For a journalist who writes about health information technology, Philadelphia turns out to be a pretty good place to live. I have had access to regular presentations by the researchers at the Center for Biomedical Informatics at The Children's Hospital of Philadelphia Research Institute, including their annual Mid-Atlantic Healthcare Informatics Symposium. Another local gem is the Jefferson School of Population Health of Thomas Jefferson University. Its founding dean, David Nash, M.D., M.B.A., brings to Philadelphia a series of speakers working on healthcare transformation.
Last week at Jefferson’s downtown campus, I had the chance to hear James Barr, M.D., talk about how accountable care organizations are engaging physicians, including providing data to help them improve.
Dr. Barr is chief medical director for Optimus Healthcare Partners and medical director of the Atlantic Health Systems ACO, which together manage approximately 1,800 physicians and 200,000 patients in New Jersey.
Barr, a family physician, got involved in the patient-centered medical home movement several years ago. He said his practice had used an electronic health record before that but never really measured how well they were doing at meeting evidence-base best practices. They just assumed they were doing a great job. He decided to take a closer look at how well they were performing with the diabetic patients in his practice. “Lo and behold, we were only 40 percent compliant with the guidelines. At first you assume the data is wrong,” he said. But then you look closer and you see the preventive screenings that didn’t get done. You realize that 40 percent number is real.”
Barr talked about how he transformed his own practice but also about how the ACO model and its analytics infrastructure can engage physicians in a high-performance network.
Barr said the biggest change he has made is one of mindset. In the old model, he said, he would think of patients who missed appointments as non-compliant. Now he thinks of himself as responsible for his patients all the time. “The patient did not fail me. I failed him,” he said. It is a different concept of proactive, not reactive, patient management. “We are trained to be reactive,” he said. “But if a patient doesn't show up for an appointment now, we call them up and ask where they are.”
He said that as well as convincing doctors that joining the ACO will improve care, he has to explain the business case in which the practices are paid extra revenue per member per month if they move toward the performance goals. That extra revenue can help offset costs of upgrading an EHR and bolstering the practice’s staff.
Another incentive is that the ACO can help practices with all kinds of reporting, including pay-for-performance and PQRS. The Atlantic ACO has an analytics team that works with the Milliman Medinsight platform to pull together claims, lab, pharmacy and EHR data. They feed data to physicians so that they can see which areas they still need to improve on to meet the ACO’s goals.
“This is full transparency. Physicians tend to be very competitive, and we try to leverage that,” Barr said. “We show everybody’s data, and who’s doing the best and then share best practices.” If the practices fail to improve over time, they leave the ACO. “Purchasers now want high-performance networks,” Barr stressed. “Physicians need to realize that unless you are providing value, you are not going to be part of the delivery system in the future.”
Here is one simple example Barr gave about how showing physician practices data can transform care. In his own practice he started getting reports on emergency room usage and diagnoses of his patients. They often involved back pain or bladder infections. He determined that 40 percent of the problems could have happened in his office. Now his clinical coordinator calls these patients up to ask if they tried to reach his office before going to the ER and to see if they would like a follow-up visit. “After one year of this effort, my patients’ ER usage went down 24 percent. My staff was thrilled to see these results every month.”
“That revenue can allow you to invest in staff to do outreach to patients who need more care,” Barr said. “This isn’t the gatekeeper model of capitation. Instead, the physician is a gateway to more care.”
Following up on a question from the audience, Dr. Nash estimated that 30 million patients are currently in ACOs but perhaps only 3 percent of those see their health data drilled down on at the sort of level being done at Atlantic. So what is keeping the rest from turning on this level of data-driven care?