MassTLC Northeast PHO, Todd Lowthers, Analytics presentation

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MassTLC Northeast PHO, Todd Lowthers, Analytics presentation

  1. 1. Northeast Physician Hospital Organization
  2. 2. <ul><li>Located on the North Shore in Eastern Massachusetts </li></ul><ul><li>Joint Venture between New England Community Medical Group IPA and Northeast Health System </li></ul><ul><ul><li>IPA contains Independent and Hospital Owned Practices </li></ul></ul><ul><ul><li>3 Hospitals and 1 outpatient ambulatory center </li></ul></ul><ul><li>327 Physicians, 113 Practices </li></ul><ul><ul><li>244 Office Based </li></ul></ul><ul><ul><li>83 Hospital Based </li></ul></ul><ul><li>25 Employees </li></ul>
  3. 3. Market Drivers For Change <ul><li>Massachusetts Market </li></ul><ul><ul><li>Managed Care Contracts </li></ul></ul><ul><ul><ul><li>Budget Based Risk </li></ul></ul></ul><ul><ul><ul><li>Quality Performance </li></ul></ul></ul><ul><ul><ul><ul><li>HEDIS, HCAPS, CMS Measures </li></ul></ul></ul></ul><ul><ul><li>Market Competition </li></ul></ul><ul><li>Federal Policy </li></ul><ul><ul><li>ARRA “Meaningful Use” </li></ul></ul><ul><ul><li>Accountability Care Organization </li></ul></ul><ul><ul><li>Value – Based Care </li></ul></ul><ul><ul><li>5010 transactions </li></ul></ul><ul><ul><li>ICD – 10 </li></ul></ul>
  4. 4. Data Environment <ul><li>Physician Adoption of EMRs </li></ul><ul><ul><li>Secure Messaging </li></ul></ul><ul><ul><ul><li>CVS Minute Clinic Progress Notes </li></ul></ul></ul><ul><ul><ul><li>Health Information Exchange </li></ul></ul></ul><ul><ul><li>E-prescribing </li></ul></ul><ul><ul><li>Document Management </li></ul></ul><ul><ul><li>Patient Portal ( under development) </li></ul></ul><ul><li>Hospital Information System </li></ul><ul><ul><li>Patient Care Documentation </li></ul></ul><ul><ul><li>Clinical Provider Order Entry </li></ul></ul><ul><ul><li>E-prescribing for discharge medications </li></ul></ul><ul><ul><li>Outbound interface (Lab results, Radiology, Departmental) </li></ul></ul><ul><li>Data Warehouse / Payer Data </li></ul><ul><ul><li>Medical Claims </li></ul></ul><ul><ul><li>Retail Rx Claims </li></ul></ul><ul><ul><li>Registries </li></ul></ul>
  5. 5. Desired State <ul><li>Aggregate data set across all payer and EMRs to better manage </li></ul><ul><li>patient care </li></ul><ul><li>Population Management at the ACO and Practice Level </li></ul><ul><ul><ul><li>Preventive screening and chronic care management </li></ul></ul></ul><ul><ul><ul><li>Evidence Based Guidelines </li></ul></ul></ul><ul><li>Point of Care Management tools for providers </li></ul><ul><li>ACO Business Intelligent Tools </li></ul><ul><ul><ul><li>Utilization Management </li></ul></ul></ul><ul><ul><ul><li>Leakage </li></ul></ul></ul><ul><ul><ul><li>Predictive modeling </li></ul></ul></ul>

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