Leveraging the use of Healthcare Technology for success in Value Based Care

Presented by BlueNovo

Introductions

CALIFORNIA PRIMARY CARE ASSOCIATION BLUENOVO

Roopak ManchandaCEO of BlueNovoCIO of CPCA

Huzefa DossajiBusiness Development, BlueNovo

Payment Reform & Health IT

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Value-based Purchasing

Analytics 2.0

Interoperability

Empanelment

Continuity of Care and a longitudinal care record requires interoperability between EHR and similar systems.

Reimbursements will more than ever be dependent upon care outcomes and smart spending thereby increasing the need for robust reporting and capable EHRs to capture and report requisite data.

With the movement to Medical Home models; care coordination, risk-stratified case management, shared-decision making, and access become the focus in the shift from fee-for-service models.

AlternativeCommunication

Engaging your patients on a predictable and steady manner. Leveraging tools including appointment reminders, patient portal, texting, email, member outreach, and electronic pre & post visit follow-ups.

Non traditionalTouches

Documenting & tracking non-traditional touches such as telemedicine visits, group visits, virtual visits, home visits, and CHW visits.

Pew Research Center

Internet Use

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

2010 2011 2012 2013 2014 2015 2016 2018 2019

Who uses the internet by Race

White Black Hispanic

50%

60%

70%

80%

90%

100%

110%

2010 2011 2012 2013 2014 2015 2016 2018 2019

Who uses the internet by Income

Less than $30,000 $30,000-$49,999

$50,000-$74,999 $75,000+

Pew Research Center

Internet Use

50%

60%

70%

80%

90%

100%

110%

2010 2011 2012 2013 2014 2015 2016 2018 2019

Who uses the internet by Education

Less than high school graduate

High school graduate

Some college

College graduate

50%

60%

70%

80%

90%

100%

110%

2010 2011 2012 2013 2014 2015 2016 2018 2019

Who uses the internet by Age

18-29 30-49 50-64 65+

Alternative Communication Modalities

Appointment Reminders Texting Secure

Messaging

Pre/Post Visit Follow-Up

Health & Educational Campaigns

Patient Portal

Proprietary & Confidential 6

Patient Outreach

A crucial component of success under VBP is to keep patients on track by checking on them regularly to make sure they have not fallen off their health goals or care plans.

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Engage patients in care activities i.e. “you are due for…” or “we have never seen you at the practice…come over”

Check in on patients i.e. “How is your Shortness

of Breath”

Remind and support patient goals i.e. “Take medicine” or “Did you

go out for a walk”

Provide education i.e. “Healthy eating”

Informational communications i.e. “flu

vaccine is in” or “upcoming health fair”

Alerting system for high risk events i.e.

“admission to hospital” or “stroke”

Access to Patient Health Information

Medication Refill Requests

Patient/Care Team Communication

Self Scheduling

Pre-visit Forms

Online Bill Pay

Patient Portals

• In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online.

• Since then, the penetration of Patient Portal has been increasing but the actual use of portals have not reflected the effort.

• Although 90 percent of providers offer patient portals to their patients and patients sign up for the tool, just about 30 percent of patients actively use the portal.

• The traditional use of patient portal (pushing information outwards), but this evolving from this trend is critical to increasing adoption.

Sources: https://patientengagementhit.com/news/patient-portal-adoption-tops-90-but-strong-patient-use-is-needed

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Models of Portal Management

Funnel Model

PORTAL MANAGER

Questions

Appointments

Medication refill

Assignation Model

Questions Provider

AppointmentsFront Desk

Medication Refill Nurse

Payments BillingNurse Front desk Provider Billing

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Non Traditional Touches“Get the care you want and need, when you want and

need it.”• Goals of outreach

• Enhance primary care delivery• Enhance health and wellbeing• Enhance access to healthcare

• Face-to-face• Home services• Group visits• Disease specific visits

• Non face-to-face• Synchronous –

• Virtual – telemedicine• Phone

• Asynchronous • E-mail

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Essential elements to be captured.Enhance Health and wellbeing.

• Acupuncture• Template development• Appropriate assessment

• Chiropractor• Ortho content

• PT/OT• Template development• Cosignatory

• Behavioral Health/Substance Abuse counseling

• Care plan• IOP• Specific questionnaires

• Education• Group documentation• Template/my phrases

• Exercise• Template

• Nutrition• Template

• Medication Management• Pharmacist as provider• Template development

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Panel Management

Assignation panels: Patients assigned to organization by external

partners (insurers or others) are properly accounted for properly in

your system.

Internal Empanelment: Patients are assigned to organization’s care

teams properly and quality of care is attributed to the proper team.

Work arounds•Creation of reportable structured data

element•Consider demographic data element•Access to element outside of the Face-to-

Face encounter•New definition of active patient•Not associated to “time since last visit” only

Panel Size • Supply of visits•3NAA•Use PCP field when available; add PCP to

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• Panel management, also known as population management, is a proactive approach to health care. “Population” means the panel of patients associated with a provider or care team. Population-based care means that the care team is concerned with the health of the entire population of its patients, not just those who come in for visits.

• Empanelment is one of the first things to focus on since many other changes are based on the existence of a good panel structure.

Interoperability & Health Information Exchange• Several failed attempts in the 1990s (CHMIS, CHINs)• 2004 – ONC creates “HIEs”/”RHIOs”• 2009 – ONC awards $564M for state HIEs (to coincide with MU)• 2010s – Several regional HIEs come & go• Recent expansion of 3 major national initiatives

• Carequality• Commonwell Alliance• Epic CareEverywhere

• 2019 - CommonWell can now connect to Carequality framework• Development of a cross-network compliant record locator• Enable CCDA exchange & record location between any member

systemsChallenges• Move to FHIR• Which HIEs will expand/disappear/merge?• Can my EMR vendor exchange directly with others?• Are nearby hospitals ready to share with us?• What data will I need to exchange in an APM world?

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Analytics 2.0

Attribution and Eligibility Reporting Access reporting

Population Health Management (Visit

planning &Tracking of outcomes)

Utilization metrics (Admissions , ER use)

Attribution and Eligibility Reporting Quality & HEDIS Reporting

Financial Reports•Classic Measures• New Measures•Realized encounter rate (VBP/APM population.)•Panel size growth•Program margin (VBP/APM revenue vs. VBP/APM cost.)

14© Andrew Principe

Analytics Governance Planning

Information governance framework specific to the healthcare industry

Ensure data integrity Allocate appropriate

resources Reduce liability

CALIFORNIA PRIMARY CARE ASSOCIATION BLUENOVO

Source: http://www.ahima.org/topics/infogovernance

Accountability Transparency Integrity

Protection Compliance Availability

Retention Disposition

Data Visualization Technologies

Turning data into information

Proprietary & Confidential 16

Operational metrics

Financial metrics Patient Experience

Clinical outcomes

RESULTS – Profitability / VBS KPIs by Collections, AR Provider, Contract, Location, Appointment Type, Quality Measure(s), Error Rate, Missed Opportunities, etc.

Quality Measures HEDIS, UDS, CMS Medicare Shared

Savings Program, PCMH, Million Hearts, Medicare 5

Star, PQRS, etc.

Clinical Training / Awareness EHR, Promising Practice Workflows, RCM Impact,

Quality Rating by VBS Health Plan, Contracting, Utilization,

etc.

Revenue Cycle Management Medical Coding, Chronic Care Management Documentation,

Medical Necessity, Risk Levels, Contracting, Patient Education, Utilization etc.

VBP

Gap Analysis

GAP-Charging Up for Full Risk

• 2015: Non-Risk Medicaid Contracts Track 1 Medicare MSSP ACO

• 2020: VBS Contracts Gainshare only CMS Pathways to Success

• 2025: Risk Bearing Entities FQHCs take on shared risk

GAP: System Enhancements

System Enhancements for Managed Care are ”SYSTEMATIC and METHODICAL” enhancements: • Does not occur “AUTOMAGICALLY” • Requires a Provider Champion that understands the

goal • Good data and a somewhat normal data preacher

Clear roles and responsibilities: • CFO, RCM, Front Desk, Referral, Appointment Call

Center, CMO, Providers, MIS and QIO

• Provider scorecards by contract, campaign, and patient panelsHealth care team incentives = investment methodology @ your health center

GAP: Partners & Growth Opportunities

STATE AND FEDERAL BUDGET PRESSURES REQUIRE WORKING TOGETHER AND NOT AGAINST

EACH OTHER:

SPECIALISTS ACROSS YOUR FQHC PARTNERS / NETWORKS

TAKING RISK AS A NETWORKAND NOT JUST AS A PROVIDER

OF CARE

NEW CUSTOMERS INCLUDE LARGE EMPLOYERS, HOSPITAL SYSTEMS, STAND ALONE ER,

CORRECTIONAL INSTITUTIONS, AND YES EVEN UCCS OR 45

MINUTE CLINICS...

NOT ALL PARTNERS ARE CREATED EQUAL...

INCLUDING THE GOOD GUYS!

Is Value Based Service A Goal for Your Org?

Can Each AssociateCarry the Goal? If

So How?

Who Have You Told?

Timeline for Goal? How to Measure?

Can All Associates Repeat the Goal?

Who Owns the Goal?

GAP: Real Time Analytics

Responsive User Interface

Domain Driven Design

Modern and Fast

Cloud-Based Solution