The Crossroads of Health IT and Accountable Care

The Crossroads of Health IT and Accountable Care

Presented by: Rich Temple, National Practice Director, Beacon Partners

February 6, 2014

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Heading – Ariel 40

• Quick Background on Beacon Partners• The Fast-Evolving Healthcare Landscape• Why Data Volumes are Exploding• The Impact of Accountable Care on Healthcare

Organizations as a Whole and Healthcare IT Departments

• Particular Challenges from Affordable Care• Population Health• Wrap-Up• Questions / Discussion

Agenda for Today

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• Consultancy founded in 19898 Exclusive focus is healthcare

• More than 300 consultants in all types of engagements all over the country and in Canada

• Focus on strategic advisory to health systems of all sizes

• Successfully completed more than 2,000 engagements with over 600 healthcare clients

• HIMSS Platinum member / CHIME Foundation member

Beacon Partners

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Heading – Ariel 40Timeline of Health IT Over the Decades

1990s

Billing systemsEnterprise Resource Planning systemsClinical Ancillary systems

Early 2000s

Billing—> Revenue Cycle systemsEarly EMR systems

Late 2000s

EMRs mature into EHRsHIEs enter the picture

2010->NOW

Meaningful UseBusiness Intelligence / Analytics Moves to the ForeAffordable Care ActValue-Based PurchasingPopulation HealthMulti-entity provider exchangeImage exchange (VNA)

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What Does the Future Hold?

Genomics / personalized

medicine

Predictive Analytics

Around Entire Populations

Streaming Info from Home

Devices

Integration across providers,

payors, and regulatory agencies

FitbitsCardiac

MonitorsBlood pressure

Monitors,etc.

Sharing of Huge Diagnostic

Images

Increasing need to capture and mine unstructured and semi-structured content

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Regulatory Mandates Keep Coming

CQM

PQRS

ACO 33

HCAHPS

Clinical Process of

Care

Outcomes

Efficiency Measures

Readmits

ICD-10

Clinical Documentation improvement,

financial modeling, code mapping, etc.

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• Prevailing wisdom says that hospital’s data storage needs will double every 18 months8 Another way of stating this is that data storage needs will

increase tenfold over a five-year period!8 There are research papers in circulation that state that this is a

very conservative estimate – that the rate of increase could actually be many times higher!

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• And this generally doesn’t take into account new repositories to cover data sources and targets such as:8 Private HIEs with a centralized structure8 Enterprise Data Warehouses (for BI/”big data”)8 Data structures built to support the data capture and rendering

requirements of Accountable Care Organizations (ACOs)

We Knew Data Needs Were Going to Be Overwhelming…

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Heading – Ariel 40• Cloud Storage (private or public “clouds”)• In-house data storage• Data management strategies• Consider different storage strategies for different types of data

8 Recent, critical data needs to be captured with the lowest-possible latency

8 Large percentage of data captured is not directly accessed again – does not need to be in low-latency, easily accessed storage

8 Archive capabilities for infrequently-used data architected to minimize bandwidth requirements

8 Data likely to be required for detailed analytics set up separately and architected to be accessible via distributed computing tools such as Hadoop

• De-duplication strategies• Redundancy strategies for disaster recovery / business

continuity

How to Store and Manage All This Data

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Accountable Care and its “parent”, the “Affordable Care Act”, are

huge drivers of these initiatives through wide-ranging data

capture, data storage, and through detailed analysis of a myriad of clinical and financial data points

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• Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

• The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

• When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

Definition courtesy of CMS: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/ACO/

What is an ACO?

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/ACO/



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• For starters, all ACOs need to report on the “ACO 33” and demonstrate a high level of quality in the following areas:8 Patient/ Caregiver Experience (7 measures)8 Care Coordination/ Patient Safety (6 measures)8 Preventive Health (8 measures)8 At-Risk Populations (12 measures)

• Diabetes (6 measures)• Hypertension (1 measure)• Ischemic Vascular Disease (2 measures)• Heart Failure (1 measure)• Coronary Artery Disease (2 measures)

What Metrics Do ACOs Require?

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Heading – Ariel 40What Metrics Do ACOs Require?

Patient/Caregiver Experience

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Care Coordination / Patient Safety

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Preventive Health

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At-Risk Populations

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“groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients."

Hospitals

Owned and affiliated physician practices

Subacute / LTC

facilities

FQHCs

Engine to feed data into in order to

establish quality and financial metrics and

compare against moving benchmarks

Other providers

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“coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time”

Capture the right data from all sources across many different provider sites and systems

Diff hosp EHRs

Diff physician

EHRs

Excel spread-sheets

Quality mgmt

systems

Case mgmt

systems

PAPER

• Normalize different system nomenclatures• Capture quality indicators across disparate systems• Establish compliance with plans of care• Weed out excess data points• Track cost of care

• Identity management across disparate systems

• EMPI• Aggregate allergy,

condition, medication, and other clinical info

Financial systems

Home- devices

HIE

Claims

Patient Surveys

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• Pulling data points from widely disparate systems is challenging enough but…

• Profoundly different workflows exist for how data gets entered into these different systems8 “Weight” could be entered in many different places even within

the same EHR8 Algorithms for computing basic metrics (e.g., Length of Stay)

may vary across providers8 Temperature: Fahrenheit versus Celsius

• Essential to do a detailed workflow analysis and standardize across all members of the ACO exactly how data must be entered for proper reporting8 Corollary to this is building “error reports” to show what

providers are not complying and thus sending over incomplete or inaccurate key metrics

It’s Not Just Blindly Aggregating Data

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Sample ACO Quality Measure Narrative

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One More ACO Quality Measure Narrative

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• There are commercial software packages (more and more every day) that purport to be able to provide these metrics but rigorous upfront preparation is necessary to avoid challenges8 Different systems feed data into a repository in different

ways• “HL7” is called a standard, but it is really more of a

suggestion. HL7 feeds vary widely from system to system• Data normalization• All the “moving parts” necessary to consider when computing

exceptions, contraindications, etc.• Data normalization• Data governance across multiple providers and types of

systems• Much more…

How Do These Metrics Get Built?

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• Real-time (or near-real-time) feeds from multiple sources

8 Optimally configured interface engines8 Connectivity that maximizes uptime and minimizes latency8 Robust error reporting

• BI/Analytics to identify problem areas and provide appropriate, targeted interventions, before problems get to the point of reaching a risk for the entire “shared savings” model of the ACO

How Do These Metrics Get Built?

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• Borne out of both Accountable Care and the Affordable Care Act, as a whole, Population Health Management (PHM) has become top-of-mind for healthcare organizations

• With the financial models for providers changing to reward truly making patients better, providers need to have tools to make sure patients are staying well, even after they leave the hospital or practice site

• This is where PHM comes in

Population Health Management

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• Case managers need to be empowered with a multitude of different types of data to identify patients at-risk of readmissions or complications and intervene right away. Besides EHR data, critical data will be:


Case Management

Systems

Risk Stratification

Systems

Medication History Access

(e.g., Surescripts)

Payor-type Actuarial

Systems (to manage risk)

Different types of Decision

Support Systems

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• Registries of patients with different types of potentially risky conditions must be able to be built

• Processes for automatic reminders, referrals, etc., need to be in place and adhered to

• PHM involves ongoing communication with patients and an awareness of their compliance with post-discharge protocols

• Targeted interventions may be needed (e.g., trips to the home) when risks are noted

• Ability to document interventions and their success or lack thereof is essential


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• Data storage requirements were increasing exponentially before Accountable Care moved into our world

• Accountable Care requires a whole new way of thinking about storing and operating on data and has brought Business Intelligence and Analytics to the center of healthcare strategy and operations

• Systems have to speak to each other as never before and they don’t always speak anything like the same language

• Systems have to support a PHM-type approach and use both data and targeted interventions to keep patients well

• Healthcare IT does have the tools to pull it all together, but it requires an understanding of people and process, as well as technology

Wrap-Up

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This is a fact of life now and healthcare organizations must embrace it if they want to survive and thrive in this new

world

Wrap-Up

1.800.4BEACON │ BeaconPartners.com

BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO

Thank You

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Thank YouFor more information

please contact:

Rich Temple, National Practice Director,

Beacon Partners

[email protected]

908-705-7108

mailto:[email protected]

Documents

The Crossroads of Health IT and Accountable Care