HIMSS: EHR delivers ROI & population health for Davies award winner

NEW ORLEANS—It’s difficult, and perhaps impossible, to kill two birds with one stone. But Hawaii Pacific Health achieved both financial return on investment (ROI) and improved population health with its EHR deployment, its leadership team shared during a March 5 session at the Healthcare Information and Management Systems Society (HIMSS) annual conference.

Selected as en enterprise Davies award winner in September 2012, Hawaii Pacific Health’s EHR journey began less than auspiciously.

In 2002, the leadership team of the Honolulu-based health system issued a mandate: build an EHR and improve quality. “There was an immediate need to reduce costs,” recalled Executive VP and CIO Steve Robertson. The four-hospital health system lost $34 million in 2002. The bill for an EHR investment totaled $32 million.

Leadership attempted to approach the EHR from a pure business case. The first estimate for ROI was -18 percent, so the project was scrapped and the team disbanded. However, further study suggested that focusing on optimized revenue cycle management in conjunction with an EHR could be a financial success.

“We doubled down and invested $57 million to replace all of our revenue cycle systems and deploy an EHR,” said Robertson. However, by the end of the third year the project had not yet delivered ROI.

Robertson transformed the hospital’s compliance team into a revenue integrity team. The approach worked. By 2008, the health system avoided nearly $2 million in controllable losses. EHR-enabled improvements included: $728,000 in late charges, $629,000 from missing or inaccurate national drug codes for drug billing $629,000, $315,000 in medical necessity denials and $154,000 in claim filed past deadline. In addition, the cost to collect $1 dropped from 2.5 cents to 1.5 cents.

In the 10 year-period, the ROI has hit 12.3 percent with stimulus funds. Major contributors include $51.3 million in improved costs to collect, $23.2 million in reduced write-offs and $15.4 million each in reduced transcription and payer quality incentives.

The virtual patient-centered medical home

ROI is an critical plus, but the healthcare product is health. Beginning in 2009, Hawaii Pacific leveraged its EHR to transform its approach to patient care, said Dale Glenn, MD, director of clinical informatics for Straub Clinic and Hospital

The health system built a virtual patient-centered medical home, using the EHR and data as its base and incorporating electronic protocols, team-based care and patient engagement. The model departs from the conventional provider-centric, fee-for-service approach.

“To transform the model of care we moved the patient to the center and built structures to support the relationship between the patient and provider with a team of people and an IT platform,” explained Glenn. Nurses take care of tasks such as disease management and pre-authorization. The team also relies on nurse educators, care coordinators and health managers.

Central to the team-based model is use of the same patient chart by multiple members of the care team. Other mission-critical changes required commitment from leadership.

For the approach to work, Hawaii Pacific Health required all providers to use the same mammography guidelines, colonoscopy preps and more. The health system also authorized all members of the team to order tests, such as Pap smear exams and colonoscopies, as indicated by the EHR.

Glenn joked about a health system motto: No one gets out of Hawaii Pacific Health without a colonoscopy. The health system achieved improved compliance by empowering care team members to phone patients to schedule screening studies as needed. Every physician in the system has signed permission authorizing the care team to use his or her name as patients are phoned to schedule appointments. That’s because scheduling is more successful when the care providers says I’m calling on behalf of Dr. so-and-so to schedule your mammogram instead of I’m calling from Hawaii Pacific to schedule your mammogram.

The results demonstrate the value of the model. From 2009 to 2012, breast cancer screening compliance increased from 66.5 percent to 77.1 percent, colon cancer screening from 61.2 percent to 77.2 percent. The health system has realized similar bumps in blood pressure control, cholesterol control for diabetic patients and other quality measures. All data are provided in a transparent manner to physicians, who can then determine their own processes for improved patient management.

Glenn concluded with two figures for bean counters. In fiscal year 2011, net population management revenue was $850,550. In fiscal year 2012, it reached nearly $2.6 million.