TREND #8: INCREASE LEVEL OF UNDERSTANDING AND CONTROL OVER ACO DATA AND ANALYTICS

Accountable Care Organizations (ACO) spend a good amount of time discussing which technology systems to use, but very little time on determining who owns the data. ACOs have multiple stakeholders including partners in the ACO, patients, and insurers. Each of these stakeholders have a vested interest in the vast amounts of data within the ACO, but many times the question of who owns the data goes unanswered.

According to Definitive Healthcare, there are more than 800 ACOs representing more than 200 health plans, 3,900 providers, and 300,000 physicians. And these ACOs use more than 125 different technology vendors, making it a very complex environment.

There are many different opinions on the topic of data ownership. Some will say patients own their own data; others believe providers own the data on their systems, and insurance companies own the data on their systems. Each of these scenarios provides challenges for ACOs, making it critical for them to have a strategy in place to tackle the issues of data ownership.

In today’s healthcare landscape, all stakeholders need to be true stewards of patient data, and they should act in the best interest of the patient. If patients are expected to be more accountable for their care then they need access to their own health information. If an ACO, health plan or healthcare provider is going to be more accountable for patient outcomes, then they need to have access to the data.

Ideally, data should be available to all stakeholders involved in the care process. Prior to merging existing systems or purchasing new healthcare IT systems, ACOs need to sort out the issues of ownership, usage, and changeability. Without quality control mechanisms and a data governance and organization strategy in place, the integrity and reliability of data within the ACO is likely to become compromised and in turn could compromise the whole essence of the ACO – collaboration to improve patient care.

This is just one of the healthcare analytics trends for 2016. In our new guide, we take a look at ten analytics trends healthcare executives need to be thinking about in 2016 and beyond. We identify technology strategies and solutions that will help healthcare organizations succeed in a data-driven, digital world.

https://www.youtube.com/watch?v=kOa9Eg9HeB8

System interoperability and integration is critical to healthcare organizations. Their ability to coordinate care across the continuum with integrated data solutions and streamlined data sharing supports population health management initiatives and makes accountable care a reality.

Using Informatica Powercenter/ Powerexchange for Mainframes as an ETL tool, Perficient has helped healthcare organizations achieve enterprise-wide ODS’ for Members, Benefits, Claims, and Providers allowing access to the best version of truth for membership data.

Implementing Informatica MDM, Perficient has also helped healthcare organizations achieve a single version of truth for membership data, a customer 360 view of Member-related information, and a centralized hub for managing Addresses, Member Matches and contracts.

Be sure to find us at HIMSS – The Perficient Healthcare Team will be available all conference long for discussions on integration and healthcare at booth 4460.

How do we engage patients, coordinate care, improve quality, lower costs and share savings all at once? A group of Accountable Care Organizations (ACOs) will be in Baltimore this week discussing this and other topics on establishing and sustaining ACOs.

One of the challenges of forming and sustaining ACOs is establishing shared goals and shared knowledge. I was involved in the airline industry earlier in my career and was part of the team who automated the On-time Departure and other performance metric bonuses at then Continental Airlines. Prior to this, I had dabbled in Change Management and Quality Assurance topics but this was my first real experience with “what you measure is what you improve” or “pay for performance”.

The ACO challenge is similar to the challenges of Performance Management within the diverse units of a hospital but it is complicated by the many different types of organizations (and communication languages) that may be partnering. I’m really looking forward to learning more about ACOs and how we can apply clinical analytics to costing solutions to measure and report shared savings.

Stay tuned for updates!

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Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased. In an ACO, healthcare providers take responsibility for the health of a defined population, coordinate care across the continuum, and are held to benchmark levels of quality and cost. In 2015 ACOs will continue to be on the rise!
Sources: Gartner; Forrester Research; Premier, Inc.

“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?

Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.

As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician. This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?!

In addition, implementing telehealth services could take us further down the road to value-based care. Like the Lion, we must have the courage to invest in new technology and workflows to improve patient care. Dr. Rasu Shrestha of the University of Pittsburgh Medical Center (UPMC) recently commented that UPMC is “able to reimburse directly to the physicians for the remote care we are providing. We’ve been continually increasing the specific types of reimbursements that are being provided for a wide variety of disease processes.”

They are currently using telehealth to remotely evaluate stroke patients, review crucial radiologic findings, perform post-op visits and are starting a chronic condition monitoring program. Dr. Thomas Watson, executive director of telemedicine for the UPMC, and a practicing colorectal surgeon notes, “People are focused on fee-for-service billing, but what’s actually important is the concept of cost avoidance,” Watson explains. “It requires working with payors and managing patients over time as part of a population, instead of as a single episodic encounter. In the broader sense, it is fairly straightforward.” But can we universally reimburse providers for this type of care? Let’s hope so.

Finally, like the Tin Man, we must develop the compassion and heart to realize that all people deserve healthy lives and healthcare providers and physicians deserve to be compensated for providing quality care. I would like to believe that the majority of healthcare providers chose their careers because they wanted to help others stay well, not just to earn a living. Let’s not lose sight of that.

So can the “yellow brick road” take us to the Land of Value-Based Care? I’ll leave that up to you. Please send any thoughts to me @DrMarcieSC.

Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like.

With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience. However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting. Therefore, it is equally, if not more important for those in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model.

Positive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting. However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities. Here are the exact details they provide:

1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
2. Patient retention, loyalty, and growth – By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients. As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy.
3. Success with accreditation and regulatory agencies – Agencies that accredit health plans now scrutinize patient satisfaction data during the accreditation process. Health plans annually measure patient satisfaction as an external review and accreditation requirement of the National Committee for Quality Assurance (NCQA), which instituted a member satisfaction survey as part of its Healthcare Effectiveness Data and Information Set (HEDIS) quality standards as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that measures the experiences of patients with their physicians and medical groups.
4. Favored relationships with health plans – To become the plan of choice for consumers, health plans want to show high CAHPS scores to prospective customers. They know members defect when they are dissatisfied and they want to retain them in their plans, so most have instituted several incentives or sanctions–all designed to encourage practices and other ambulatory care settings to enhance the patient experience. The better a medical practice or ambulatory care center satisfies its patients, the greater negotiating power with payers.
5. Lower costs of doing business – By providing the exceptional patient experience, medical practices and ambulatory care centers also reduce the costs of doing business. Patients more satisfied with their experience are also less likely to file malpractice lawsuits that drain provider time, energy and coffers. Also the work climate is more satisfying to staff which in turn reduces costly staff turnover.
6. Reputation, pride and satisfaction – In an atmosphere of consumer savvy and scrutiny, the quality patient experience wins physicians and ambulatory care centers an admirable reputation and a grapevine that results in widespread respect in the community. Members of the care team build relationships with patients that last. People trust the care team, and because they are more satisfied, they complain less. All of this translates into the psychic rewards of greater job satisfaction for the care team and greater pride in their impact on their patients’ health status.
7. Profitability – By providing an exceptional patient experience, medical practices and ambulatory care centers win favor from consumers, purchasers, accrediting agencies and health plans that affect their practice’s financial health and profitability. 

As the U.S strives to change patient experience from a fad to a priority in how we deliver care, outpatient medical practices need to understand the positive impact improvement can make, not only to their business operations, but more importantly to the outcome of patient care.

What other benefits do you see by improving your patient’s experience?

HIE, clinical data, quality measures, financial and claims data along with healthcare analytics – what does it take to decrease readmission rates in nursing homes?

There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?

It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”

The American Health Care Association (AHCA), the largest association representing skilled nursing care centers in the country, reports that every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Of readmissions, one fourth are skilled nursing care patients, receiving post-acute care (recuperative or rehabilitative services).

According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447).

CMS concurred on the recommendations from the report to:

1. Develop a quality measure that describes nursing home resident hospitalization rates and
2. Instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.

As noted in David Gifford’s blog on January 17, 2014, AHCA also agrees however does not think the OIG went far enough.

What will it take to get the right data to actually make the changes needed to decrease readmissions, cost of care and, most importantly, quality of health for nursing home residents? What would it take to get timely access to risk-adjusted Medicare claims data in addition to claims data for supplemental coverage by other insurance and health plans? What other clinical data would be critical to this analysis?

Seems that there is no way around having to optimize claims and financial data with other clinical data and quality measures. Population management and predictive analytics could help identify what changes are needed to decrease these and other readmission. Stop by the Perficient booth #2035 at HIMSS 2014 and talk with us about your experience in decreasing readmission rates.

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

While I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely. One of the key learning points for me from these sessions was this: “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics? There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics? Do we “build vs. buy”? Depending upon the organizational size, legacy systems and IT support, the decision can be difficult. What is good for one system may not work in another. So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step. Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics. Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

If you choose to build, there are excellent offerings for Enterprise Data Warehouse (EDW), Enterprise Master Patient Index (EMPI), and reporting and analytics solutions from IBM, Microsoft and Oracle.

The “buy” decision can be even tougher because there are numerous point solutions available which can be layered onto existing legacy systems to extract data for reporting and analytics. Many times these solutions have very defined purposes, which may be exactly what you need to fill a gap in your reporting structure at a lower cost than building it. There are solutions which focus primarily on ACO’s, Care Coordination or Population Health. If needed, there are also point solutions which provide excellent reporting capabilities with familiar outputs such as PowerView and PowerPivot, Cognos or Business Objects.

So “reframe the problem” by evaluating what works best for your organization.

“Take all these extraordinary tools we have out there, and have them work together and who knows what extraordinary changes that can bring about?” Gladwell concluded in his speech. “You are on to something very crucial here, and I wish you all the best.”

Go to HIMSS and start looking. Perficient would be happy to help! Stop by Booth 2035 to see us.

The patient centered medical home (PCMH) emphasizes care coordination and communication between various healthcare delivery systems. This coordinated care system can lead to better quality healthcare delivery as well as a better patient experience – but in order to achieve these benefits, providers must be able to see and interpret data from across the many entities the patient interacts with.

Leveraging clinical data from EMRs, HIEs and patient devices allows organizations to:

• Enhance access and continuity
• Identify and manage patient populations
• Plan and manage care
• Provide self-care support and resources
• Track and coordinate care
• Measure and improve performance

Join us October 29th for the webinar “Make the Most of Your ACO with Healthcare Analytics.” You will learn how Oracle Enterprise Health Analytics (EHA), coupled with Oracle Business Intelligence and Oracle WebCenter, fulfills the ACO mandate for a patient centered medical home.

Click here to register for the webinar.

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Accountable Care Organizations: First Year Results

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. First year results for ACOs were recently released, with very mixed success and several hospitals dropping out of the program.

• The First-Year Pioneer ACO Results: Predictable Bumps In The Road
• Annual ACO survey shows care coordination remains a work in progress for many providers
• Seven ACO Pioneers Drop Out, Others Say It’s the Future
• Obamacare’s ACO Conundrum
• CMS’s Pioneer ACO May Lose Nearly Half Of Its Participants

The Quantified Self

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

• Hang on; I’m getting a notification from my body on my phone
• How the Quantified-Self Will Make Big Data a Normal Part of Life
• Tell me EVERYTHING about you: What’s next in Quantified Self?
• Tracking the Quantified Self
• Are you sensing my stress?

Healthcare Payment Reform

It is a common opinion that our healthcare system does not provide good value for the care received. Incentives for hospitals are not properly matched with delivering the best possible care at an affordable rate. In response, healthcare payment reform models have been created. Bundled payments reimburse healthcare providers based on the expected cost of a group of services delivered, instead of payment for each treatment provided. Hospital value based purchasing tie reimbursement to the quality of care delivered based on clinical results and patient satisfaction.

• Rising To The Challenges Of The Evolving Reimbursement Environment
• Hospitals Keep Eye on Patient Satisfaction
• Insurer’s Reimbursement Model Rewards Lower Costs
• Don’t Give Up on Health Care Cost Control
• Survey Assesses Views Of Physicians Regarding Controlling Health Care Costs

The Obamacare Delay

The Patient Protection and the Affordable Care Act, or Obamacare, was introduced in 2010 as a national healthcare plan to reform the American healthcare system. Starting in October 2013, over 48 million uninsured Americans will be eligible for enrollment in subsidized plans through state-run health insurance exchanges, with annually increasing fines for those who go uncovered. A recent delay in the requirement that employers with over 50 employees provide health insurance or face a penalty has caused a stir, as some interpret this as the government acknowledging the heavy strain of Obamacare.

• Obamacare’s rule delay could make mandate difficult to enforce
• It’s not just the employer mandate: Three Obamacare delays you haven’t heard about
• Obamacare delay emboldens repealers, makes it 2014 issue
• Obamacare delay passes insurance burden onto workers
• Far-Reaching Implications of Obamacare Delay of Employer Mandate

Population Health Management

PHM aims to improve the overall health of high- and low risk patients by addressing personal health behaviors. PHM places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.

• Harnessing Hospital Data to Improve Healthcare
• IOM calls for ‘unified portfolio’ of population health
• Population Health Pros Get National Support
• Study shows savings within two years of program launch
• How to aggressively pursue population health

By Lesli Adams, MPA
Director, Oracle Healthcare Business Intelligence

Claims + Meaningful Use participation + GPRO + Survey = CMS ACO SSP

Simple, right?

How will your facility approach the December 31, 2013 deadline?  Will they cut and paste result sets from 4 or more systems?  Hand code at the top level from a screen shot?  Or does your enterprise have a strategic vision to present an integrated view of the Clinical Measurement world?  33 discrete measures, 33 answers.  Done.  But those 33 measures are a synthesis of outpatient visits, inpatient stays, lab results, pharma compliance, and survey results.  Those 33 measures are a reflection of thousands of patients and thousands of man hours for no less than hundreds of doctors and nurses.

At Perficient, we see those 33 measures as an opportunity to take the blindfold off of patient care; a way to let the leadership at the hospital, the doctors, the nurses, and the care team discover how each unique event with each unique patient becomes population health.

Using Oracle’s Enterprise Health Analytics, Oracle Endeca Information Discovery, and Perficient’s Clinical Measurement Framework, we have integrated the solution to aggregate the data, map the data to each discrete measure, across the domains, and we understand how the data is a synthesis of claims, survey, and the data you may currently put I the GPRO web interface.

For more information on CMS ACO SSP measures  http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-Guide-Quality-Measurement-2012.pdf

Follow me on Twitter, lesliadams

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

ACOs and Patient Centered Medical Homes

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Patient Centered Medical Homes (PCMH) focus on improving the quality of care delivered by creating a health care environment that facilitates communication between the patient and their physician, allowing patients to receive and understand the care they need when they need it.

• Will ACOs drive up costs for patients?
• Infographic: Accountable Care Organizations Tools for Success
• Study: Accountable Care Organizations may improve quality and lower costs
• Medical home initiative reduces costs
• Patient-Centered Medical Home Program Trims Expected Health Care Costs by $98 Million in Second Year

Telehealth and Remote Patient Monitoring

The healthcare industry is experiencing revolutionary changes stemming from the rapidly shifting role of the patient within the continuum of care. This is resulting in high demand for easier access to healthcare professionals, access to online medical information, and alternatives to traditional care. Telehealth allows for the transmission of medical images, video, audio and information related to diagnosis and treatment can be stored and sent from the provider’s computer or mobile device via secure data exchanges. Remote Patient Monitoring allows patient’s health data to be sent electronically to a provider who then can analyze it and respond with appropriate recommendations.

• Telehealth sees explosive growth
• 5 focal points for telehealth efforts
• Informed consent central to telehealth, poses challenges
• Tool Forecasts Remote Patient Monitoring ROI
• Health apps, virtual visits and remote monitoring

Health Insurance Exchanges

Exchanges are organizations that will encourage a more organized and competitive market for buying health insurance. They offer different health plan options; certifying plans that participate and providing information to help consumers better understand their options. These exchanges will open in October 2013 with a required start date by 2014, and will assist individuals and small businesses in comparing and purchasing health insurance coverage.

• 100 days to ‘biggest ever’ health insurance open-enrollment season
• What if the Exchanges Aren’t Ready On Time?
• Health-Insurance Exchanges Are Falling Behind Schedule
• Health insurance exchange law confuses still
• Healthcare Reform: Payers – HIXs and Eligibility

ICD-10

Starting in October 2014, the U.S. healthcare system will begin mandating the use of ICD-10 codes to replace the ICD-9 coding system. The updated ICD-10 codes will be more specific and allow for more precise billing and address advances in medical knowledge and technology. While ICD-10 implementation can be challenging and places new demands on the provider community, it also opens up the opportunity for deeper data, which can be a tool to improve care and lower costs.

• Who Will Blink First On Government ICD-10 Deadline?
• AMA refuses to accept ICD-10 implementation again
• Mostashari: No more ICD-10 extensions
• ICD-10 Impact on Productivity – Offensive vs. Defensive Game
• Preparing For ICD-10: Staying Ahead Of The Compliance Curve

Social Media

Social networking and collaboration tools provide one-to-one streams of interactive communication which enable patients to seek out information about diseases and treatment options. Social tools can also be used to facilitate collaboration within the enterprise between clinicians, researchers, and partners. Social media has been used effectively for patients with cancer, diabetes, congestive heart failure, asthma, obesity etc. to help patients manage chronic disease and prevent readmission.

• Social Digestion: Social Media and the Thinking Organization
• 5 ways hospitals can use social media
• The (Healthcare) Social Network
• Social media helps patients share their medical news
• 5 benefits of online patient communities