an insider's look at an accountable care organization (bidco)
DESCRIPTION
Christina Serverin, CEO of the Beth Israel Deaconess Care Organization, shares her perspective on the challenges of leading an ACO and how tech innovators can help (and help more than they already are).TRANSCRIPT
MIT Innovation Series
Christina Severin, President and CEO
April 30, 2014
About BIDCO
• BIDCO is a value-based, physician and hospital
network and an Accountable Care Organization (ACO).
Located in Westwood, Mass.
Employs more than 80 staff members
Contracts with 2,100 physicians, including nearly 450 primary
care physicians and 1,700 specialists and 6 hospitals
Contracted by Centers for Medicare and Medicaid Services
(CMS) as a Pioneer ACO
• $1B in risk revenue management
• Our highest level goal is to promote the best quality
and value of care to patients, providers, health
insurers, and employers.
2
BIDCO structure
3
BIDCO
Confidential
Physician
LLC
Hospital
LLC
High-level goals
• Grow the business
Creates virtual cycle of opportunity
Ensures needed scale
• Effective risk contracting
Moves away from fee-for-service (“click-fee”) model
Manages total cost of care for populations
• Beating budgets to earn surplus (or not)
Offers financial opportunity for improved quality (P4P)
• Provide governance structure needed to support
legal and business requirements of an ACO
4
Essential business functions
• Ensure business processes that support cost management and quality improvement goals Financial management of risk contracts
Care management
Disease management
Quality improvement
Clinical integration • EHR hosting and support
• Data interchanges
Provider support services
Risk contracting with CMS and other managed care companies
5
Highest level challenges
• Manage total cost of care (“TME”) budgets
Effectively manage risk contracts to return value to
Members (>$1B)
Right care in the right place at the right time
• Improve quality
Effectively earn quality dollars to return value to
Members
76 unique ambulatory goals over four major contracts;
only two goals appear in all contracts
6
Technology limitations
• Inherent complexities of data-sharing in an environment of minimal interoperability Patient information in silos (e.g., stand-alone EHRs)
Limitations in moving information along a system of care
• Clinical integration Fragmented access to data (access to some EHR data)
Cumbersome user experience for physicians and care management teams (multiple vendors, products, and modules)
Limited ability (claims data) to access “full view” of care experience
• Therefore, there are several ways in which new technology could help solves for these limitations
7
Innovation need #1
• One-stop, comprehensive physician performance
reporting
Performance metrics, improvement suggestions
High-risk, high-cost members
Patient rosters, including location, diagnosis, ED visits
Gaps in care assessment
Prescription status
Coding improvements
Predictive tool to identify needed intervention,
suggests intervention based on circumstance algorithm
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9
Quality report
Efficiency report
EHR Financial
performance
Patient list
Check email
High-risk patient registry
Current state: Performance reporting
Login to
Application
#1
Future state: Performance reporting
Comprehensive
physician
performance
reporting tool Single
login
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BIDCO
Data repositories
Claims
Lab/ Rad
Care mgmt.
EHR
Clinical data
Innovation need #2
• ACO care record that travels with patient to site
of care
Move fully integrated health information across care
continuum
A fully connected clinical ACO community that leap
frogs inter-operability by generating a clouded-based
HIX for fully integrated data capture of all experience
regardless of the site of care
11
Current state: BIDCO data exchanges
BIDCO Community
EHR Integrated EHR,
PMS & Billing 100+ databases
Electronic Health
Exchange Longitudinal
Community Health Record
Quality Data Center
Clinical Quality Data repository of
BIDCO member EHR Clincal data
Payors
Lab/ radiation
Claims Data Warehouse
Data Warehouse: Consolidation of
claims, labs & clinical data for
reporting
CMS ACO reporting
tool
High-risk patient
identification and
stratification tool
WebOMR BIDMC EHR
Other Community
Systems Centricity NextGen
Other
Risk- flagging
database
Hospital HIS
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PCP Office
Surgical Center
Pharmacy
Skilled Nursing Facility
Physical Therapy
MRI Center
Orthopedics
Future state: BIDCO data exchange
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Community
Medical Record
Inpatient
Summary
• The majority of new innovations being offered to ACO’s, are developed based on a concept that an ACO has simple data architecture Data mining (how can you mine data if you can’t access the data?)
Predictive modeling (how can you predict if you can’t access all the data?)
Population management (how can you tell a doctor a patient needs a Ha1C if you don’t have access to all lab data?)
• Payer claims data remains the most straight forward way to perform all analytics However, this leaves EMR data – the primary source of clinical data – out of
the picture
• The reality is that our architecture is incredibly complex and diverse
• Therefore, the most important solutions need to focus technology that can solve our complexity issues
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Questions
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