the crossroads of health it and accountable care
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The Crossroads of Health IT and Accountable Care. Presented by: Rich Temple, National Practice Director, Beacon Partners February 6, 2014. Agenda for Today. Quick Background on Beacon Partners The Fast-Evolving Healthcare Landscape Why Data Volumes are Exploding - PowerPoint PPT PresentationTRANSCRIPT
The Crossroads of Health IT and Accountable Care
Presented by: Rich Temple, National Practice Director, Beacon Partners
February 6, 2014
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• 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?
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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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Heading – Ariel 40What Metrics Do ACOs Require?
Care Coordination / Patient Safety
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Heading – Ariel 40What Metrics Do ACOs Require?
Preventive Health
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Heading – Ariel 40What Metrics Do ACOs Require?
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:
Population Health Management
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
Population Health Management
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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
908-705-7108