risk of developing chronic illnesses or hospitalization, supporting efforts to intervene proactively. If there is a patient who needs to be checked for certain diabetic measures, this gives BQA more of an opportunity to reach out and engage patients. “We are creating a care coordination infrastructure, and those care coordinators can reach out and get patients into the office,” Couch said.
Couch also likes that Humedica, which is now part of Optum, offers population segmentation and risk analysis tools. “It has built-in predictive modeling to help us identify the sickest patients and who is at risk of falling into that category. We know that the top 5 percent of patients account for 50 percent of the cost and the top 20 percent for 80 percent of the cost,” he said. “If we can identify conditions where we have the opportunity to intervene, it can make a huge difference.”
Couch said that the toughest part of the implementation rollout would be cultural. It is a major cultural shift to accountable care, he explained. It is a shift from a fee-for-service world where more care was always better. “We are working on clinical integration and getting different providers to talk to each other.”
There are inevitably three phases doctors go through as they learn to work with data. First, they challenge it, saying the data must be wrong. “That’s why when you ask them to start working with data, there is an obligation that you have a continuous improvement process to improve the validity of the data,” Couch explained. In the second step, doctors say their patients are sicker than those of other doctors and that explains why their performance is lower. “This is usually not the case,” Couch said, “but we can do risk adjustment on the data to account for that.” The third phase is acceptance of the data and the first efforts to look at what they can do to improve performance.
“We are loading data into Humedica now and expect to have a full roll-out by September,” Couch said. “We’re excited about it. We know that if you don't have data, it is hard to improve.”
Besides using MinedShare, BQA will also participate in the American Medical Group Association’s (AMGA) Anceta Collaborative to enhance shared learning with other AMGA members. Anceta describes itself as a learning community that illuminates the relationships between care process, patient outcomes, and cost—all the elements of the value equation.“As we approach population health, we have to come to it with a certain degree of humility and admit there is a lot we don’t know and that we want to learn from the best,” Couch said, “and also share what we learn.”