Providers share care transformation strategies

Across the country, providers are using a variety of techniques to bend the curve on healthcare costs and outcomes. A panel at the Centers for Medicare & Medicaid Services’ eHealth Summit shared their strategies on Dec. 6.

Vermont is working off a foundation of patient-centered medical homes (PCMHs) and a system of community health teams that can be accessed by any patient in a PCMH, said Steve Maier, healthcare reform manager at Department of Vermont Health Access. Currently, PCMHs are paid on a sliding scale, based on their NCQA score, just for participating. “Each of our major public and private payers also pay in separately to support resources on the ground.”

A statewide registry supports reporting for both physicians and program managers to see data across practices and regions. “The biggest point is having health information presented in actionable ways to our providers and to our patients.”

Vermont has just three healthcare systems so they’ve had success using an all-payers claims database, flagging high-risk patients and comparing control groups.

In Maryland, the Chesapeake Regional Information System for our Patients (CRISP) is the state’s HIE. They’ve been using a query portal so emergency physicians can get more medical history on patients, facilitate post-discharge care and conduct a reporting service, said David Horrocks, president. The first set of reports were on readmission rates.

“There are many things we’d like to do but it’s hard to pull them off,” he admitted. Success requires three elements, he said: an idea that’s technically feasible, the appropriate infrastructure and patient benefit. “There has to be a financial benefit to the stakeholders who have to do the work. If you don’t have that, you’ll get agreement that [the idea] should happen and a little bit of effort but not the momentum for the idea to really take hold.”

Currently, Horrocks said CRISP is working with organizations that submit the data to create a combined identity so providers can see charges across hospitals for their patients.

As executive director of MedChi Network Services, Craig Behm oversees three advanced payment organizations in Maryland. His organization pledges to do no harm, be supportive and provide resources at the practice level. “Health IT is a very helpful piece but there is a lot of difficulty and complexity. We’ve come a long way in a brief time.”

As head of a 10,000-patient practice, Eugene Heslin, MD, said all the data dumps are very difficult to manage. “We’re scrubbing our data constantly. We hired more people just to scrub data as they come in.” His practice, Bridge Street Medical Group in Saugerties, N.Y., built a risk stratification tool as an add-on to its EHR. The combination of medical questions, diagnoses, social issues and healthcare literacy provides a risk gap.

Vermont has been using a clinical registry product to define core measures by different chronic conditions, said Maier. Clinicians can request reports for different categories of patients, such as women over 50 or people with diabetes. “The different types of information given back gives them the ability to be more proactive. It does tend to focus their efforts on more complex patients.”

Patient satisfaction is growing in importance, said Heslin. His patients “are feeling that we’re paying attention to them and not just what’s broken on them. That makes a big difference in how patients feel and it is critical.” He said providers should consider the computer another tool, similar to a stethoscope or reflex hammer, rather than a replacement of the clinician.

When asked about the growth of accountable care, Behm said there has to be a method of securing community information to practice in a format the practices will actually use. However, not all components of successful accountable care organizations are IT-related, he said, noting the importance of change management and workflow enhancement. “It’s not just flicking a switch and installing a new system.”

Heslin said the first step has to be change management and the building of team-based care. “Unless you do that first, you can’t get to the next stage. People just sit around and can’t function.” That piece was critical for his practice, he said, and gave them the resources to further build out their team. They built in a care management layer. “It’s very difficult to be able to do this. I challenge vendors to get this right or it’s going to kill small providers. We cannot survive this.”

Maier added that the patients with the highest costs and worst outcomes almost always have mental health or substance abuse issues. “If we look at where those organizations that provide those services are, they are way back at the starting gate.” Stakeholders need to engage around the exchange of substance abuse data at the federal level, he said. If that doesn’t happen, healthcare won’t realize the promise of information exchange.

A lot has changed since 2009, Horrocks said, “but it’s still difficult to do the kinds of things that will bend the cost curve. His top priority and hope is Direct secure messaging. “If we had that standard ubiquitous, the ways it would get used we can’t even predict.”