Three years ago I interviewed Bill Gillis, CIO of the Beth Israel Deaconess Care Organization (BIDCO) in Boston, about the decision he had made to outsource his organization’s quality reporting data center function to the Massachusetts eHealth Collaborative (MAeHC). I recently had a chance to catch up with Gillis about progress at BIDCO on bringing together claims data with the clinical data in the Quality Data Center (QDC) to hone its population health efforts.
BIDCO, an independent physician network and ACO, has approximately 2,500 participating providers and is affiliated with the Beth Israel Deaconess Medical Center.
Gillis spoke about the increasing sophistication of the population health services BIDCO is able to offer its physician practices.
“When we talked in 2014, we were in the infancy stages of what we were trying to accomplish,” Gillis said. “We were gathering all the data in the QDC, but there is a huge normalization task, and we had to figure out how we were going to leverage that data to make some changes. We have proved that out and are moving forward on a grander scale using the same concepts.”
Every day the QDC gets real-time feeds from the clinical encounters that happen at the practice level. Normalization and validation of the clinical data happens there, and then on a weekly basis that data is sent to a population health platform from athenahealth, where it is merged with claims data. BIDCO is planning to move this summer from that platform to a new analytics platform from Arcadia Healthcare Solutions.
“What it provides us that athena didn’t is the ability to merge and digest that data on a daily basis,” Gillis said. “We will move away from a weekly feed from the QDC to a daily feed into the Acadia platform,” he explained. The claims come in with a 90-day lag, but when they come in on a monthly basis, it will within 24 hours be merged into that data environment.
“The clinical data really gives us a sense of trajectory,” he explained. “With the claims data, you never really know what the payer’s perspective is until the claim is adjudicated. We use the clinical data to give us an idea of where we think things are going,” he said. From the clinical data, it might look like you have closed 75 percent of your gaps on colonoscopies, but when you get the claims data, it may show that you are only at 60 percent. “When we dig into that, we may find a claim was denied or never went out of the billing system.”
The Arcadia platform also allows BIDCO to absorb scheduling data from all the clinical systems into its analytics environment. “You can see who is coming in so you can work with the practice to make sure all the care gaps are scheduled to be closed,” Gillis said. “It allows you to work in a more real-time environment. Once we are live with Arcadia, it will tie more closely to what is going on in their EHR. We will also get more real-time lab data from the EHRs.”
BIDCO has optimization teams that work with practices directly to close care gaps in various contracts. They started with the Pioneer ACO and then added a Blue Cross Blue Shield contract. “We started moving the needle,” Gillis said. “We were able to prove it out by getting this data back into practices’ hands, so they could focus on closing care gaps and dealing with the more unhealthy part of their patient population.”
BIDCO is also looking at embedding the admit, discharge and transfer (ADT) information from member hospitals and facilities into the Arcadia platform so that if a patient shows up in skilled nursing or is discharged, it can trigger a care management follow-up.
One of the challenges Gillis has had to deal with is interoperability between the approximately 40 different EHRs used within the system.
BIDCO has been forced to change its policy around which EHRs its practices can use. The old policy was that as long as you had a Meaningful Use-certified EHR, you could come into BIDCO with that system. “I helped draft that policy,” Gillis said. “It was my own naiveté. My assumption was that MU had a certification requirement for CCD data exchange. We thought that if they are wired by meaningful use to send CCDs, they could just send us CCDs every day. Nice and simple.” But he said that the reality they found once they started to get some of the data was that the majority of these systems could not do it in a production way, and the envelope of data within that CCD is so varied from vendor to vendor. “You could have some systems with a robust payload of data in that CCD, like athena, and you have others that have really nothing at all. That was a real shock for me. It was my assumption that Meaningful Use was going to help us solve this problem. That is why you are starting to see the rise of FHIR now because it is a vendor-driven initiative, whereas CCDs were the government pushing it down.”
The new policy is that practices must use one of five EHRs or the internally developed WebOMR. “These are vendors we have a solid data delivery mechanism with,” Gillis said. “They have worked with us to normalize code sets and committed to interoperability. We have the ability to build clinical viewers, so that from within one system you can query those other systems and see problems, meds, and allergies on a patient in that other system. Those five vendors have committed to doing that work. If you have one of those six, you are all set. If not, you have to convert to the BIDCO-hosted eClinicalworks in its private cloud, or athena clinicals. Providers have until April 2018 to have a signed contract with one of those vendors.
BIDCO has increased the population health services it offers to its provider community, including disease management, clinical guidelines and community care management.
“As we have gathered data and gained expertise around being an ACO, we have pivoted to providing the services that we had gaps in,” Gillis said. Before BIDCO was an ACO and it was just dealing with fee for service contracts it worked on claims data aggregation analytics. “Now we are trying to look at all the various data components to give that focus of what is really going on with the patient. We are expanding the services we provide to focus more on the ones that make the most sense in an ACO global payment structure.”