Beacon Nation: 17 Communities Evolve

The Beacon communities are a success story. In all, the 17 communities touched 8 million lives during the three-year grant period via $250 million in HITECH funding. The Office of the National Coordinator (ONC) is now in the process of defining best practices and disseminating lessons learned while the Beacons review their successes and look ahead to remain sustainable organizations. Here’s a look inside five.

San Diego

The San Diego Beacon Community Collaborative worked to improve information exchange through a notification system.

They created an EMS Hub to get patient care information, 911 data, EKGs and other images from the field translated and sent to hospitals. The 911 data are important because they include timestamps and locations to aid in analytics, says James Killeen, MD, director of IT service for the University of California at San Diego ED. The community established a care manager position who is alerted to high utilization of the ED. The care manager was charged with finding out the cause and usually learned that patients required social services, not healthcare services. This resulted in a clear ROI as they found that each ED frequent user cost about $100,000.

By providing a health coach to see patients within their discharge timeframe, the Beacon decreased 30-day readmissions significantly, Killeen says. The San Diego Beacon also wanted to decrease door-to-balloon time for acute myocardial infarction. Presenting EKGs directly to ED physicians and cardiologists decreased the false positive activation rate. “We’ve been able to maintain this for true ROI savings,” he says.

The San Diego Beacon has found innovative opportunities with the region’s HIE using three different clouds—prehospital, population and public health and clinical. The Population and Public Health Hub (PPHealthHub) is the cloud solution for Meaningful Use  and statutory information exchange for public health agencies and their partners, Killeen says. The hub provides a collection of collaboration, reporting, visualization and situation awareness tools and allowed them to create a standardized test catalog. 

New Orleans

The Crescent City Beacon Community has a unique background compared with other Beacons since the aftermath of Hurricane Katrina gave the community a chance to rebuild their healthcare system.

The Beacon had three major goals: improve chronic care management; reduce costs through improved transitions of care; and test innovative technologies and strategies to engage patients.

With 60 percent of New Orleans residents having at least one risk factor for diabetes, the Beacon wanted to find ways to “reduce the pipeline of people with chronic conditions,” says Anjum Khurshid, PhD, MPAff, MD, director health systems at the Louisiana Public Health Institute. “Unless we do something upstream, we’re always going to be running after an increasing number of diabetics and prediabetics.”

The Beacon focused on working with community health centers to establish patient-centered medical homes (PCMHs). Most had EHRs in place but the Beacon did “a lot of coaching and handholding,” Khurshid says. “It’s not enough for physicians to understand the medical home. There has to be a team approach in the primary care setting to be effective.” Practice coaches worked with change teams and created a learning collaborative.

Better communication of transitions of care was important for the Crescent City Beacon as well. “If we do not know what is happening in the rest of the healthcare system, we cannot provide quality care for our patients,” he says. They connected primary care practices with hospitals and specialists to “strengthen the healthcare delivery model based on a PCMH.”

Consumer engagement also was important because “we’re set for failure if we don’t engage the patients,” says Khurshid. “We wanted to move beyond engagement to a marriage where patients are equal partners in their healthcare.”

Cincinnati

The Greater Cincinnati Beacon Community found that technology is important but not enough. “We cannot improve without it but we also need practice redesign and focused intervention,” says Keith Hepp, CFO and vice president of business development for HealthBridge, which managed the Beacon.  

Focusing on children with asthma, the Cincinnati Children’s Beacon team put in a specialized registry and used a combination of clinical interventions and alerts to increase the average time between emergency department (ED) visits from 173 days to 311 days.

An ED/admission alert system focuses on reducing the avoidable use of ED and readmissions. The system includes 21 hospitals and 87 primary care practices. “As an HIE since 2000, we already had lots of admission, discharge, transfer [ADT] data flowing through us,” says Hepp.

They decided to “repurpose” the data to send alerts to primary care providers (PCPs) when their patients go to an ED. Between 7,000 and 10,000 alerts are sent each month. The alert system was a huge win, he says, because “the cost was very, very low but the incremental benefit was very high.”

Most doctors thought their patients stayed within their integrated delivery network. “They were operating under the assumption that 95 percent of their patients ended up in their ED and just wanted to capture that last 5 percent,” says Hepp.

All Beacon practices found that up to 35 percent of their patients visit an ED that is not part of their PCP’s system and many ED visits could have been handled by the PCP. Many of the ED visits occurred during the day when the practices were open for business but patients didn’t know about the availability of same-day appointments.

Maine

The state HIE played a big part in the Maine Beacon Community’s efforts as well. The Beacon is “rapidly turning into a well-developed and well-defined accountable care organization [ACO],” says Devore S. Culver, executive director and CEO of HealthInfoNet, the state-designated statewide HIE which covers 88 percent of the state population.

The Beacon had four main objectives: practice redesign, community engagement, health IT and consumer empowerment. “We did well on most of these but consumer engagement is the hardest piece,” says Culver. “One-to-one we do well but the process is difficult to keep going.”

The Beacon reduced hospital readmissions by 58 percent and ED visits by 34 percent. They improved 84 percent of their performance improvement metrics and 84 percent of the community’s primary care providers successfully attested to MU Stage 1, exceeding the grant goal of 60 percent.

Statewide interoperability through the HIE reduced the time and cost to build out ACO integration and enhanced tracking of ACO patient utilization. Data aggregation and standardization supported ACO mandatory reporting requirements and helped with predictive analytics, variance analysis and outcome improvement testing and validation. “We spent too much time on the transport mechanism,” Culver says. “Without standardization, you really can’t do the kind of work you need to be doing across an ACO environment. Everyone has a different dataset.”

Because technology is transient, he recommends defining the vision and the goals and letting “the technology grow into the challenge over time.”

he Beacon was acutely aware of the uncertainties of the future of federal requirements and incentives as well as of the rapidly evolving healthcare delivery market. That, as well as the limits of EMRs and interoperability standards to effectively export and deliver universally accessible, discrete and comprehensive standardized data, serve as significant barriers to sustaining evolving payment models, Culver says.

Central Pennsylvania

The Keystone Beacon Community included five counties in central Pennsylvania and focused heavily on IT infrastructure, says Jim Younkin, IT director at Geisinger Health System in Danville, Pa. “We were able to connect 20 of the 21 hospitals that were part of this central northeastern Pennsylvania initiative as well as 172 practices. That enabled us to go much deeper into the technology for these organizations that would have been unable otherwise.”

For example, they layered a strong care coordination program on top of the existing KeyHIE, Younkin explains. A transition of care call center rotated care managers through to provide follow-up phone support. They would make sure patients were stable at home, go through the medication reconciliation process and ensure that follow-up visits with their PCPs were scheduled within 7 days. A paper on the results of the call center is in the works.

KeyHIE has worked to incorporate EHRs which proved difficult. “Everyone says how hard that is and they’re absolutely right,” says Younkin. “It was a significant challenge but provides a huge amount of value to clinicians because they don’t have to go to another portal.” Notifications also provide great value. Home health nurses, for example, were trekking to patients’ homes only to find out that some of the patients had been admitted to the hospital.

Lessons & Tips

Now that the Beacon Community projects have come to the end of their financing, the ONC has been working to create learning guides, a series of webinars and workshops designed to disseminate the lessons learned and define best practices.

The Beacon project teams made numerous gains during the three-year grants and have much to share. Most are working toward becoming successful ACOs.

“Plan time for physicians to buy into the data,” says Hepp. Plan for the first reports to be disappointing, he adds. “Coding the data is really tough. The true value is in combining clinical and claims data. You need both to be effective.”

Hepp also suggests picking initiatives “very carefully. Fatigue is real.”

The San Diego Beacon is in the process of evolving into BEACH—Beacon Education Analytic Coordination Hub, says Killeen. The new 501(c)(3) organization was formed on Oct. 1, 2013, and began moving operational-ready services to San Diego Health Connect. The organization is based on business value, functional utility, technical readiness, stakeholder processes and ongoing sustainability, he says.

The experiences of the Beacon communities should pave the way for many other efforts designed to improve patient outcomes, utilization and care coordination.