Anatomy of a Health System
July 23, 2014
Marc Lassaux, CTO, Quality Health Network
Justin Aubert, CFO, Quality Health Netw...
Agenda for this session
 Quick Overview
 Technology to support Pop. Health
 Sustainability consideration
 Operationali...
Formed in 2004
Two Hospitals, Physician Organization
Payer, Community Resource Organization
Over 200 organizations and...
QHN’s Regional Connectivity - 2013
Including Providers
Copyright Quality Health Network
Connections In Development
• The M...
RMHP and QHN
 RMHP one of QHN’s five founding members
 Colorado Beacon Consortium
• Rocky Lead, QHN Sub recipient
 Prac...
Sustainability
Considerations
Justin Aubert CPHIT, CPEHR
CFO, Quality Health Network
©2014 Quality Health Network (QHN) – ...
Historical Funding of QHN
 Initial Funding from Private Capital
 Core Operations are Funded by Subscription Fees
 Every...
Historical Funding of Technology
 Grant from The Colorado Health Foundation
• Expand HIT through out western Colorado
• D...
Considerations
 New Technology is Expensive and Changing Fast
 Open Source vs. Proprietary
 Contracting Issues
• Vendor...
Considerations
 Population Based Pricing
• Western Colorado’s population less than 500K
• First tier pricing typically up...
Looking Forward
 Value Add to Participants of HIE
• Data delivery moving towards a commodity
• Longitudinal patient recor...
Clinical Aspects When Operationalizing QI and PH
- 7/22/14 Anatomy of Health System Panel Presentation
- Institute for Hea...
Disclaimers
• Family Doc
• RMHP CMO
• Doctors On Call
14
Anatomy of a Health System
- Where We’re Focused
Focus Region
- Approximately 850,000
Residents
- RMHP Key Markets
- RCCO ...
RMHP Initiatives
• Office Record Review (ORR) since the 90’s
• Chronic Disease Management since the early 2000’s
• Beacon ...
Primary Care Practice Transformation
• Top RMHP Priority and Investment Area
• Maximize Primary Care Population Management...
Barriers To Change
• Non-integrated delivery system
• Frontier communities (IPA’s)
• Evolution of their delivery systems
•...
Accountable, Population-Focused Care
- Technology is a Cog in the Machine
Population-
Focused Care
Payment
19
Measurement
Boots on the Ground
- Practice Transformation
20
A Rising Tide
• 2012: 51 Practices (Beacon).
• 2013: 102 Practices -- 50%...
Our Goals
Small tests of change emphasizing the triple aim through
population health management:
• Population management t...
Whole Person Support
22
• Comprehensive Assessments
• Health, Behavioral, Social, Functional Domains
• Coordinating the Co...
RMHP Statewide RCCO Report
RMHP Statewide RCCO Report
• Practice Transformation
• Measurement & Feedback
• Workforce (Human Capital)
• Payment
• Technology
25
Anatomy of a Heal...
Global Outcomes Score
(“GO Score”)
1. Comprehensive and Continuous
2. Guidelines and Predicted Risks
3. Net Benefit Focus ...
What is the“GO Score”
Predicted # events prevented by PCP
Opportunity Benchmark
GO Score =
• In example above GO Score = 1...
How is the GO Score different?
28
The Global Outcomes Score measures CVD risk reduction in populations
• Credits providers...
Oversimplified guidelines impact care
29
Mrs.
Smith
Mr. Jones
SBP = 142 SBP = 138
age = 45age = 42
LDL = 116 LDL = 178
HDL...
What actions increase your GO Score?
Prescriptions (15 month
grace period for
incentive)
• Statins
• Thiazides
• ACE/ARB
•...
Contact
Kevin Fitzgerald, MD
Chief Medical Officer
Rocky Mountain Health Plans
kevin.fitzgerald@rmhp.org
31
Health IT Summit Denver 2014 - "Anatomy of a Health System"
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Health IT Summit Denver 2014 - "Anatomy of a Health System"

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Health IT Summit Denver 2014 - "Anatomy of a Health System"

This unique discussion series explores behind-the-scenes looks at the most progressive and high performing health systems in the country. Panelists will discuss critical areas such as go-live strategy, vendor management, patient engagement, IT governance and more. Attendees will walk away with a better understanding of how departments can effectively work together, tangible strategies for delivering high quality care while maintaining an efficient and secure health information system.
Moderator: Cynthia Burghard, Research Director, IDC Health Insights
Marc Lassaux, CTO, Technical Director Beacon Project, Quality Health Network
Justin Aubert, Chief Financial Officer, Quality Health Network
Kevin Fitzgerald, MD, CMO, Rocky Mountain Health

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Health IT Summit Denver 2014 - "Anatomy of a Health System"

  1. 1. Anatomy of a Health System July 23, 2014 Marc Lassaux, CTO, Quality Health Network Justin Aubert, CFO, Quality Health Network Kevin Fitzgerald, MD, CMO, Rocky Mountain Health Plans
  2. 2. Agenda for this session  Quick Overview  Technology to support Pop. Health  Sustainability consideration  Operationalizing Clinically  General Discussion
  3. 3. Formed in 2004 Two Hospitals, Physician Organization Payer, Community Resource Organization Over 200 organizations and 850 providers HIE, HISP, eHealth Exchange participant Data Aggregation and Applications Incorporated as Non-profit 501 (c) 3 - August 2004 “Trusted, non-exclusive, and apolitical Organization” Live Operations: October 2005 Private Capital $2.75 million Cash Flow Positive from Operations - 2007 The Start:
  4. 4. QHN’s Regional Connectivity - 2013 Including Providers Copyright Quality Health Network Connections In Development • The Memorial Hospital, Craig • Yampa Valley Medical Center, Steamboat Springs • VA Medical Center, Grand Junction • CORHIO – Colorado eastern slope Hospital & Lab Connections • St. Mary’s Regional MC • Community Hospital • Family Health West • Aspen Valley • Montrose Memorial • Rangely District • Delta County Memorial • Gunnison Valley • Grand River Health (Hospital) • Valley View/Glenwood • Pioneers/Meeker • LabCorp • Quest Diagnostics • Grand Junction Diagnostics • Internal Medicine Assoc. • DCI Hospice PACE (Senior Community Care) Care Transitions Home Care DME Respiratory & Physical Therapy Long-Term Care Assisted Living Connected Providers . . . .. ... . ... . .. ........... ................................................................................ .................... .......................................... ...... ......... ................. .. . . .
  5. 5. RMHP and QHN  RMHP one of QHN’s five founding members  Colorado Beacon Consortium • Rocky Lead, QHN Sub recipient  Practice Redesign and Quality Improvement  Population Health Tools • Disease, Wellness, Risk  Care Coordination
  6. 6. Sustainability Considerations Justin Aubert CPHIT, CPEHR CFO, Quality Health Network ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution. 7
  7. 7. Historical Funding of QHN  Initial Funding from Private Capital  Core Operations are Funded by Subscription Fees  Everybody Connected Pays  Self Sustaining Since 2007  Development Fund • QHN initially Mesa County initiative • New neighborhoods contribute to infrastructure 8 ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution.
  8. 8. Historical Funding of Technology  Grant from The Colorado Health Foundation • Expand HIT through out western Colorado • Defray one-time costs to connect to the HIE  Colorado Beacon Consortium ONC ARRA Grant • Federal funding to procure technology • Capital investment vs. operational  Increase Value to Participants • Population Health • Quality Improvement Initiatives ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution. 9
  9. 9. Considerations  New Technology is Expensive and Changing Fast  Open Source vs. Proprietary  Contracting Issues • Vendor pricing typically ASP • QHN negotiated contracts for perpetual licenses with annual maintenance vs. ASP model - Larger up front costs with lower recurring - Sustainability plan for post grant funds ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution. 10
  10. 10. Considerations  Population Based Pricing • Western Colorado’s population less than 500K • First tier pricing typically up to 1M lives - Non-starter in rural areas - Not economically feasible unless partnering or revised tiers  Partnering with Other Organizations • Cheaper to incrementally increase existing license • Take advantage of economies of scale • Create similar initiatives across geographic areas ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution. 11
  11. 11. Looking Forward  Value Add to Participants of HIE • Data delivery moving towards a commodity • Longitudinal patient record is key value • Use the data to increase value to providers and patients  What Role Does the HIE Play • EHR’s will/could have functionality • Workflow, workflow, workflow ©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution. 12
  12. 12. Clinical Aspects When Operationalizing QI and PH - 7/22/14 Anatomy of Health System Panel Presentation - Institute for Health Technology Transformation (IHT ) Kevin R. Fitzgerald, MD Chief Medical Officer Rocky Mountain Health Plans 2
  13. 13. Disclaimers • Family Doc • RMHP CMO • Doctors On Call 14
  14. 14. Anatomy of a Health System - Where We’re Focused Focus Region - Approximately 850,000 Residents - RMHP Key Markets - RCCO Service Area - QHN Footprint - Distinct Patterns of Care (Dartmouth Atlas)
  15. 15. RMHP Initiatives • Office Record Review (ORR) since the 90’s • Chronic Disease Management since the early 2000’s • Beacon 2009 • CPCi/Practice Transformation 2013 and ongoing • Medicaid RCCO (ACO) Region 1 2013 and ongoing
  16. 16. Primary Care Practice Transformation • Top RMHP Priority and Investment Area • Maximize Primary Care Population Management Capacity − Data Use and QI Competencies – Adopt New Tools – Integrate New Staff – Team Based Care • Five Active Learning Tracks – Foundations – Masters 1 – Masters 2 – PCMH Recognition – CPCi
  17. 17. Barriers To Change • Non-integrated delivery system • Frontier communities (IPA’s) • Evolution of their delivery systems • Improve communication in their communities • Create a culture of innovation in the medical community
  18. 18. Accountable, Population-Focused Care - Technology is a Cog in the Machine Population- Focused Care Payment 19 Measurement
  19. 19. Boots on the Ground - Practice Transformation 20 A Rising Tide • 2012: 51 Practices (Beacon). • 2013: 102 Practices -- 50% growth or doubling of the number of practices we supported in 2012. • 2014: 95 Practices to date -- with 50 practices in queue for recruiting into any one of the program tracks.
  20. 20. Our Goals Small tests of change emphasizing the triple aim through population health management: • Population management through registries • Practice case management • Risk rating and patient stratification • Referral systems/continuity in transitions • Community care management of the person • Community care plans • Community surveillance models
  21. 21. Whole Person Support 22 • Comprehensive Assessments • Health, Behavioral, Social, Functional Domains • Coordinating the Coordinators
  22. 22. RMHP Statewide RCCO Report
  23. 23. RMHP Statewide RCCO Report
  24. 24. • Practice Transformation • Measurement & Feedback • Workforce (Human Capital) • Payment • Technology 25 Anatomy of a Health System - Key Drivers in an Accountable Community
  25. 25. Global Outcomes Score (“GO Score”) 1. Comprehensive and Continuous 2. Guidelines and Predicted Risks 3. Net Benefit Focus - Counterintuitive Results
  26. 26. What is the“GO Score” Predicted # events prevented by PCP Opportunity Benchmark GO Score = • In example above GO Score = 100/180 = 55 •The opportunity captured is 55% of total benchmark 0 20 40 60 80 100 120 140 160 180 200 Opportunity Benchmark CurrentTreatment 5-Year CVD Events Prevented 180 events 100 events
  27. 27. How is the GO Score different? 28 The Global Outcomes Score measures CVD risk reduction in populations • Credits providers for reducing risk not just meeting a treatment target or process measure Corrects problems with current simple performance measures such as the blood pressure guidelines: • Credit is given to reduced SBP from 142 to 138 • No credit is given for reducing SBP from 200 to 142 • Other patient risk factors are largely ignored • Leaves little room for physician discretion NCQA is testing the GO Score as a performance measure • PCP will be one of the first groups in the country to test this new approach
  28. 28. Oversimplified guidelines impact care 29 Mrs. Smith Mr. Jones SBP = 142 SBP = 138 age = 45age = 42 LDL = 116 LDL = 178 HDL = 35HDL = 61 FPG = 116FPG = 89 weight = 244 weight = 345 height = 5’6’’ height = 5’11’’ GO Score will give more credit for treating Mr. Jones 1.2% Risk of MI or stroke in 5 years 7.1% 0.4% Absolute risk reduction if lower BP 2.1%
  29. 29. What actions increase your GO Score? Prescriptions (15 month grace period for incentive) • Statins • Thiazides • ACE/ARB • CCBs • Beta Blockers Smoking (cessation during the year) Weight loss >5% during the year (BMI>25 at outset) 30 Future versions may include other interventions and other diseases provided data quality is sufficient
  30. 30. Contact Kevin Fitzgerald, MD Chief Medical Officer Rocky Mountain Health Plans kevin.fitzgerald@rmhp.org 31
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