PHYTEL | WHITEPAPERPopulation Health ManagementBuilding Clinical Integration as aFoundation to Become a Successful ACO
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights re...
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Building Clinical Integration as a Foundation to Become a Successful ACO

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More and more healthcare organizations are recognizing that clinical integration of providers is a prerequisite to care coordination, population health management, and accountable care organizations. They also know that patient centered medical homes—the building blocks of ACOs—can thrive only in patient-centered medical neighborhoods where specialists collaborate with primary care physicians. For this cooperation to be truly effective, all of these providers must be clinically integrated. This paper explains the components of clinical integration and summarizes the kinds of information technology required for its implementation. Case studies of organizations that are building the necessary infrastructure are also included.

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Building Clinical Integration as a Foundation to Become a Successful ACO

  1. 1. PHYTEL | WHITEPAPERPopulation Health ManagementBuilding Clinical Integration as aFoundation to Become a Successful ACO
  2. 2. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 2Page 3Executive SummaryPage 4Clinically Integrated NetworksPage 5Case Study: Jackson Health NetworkPage 6Automation ToolsRisk stratificationPage 7Case Study: Orlando HealthPage 8Care managementPage 9Post-discharge carePerformance evaluationPage 10ConclusionPage 11NotesContents
  3. 3. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 3Executive SummaryMore and more healthcare organizations are recognizing that clinical integration of providers is a prerequisiteto care coordination, population health management, and accountable care organizations. They also know thatpatient centered medical homes—the building blocks of ACOs—can thrive only in patient-centered medicalneighborhoods where specialists collaborate with primary care physicians. For this cooperation to be trulyeffective, all of these providers must be clinically integrated.The Premier Healthcare Alliance recently published a study of the capabilities of organizations in itsACO collaborative. According to the study, most of these healthcare providers lacked the clinicalintegration they needed for ACO success.Given that clinical integration is the ability to coordinate appropriate care for the population served, thiscapability represented a significant gap across all organizations. Those organizations that did scorehigher definitely exhibited a greater ability to foster coordination and collaboration across the multiplehealthcare providers during the patient’s episode of care. Disease management programs are oneexample of such care coordination.1The backbone of clinical integration is a robust health IT infrastructure. To enable care teams to deliverefficient, high quality care, this infrastructure must consist of far more than networked electronic healthrecords. Provider organizations must also deploy analytics and automation tools that make the dataactionable in clinical workflows and that facilitate population health management. When properlyintegrated with EHRs and financial systems, these applications can enable organizations to scale upquickly for care management at a population-wide level and can provide them with the insights theyneed to take financial risk.This paper explains the components of clinical integration and summarizes the kinds of informationtechnology required for its implementation. Case studies of organizations that are building the necessaryinfrastructure are also included.To enable care teams to deliverefficient, high quality care,organizations must also deployanalytics and automation toolsthat make the data actionable inclinical workflows and facilitatepopulation health management.
  4. 4. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 4Until recently, except in group-model HMOssuch as Kaiser Permanente and GroupHealth Cooperative, clinical integration wasviewed primarily as a legal concept thatallowed unrelated fee-for-service providersto negotiate joint contracts with payers.These providers often came togetherthrough vehicles such as physician-hospitalorganizations (PHOs) and independentpractice associations (IPAs).The Federal Trade Commission (FTC) andthe Department of Justice (DoJ) initiallyregarded efforts by providers to negotiatetogether as per se violations of antitrust lawthat would lead to price fixing. But about15 years ago, the agencies began to issuestatements and rulings that carved out alegal space for clinically integrated networksto bargain with payers if their stated purposewas to improve quality and reduce costs.These opinions have continued to grow inscope over the years.2In February 2013, for example, the FTCissued an advisory opinion permitting theoperations of the Norman (Okla.) PhysicianHospital Organization, a partnership betweenthe Norman Regional Health System andthe Norman Physicians Assn. Although thisclinically integrated network (CIN) plans tonegotiate prices with payers, the FTC saidthat was unlikely to lead to a restraint of tradesince the independent physicians are free tocontract with health plans on their own.3The FTC and DoJ define a permissible CINas “an active, ongoing program to evaluateand modify the clinical practice patternsof physician participants to create a highdegree of interdependence and collaborationamong the physicians to control costs andensure quality.”4Among the criteria forsuch a program, the agencies state, are theselection of high quality providers, ownershipand commitment by providers, physicianinvestment in the program, appropriateuse of health IT, collaboration in the careof patients, quality and cost-improvementinitiatives, data collection and dissemination,and accountability.As healthcare organizations prepare foraccountable care, these requirementshave taken on a new importance. That isbecause few organizations encompassall of the providers they need to delivercomprehensive, integrated care to apopulation across all care settings. Evenif healthcare systems employ physicians,they usually need help from private practicedoctors and other unrelated providers in thecommunity. That means that their clinicallyintegrated networks must cross businessboundaries and that unrelated providerswill be bargaining with health plans onshared savings and bundled paymentarrangements. To do that legally, they mustabide by the federal rules.Current definitionOne current definition of a CIN is a jointlygoverned group of providers, includingindependent physicians, physician groups,employed physicians and hospitals or healthsystems, that work together to:• Develop mechanisms to monitor and improve the utilization, cost and quality of health care services provided• Develop and implement protocols and best practices• Furnish higher quality, more efficient care than could be achieved by working independently• Pool infrastructure and human and financial resources• Jointly contract with commercial and government payers and employers on a shared savings or financial risk basis.4This approach is especially importantto healthcare systems because theiremployed physician groups often do notinclude enough primary care physiciansfor a successful ACO. The CIN approachallows them to integrate outside PCPswith their employed doctors to create theproper balance of specialties. For example,Orlando Health in Orlando, Fla., employs500 physicians, the bulk of them non-primary-care specialists. To align communityPCPs with its goals, Orlando Health hascreated a 400-doctor CIN that includes bothemployed and independent physicians andhas partnered with the largest primary caregroup in central Florida (see sidebar A).According to the Premier ACO collaborativestudy, having more employed physicianswas not associated with a more successfulACO strategy. “In fact, some of the highestperformers had the lowest proportionof employed physicians.”5So a clinicalintegration approach can be the best wayto gear up for accountable care or value-based reimbursement.Clinically Integrated NetworksA CIN is defined as “an active, ongoing program toevaluate and modify the clinical practice patternsof physician participants to create a high degreeof interdependence and collaboration among thephysicians to control costs and ensure quality.”
  5. 5. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 5Basic requirementsSuccessful clinical integration requires atightly aligned, physician-governed networkthat uses a single set of performancemetrics. Engaging physicians and gettingthem to agree on clinical protocols isnot easy, but it is essential to clinicalintegration and a common approach tocare management. The organization mustalso agree on how to measure utilizationof resources and network financialperformance.The health IT infrastructure has to supportnot only performance measurementand reporting, but also the operationalrequirements of improving performance oncost, quality, and patient experience. Toachieve these goals, it must be able to:• Interface multiple EHRs to a population health management platform, either directly or through a health information exchange• Integrate lab, pharmacy, imaging and other ancillary data• Apply business and clinical intelligence to data in near real time• Provide a single view of patient data to providers and care managers• Enable managers to pull up data quickly on subpopulations of patients• Generate performance assessments of individual providers, sites, specialties, and the entire organization.Healthcare organizations have someproblems with claims data, which is out ofdate and often flawed. But at least for now,it is difficult for most organizations to get anaccurate idea of how much care deliverycosts them without some claims data frompayers. In addition, this data can be usefulin tracking out of network referrals.Case Study: Jackson Health NetworkThe Jackson Health Network (JHN) is a clinically integrated network in Jackson,Mich. Affiliated with Allegiance Health, JHN includes 75% of the local physicians,including 218 employed and independent doctors in 28 specialties. The CIN wasformed to improve community health and to enable the area physicians—most ofwhom are in small practices—to negotiate value-based contracts with payers.Several factors have aided JHN on its road to clinical integration. First, 60% ofits primary care practices have been recognized as patient-centered medicalhomes. Second, more than 150 JHN physicians, including employed andcommunity doctors, are using the same electronic health record, which wassubsidized by Allegiance. Third, the county health department is using that EHR,too, and is aligned with JHN’s health improvement goals. And fourth, the CIN isusing a suite of automated tools designed for population health management,including automated patient outreach.JHN now has a web-based patient registry that it has aligned with its casemanagement information system. Analytics applied to the registry enable JHN torisk-stratify its population. A quality reporting system based on the same registryis enabling physicians to see how they compare with their peers and to identifythe care gaps of individual patients. Each specialty has its own report card,which is used to determine incentive payments to physicians.JHN discovered that its physicians were reporting on 600 metrics to variousparties. The CIN has cut that down to 70 measures that all of its physicians arecommitted to using. But it’s still finding it difficult to get all the local health plans touse the same set of metrics.This year, JHN plans to get its specialists more involved in clinical integration. Itwill also pilot care management programs and expand workflow redesign in itspractices.Like every other CIN and accountable care organization, JHN has had to workhard to clean up its data and preserve data integrity. The use of a common EHRand the ability to maintain a single version by updating it for all users has helped.So has the prevalence of pay for performance in Michigan, which has accustomedphysicians to entering the required data in their EHRs. But they don’t always enterthe information in the right fields, and JHN has encountered difficulties in importingdata from labs and imaging centers outside of the CIN. In addition, there are thecustomary problems with patient identification and provider attribution.Nevertheless, JHN’s managers are fairly confident that they’ve worked throughthese challenges, and they plan to pilot their new care management this year.They are also expanding workflow redesign and trying to get specialists moreinvolved in the clinically integrated network.
  6. 6. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 6Automation toolsToday’s clinical integration networks must beable to do population health management todemonstrate their value to payers. CINs mayuse nurse care managers to perform tasksthat require human intervention, such asworking with high-risk patients and callingdischarged patients who don’t understandtheir discharge instructions. But to managepopulation health effectively, CINs need ahigh degree of automation that allows themto provide appropriate care to every patient.Organizations cannot hire enough caremanagers to track, monitor, contact andintervene with every patient who needs helpif they rely on manual methods.6The first step in creating a CIN health ITinfrastructure is to aggregate data in adata warehouse. That is no different thanwhat any healthcare enterprise or grouppractice must do to get value from thedata. But, unlike an integrated group, a CINconsists of many different business entitiesthat use disparate EHRs. So the CIN musthave a strategy and the appropriate toolsfor mapping the data from many differentsources to a single, normative database or asingle view of data.This mapping process must overcomenumerous obstacles. For example,patients must be uniquely matched to theavailable data on them, and they mustalso be attributed correctly to their primaryproviders. This attribution is not easywhen patients have multiple providers orfrequently move from one physician toanother. Also, the data has to be madeactionable for patient engagement. Thatrequires cleaning up the demographic dataand contact information.CINs must also verify and ensure theintegrity of the clinical data, using specialanalytic tools. Part of the data aggregationand normalization process involves theidentification of gaps and errors in theinformation. If the informaticians who do thissee that certain data elements are missingor clearly out of range, they have to go backto the practice or the hospital that generatedthat data and find out why.The health IT staffers in most healthcareorganizations are neither trained for nor havetime to do this kind of work. Yet it is essentialto clinical integration and population healthmanagement. So CINs may have to retainoutside specialists who have the expertiseand the right tools to complete this key stepsuccessfully.Risk stratificationTo automate population health management,support providers at the point of care,and increase the effectiveness of caremanagement, CINs must apply analyticsto the clinical data in their repositories andregistries. This starts with risk stratificationof patients into high, medium, and low-risk categories. Risk stratification can beused to assign patients to different kinds ofinterventions; in combination with predictivemodeling software, it can also forecastwhich patients are most likely to get sick.7To automate population health management, support providers at the pointof care, and increase the effectiveness of care management, CINs mustapply analytics to the clinical data in their registries.Patient EngagementCare ManagementPatient OutreachRisk StratificationClaims/CostData Registry
  7. 7. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 7Patient outreachBy applying clinical protocols to a registry,analytic tools can identify patients’ preventiveand chronic care needs. CINs can connectthat solution with automated outboundmessaging to remind patients when it istime for them to make appointments withtheir providers for necessary care. Suchan approach has been shown to increasethe likelihood that patients will seek thecare they need.8It also provides value byre-connecting patients with their physiciansafter a long hiatus.The same approach can be used as thebasis of campaigns to get patients moreengaged in their own care so that they willnot have to see a provider. For example,automated messages could suggest thatpatients take specific steps to stop smokingor lose weight. This kind of outreach couldbe coordinated with public health campaignsdirected at the same behavior change.In terms of population health management,automated outreach is critical for preventingpeople from getting sick or sicker. Everypatient of the CIN’s providers must bemonitored and encouraged to seekappropriate care or take better care ofthemselves to optimize population health.Case Study: Orlando HealthOrlando Health is a large healthcare system that includes seven hospitals witha total of 1800 beds. It employs 500 physicians, most of them specialists. Toachieve its goal of becoming the highest-quality, lowest-cost provider in centralFlorida, Orlando Health needs to get additional primary care physicians on theteam. So it has formed a clinically integrated network that includes its employeddoctors, independent primary care physicians, and practitioners employed by theUniversity of Florida healthcare system. It has also become aligned with the largestprimary care group in the region.Meanwhile, Orlando Health is moving forward on several related fronts. It isparticipating in a CMS Medical Neighborhood demonstration project with VHA,TransforMed, and Phytel. Most of its ambulatory care offices are on their way tobeing recognized as patient-centered medical homes. And it has formed an ACOthat has shared savings contracts with CMS and private payers.Early on, Orlando Health recognized that its clinical integration strategy requiredthe use of automation tools for care management and patient engagement. Afterdoing onsite demos and site visits with 10 population health management vendors,it chose a company that offered an easy-to-use provider interface, snapshots ofpatient care gaps, the ability to interface with multiple EHRs, the ability to integratepharmacy and lab data, and integrated patient outreach and education capabilities.To do population health management across the continuum of care, OrlandoHealth’s CIN also needs to build a health information exchange, and its physiciansmust agree on the clinical protocols that they’re willing to follow and be evaluatedon. In addition, its health IT infrastructure must be capable of reporting on qualitymeasures to Medicare and commercial payers.Orlando Health is depending on its population health management vendor to do theheavy lifting, including data integration and workflow assessments, data mappingto protocols, system configuration, training and implementation. The vendor isalso identifying and addressing problems with data integrity, including those thatoriginate in the clinical workflow. The organization would prefer not to rely solely onhealth plans’ claims data because it is usually not timely enough to be actionable.An early win for Orlando Health has been its use of the vendor’s patient outreachprogram. This ongoing automated messaging campaign has persuaded manypatients who need preventive or chronic care to make appointments with theirdoctors. Orlando Health has also used it as the basis for a local school system’scampaign to increase the use of breast cancer screening. Many women are nowgetting mammograms as a result.In addition, Orlando Health is using an automated care management programto identify care gaps and intervene with patients who have hypertension, highcholesterol, and/or diabetes. And it employs a different form of outreach providedby the same firm to follow up with patients after hospital and ED discharges. Thenext step will be to integrate these tools with a single patient portal for the CIN.For Orlando Health, automation is the key to both clinical integration andpopulation health management. By automatically risk stratifying the population,identifying care gaps, engaging patients, managing care for high-risk patients,and evaluating performance, Orlando Health can quickly scale up its CIN withoutspending a huge amount of money on care coordination and care management.
  8. 8. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 8Care managementThe automation of care management offersseveral advantages. First, outreach to keeplow-risk patients on track can be done witha minimum of effort. Also, care managerscan use automated care gap identificationto draw up work lists of high-risk individualswho need their attention. As for those atmedium risk—chiefly people who havechronic diseases—care managers canuse automation tools not only for outreach,but also for targeted interventions suchas educational campaigns, diseasemanagement, and arranging group visits.In a mature CIN that has used these toolsfor some time, care managers can initiatehundreds of such campaigns by using thesoftware to set parameters for people withdifferent conditions and for subcategoriesof those populations. This approach canmultiply the effectiveness of a single caremanager many-fold. Early stage CINs maywant to start with priority conditions andexpand from there to make sure their careteams are prepared for the influx of patients.The worst thing organizations can do is totell patients they need care and then not beable to provide it to them in a reasonabletime frame.A CIN must create a unified caremanagement structure on behalf of allits member practices. While patients willview the care managers as an extensionof their providers’ practices, those nurseswill actually perform care management andpatient engagement tasks for the entirenetwork. Similarly, the data that forms thebasis of the care managers’ work lists willcome from a central database, and the caremanagers will all use the same analytic andautomation tools.This middle layer of technology betweenindividual practices and the CIN can also beused to increase patient engagement. Wehave already mentioned automated patientoutreach and educational campaigns. Butthat is only the beginning of the modalitiesthat technology can facilitate. Among theother tools CINs can use to get patientsmore involved in their own health are onlinehealth risk assessments, mobile healthapps, secure texting, and patient portals.Patient portals can be used for recordsharing, results delivery, appointment andrefill requests, and online communicationwith providers. The use of these websitesis soaring because providers need themto meet requirements of Meaningful UseStage 2 by sharing health records with theirpatients.9But portals attached to EHRs inphysician practices can pose a problem,because patients would prefer not todownload multiple records from differentproviders. So some CINs are beginning tocreate unified portals that offer a single pointof contact to patients.Nevertheless, CINs should not base theirpatient engagement strategies on portals.Many providers do not yet have them, andmany patients don’t use them. Even atKaiser Permanente, which has had a portalsince 2005, only about 60% of memberswith website access use it regularly.10Soautomated messaging to patients—byphone, text or email—will continue to be anessential method of contacting patients whohave care gaps or who need to be furtherengaged in their own care.Care managers canuse automationtools not only foroutreach, butalso for targetedinterventions suchas educationalcampaigns, diseasemanagement, andarranging groupvisits.
  9. 9. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 9Post-discharge careCINs must also have a way to follow upwith patients after discharge from a hospitalor an ED. One efficient way of doing thatis to use automated messaging to surveypatients within the first 24 hours afterdischarge to home. Using feedback fromthe survey calls, care managers can contactpatients who have questions about theirdischarge instructions or their medicationsor who have not made an appointment witha primary care provider.If hospitals wish, they can use the samemechanism to notify providers that theirpatients have been discharged and are inneed of follow-up care. If a patient is havingdifficulty scheduling a doctor appointment, acare manager can contact their physician’spractice and find out what the problem is.Performance evaluationJust like any healthcare system or grouppractice, a CIN must be able to measureperformance in order to improve it. Thisrequires analytic tools that can evaluateperformance at the level of individualproviders and offices as well as for theentire organization. Among the parametersthat must be measured are quality, cost,utilization, and patient experience. Inaddition, CINs must be able to analyzeadherence to protocols in the care ofsubpopulations such as patients with type 2diabetes or patients who have both type 2diabetes and hypertension.Before a CIN can measure performance,the providers in the network must agreeon a set of clinical protocols that they aregoing to follow. This is a difficult but notinsuperable challenge. As one study ofclinical integration points out:“For a new CI program, it can be difficultenough just to get physician buy-in forperformance measurement, let alonefor care pathways. But as CI programsdevelop stronger physician engagement,clinical standardization seems to becomeeasier. Indeed, the challenge becomes lessabout winning physician buy-in and moreabout how the program can accelerate thestandardization process across hundreds ofconditions or diagnoses, many of which cutacross specialty areas and care settings.”11Once a CIN has its protocols and itsphysicians have committed to followingthem, it can begin to measure how closelythey are to those guidelines. CIN managerscan also use dashboards based on clinicalanalytics to see how well their approachesto caring for certain subpopulations areworking. If the percentage of diabeticpatients with HbA1c >9 does not fall overtime, for instance, the medical director of aCIN can drill down into the data to find outwhy and do something about it. That mightinclude talking to doctors who are outliers orcreating automated campaigns to increasethe engagement of patients who havediabetes.Physicians must be able to view dataon their own patient panels so they cansee how well various segments of thatpopulation are doing and assess their ownperformance. A dashboard designed forproviders should also give them access todata on individual patients so they can seewhich ones have care gaps and/or needinterventions to improve their health.To follow up with patients after discharge, a CIN can use automatedmessaging to survey patients within the first 24 hours after discharge to home.
  10. 10. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 10ConclusionClinically integrated networks are still fairly new, although a few IPAs and PHOs have had success with thisstrategy for years. Among them is Advocate Physician Partners (APP), a cluster of PHOs associated withAdvocate Healthcare in Chicago. APP has long held risk contracts from local payers, and its ACO has cutcosts for Illinois Blue Cross and Blue Shield. The organization has also improved quality, safety and patientsatisfaction.12Founded in 1995, APP took nearly a decade to fully develop its CIN. Lee Sacks, MD, chief medicalofficer of Advocate, told the New York Times recently, “It’s hard to imagine you could start from scratchand do this and be successful in three years.”13Unfortunately, healthcare organizations gearing up for accountable care today must move faster thanAdvocate did. So they will have to figure out new ways to do it. Part of the solution is for every provider inthe CIN to use electronic health records—something that APP emphasized early on. But in addition, theyneed automation and analytic tools that can enable the CIN to scale up quickly for population healthmanagement.Ultimately, the ability of providers to integrate clinically depends on effective physician governance andculture change. Financial incentives must be aligned, and doctors must be willing to give up some oftheir autonomy to work with other care providers as a team.Nevertheless, a robust health IT infrastructure is also a prerequisite for clinical integration. Solutions nowexist to automate most of the routine tasks involved in population health management. CINs that usethese tools can accelerate the process of becoming more tightly integrated and providing value in themarketplace.Part of the solution for accountablecare is for every provider in a CIN touse electronic health records—butin addition, they need automationand analytic tools that can enablethe CIN to scale up quickly forpopulation health management.
  11. 11. PHYTEL 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | phytel.com Copyright ©2013 Phytel Inc. All rights reserved. 111. Eugene Kroch, R. Wesley Champion, Susan D. DeVore, Marla R. Kugel, Danielle A. Lloyd, and Lynne Rothney-Kozlak, “Measuring Progress Toward Accountable Care,” Premier Research Institute, Dec. 2012.2. Christi J. Braun, “Creating Clinical Integration in a Physician Network,” Care Continuum Alliance Forum white paper, September 2011, accessed at http://www.carecontinuumalliance.org/theforum11/Presentations/Creating_Clinical_ Integration_in_a_Physician_Network.pdf.3. Alicia Gallegos, “Clinical integration model gets FTC green light,” AM News, March 11, 2013, accessed at http://www.amednews.com/article/20130311/ government/130319976/6/.4. Premier Healthcare Alliance, presentation, “Clinically Integrated Networks: a Population Health Building Block,” 2013.5. Kroch, Champion, et al., “Measuring Progress Toward Accountable Care.”6. Institute for Health Technology Transformation, Institute for Health Technology Transformation, “Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare,” 2012, accessed at http://ihealthtran.com/pdf/ PHMReport.pdf.7. Ibid.8. Ashok Rai, Paul Prichard, Richard Hodach, and Ted Courtemanche, “Using Physician-Led Automated Communications to Improve Patient Health,” Journal of Population Health Management (10.1089/pop.2010.0033).9. Centers for Medicare and Medicaid Services, “Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals,” August 2012, accessed at https://www.cms.gov/Regulations- and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2Comp TablesforEP.pdf.10. Ann-Lisa Silvestre, Valerie M. Sue, and Jill Y. Allen, “If You Build It, Will They Come? The Kaiser Permanente Model of Online Healthcare,” Health Affairs, 28, No 2 (2009):334-344.11. Sarah O’Hara, “Next-generation clinical integration: early findings from a new research initiative,” Network Advantage blog, The Advisory Board Co., Jan. 30, 2012, accessed at http://www.advisory.com/Research/Health-Care-Advisory-Board/Blogs/Network- Advantage/2012/01/Next-generation-clinical-integration-early-findings-from-a-new- research-initiative.12. Mark C. Shields, Pankaj H. Patel, Martin Manning and Lee Sacks, “A Model for Integrating Independent Physicians into Accountable Care Organizations,” Health Affairs, 30, No. 1 (2011):161-172.13. Annie Lowrey, “A Health Provider Strives to Keep Hospital Beds Empty,” New York Times, April 23, 2013.Notes

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