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Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

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Crystal Run Healthcare — a physician-led Accountable Care Organization (ACO) and one of the first ACOs to participate in the Medicare Shared Savings Program — is experiencing the long-anticipated shift toward more value-based reimbursement.

To ensure financial stability as they assume more risk, Crystal Run is implementing a strategy focused on rapid growth and aligning physician reimbursement with favorable patient outcomes. To effectively execute on this strategy they knew they needed to become more data-driven. Webinar attendees will learn how this ACO is using advanced analytics to execute on their population management and growth strategies with a focus on continuous improvement in the following areas:

Ensuring patient care aligns with evidence based practices
Reducing inappropriate clinical variation
Enhancing operational efficiency
Analyzing data from a “single source of truth” integrated from their EMR, billing, costing, patient satisfaction and other operational systems
Making “self-service analytics” available to decision-makers to decrease time to decision

Please join Greg Spencer, MD, Chief Medical & Chief Medical Information Officer and Scott Hines, MD, Chief Quality Officer and Medical Specialties Medical Director, Crystal Run, as they discuss how advanced analytics is helping position the ACO for continued success in an increasingly value-based reimbursement environment.

Published in: Healthcare

Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

  1. 1. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright © 2014 Health Catalyst www.healthcatalyst.comCreative Commons Copyright Dr. Greg Spencer & Dr. Scott Hines Preparing for the Future: Using Analytics to Drive Clinical & Operational Excellence
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Today’s Hosts Dr. Gregory A. Spencer is the Chief Medical and Chief Medical Information Officer at Crystal Run Healthcare and the Vice President of Medical Staff at Orange Regional Medical Center (ORMC). Dr. Spencer graduated from the Medical College of Wisconsin (Marquette University) Medical School and completed his residency in Internal Medicine while in the U.S. Air Force at Wilford Hall USAF Medical Center in San Antonio, TX. Dr. Spencer joined Crystal Run as an internist in 1996 and was appointed to Chief Medical Officer and Chief Clinical Information Officer in 2008. Dr. Spencer is board certified in Internal Medicine and is a Fellow of the American College of Physicians. Scott Hines, MD is Crystal Run Healthcare’s Co-Chief Clinical Transformation Officer, Medical Director and physician leader for Crystal Run Healthcare’s medical specialties division. Dr. Hines is board certified in Internal Medicine, Endocrinology, Diabetes and Metabolism. Dr. Hines earned his Medical Degree from the Wake Forest University in Winston-Salem, NC and completed his residency in Internal Medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, NH. Dr. Hines completed his Endocrinology Fellowship at the University of Maryland Medical Center in Baltimore, MD. Dr. Hines joined Crystal Run Healthcare in his current capacity in 2006 to help develop and implement the clinical programs necessary to deliver value based care.
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Topics ACO progress review – national trends and Crystal Run1 Review of progress in data-driven decision making2 Review progress with key challenges3 Early results and wins4 What’s next?5
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Poll Question 1. What best describes the organization you belong to? 235 responses a. Hospital – 21% b. Health Plan – 11% c. Physician Group – 13% d. Provider Organization – 12% e. Vendor – 43%
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare  Physician owned MSG in NY State, founded 1996  325+ providers, 20+ locations  Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology  Early adopter EMR (NextGen®) 1999  Accredited by Joint Commission 2006  Level 3 NCQA PCMH Recognition 2009, 2012  Approved Health Plan (NY)
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare  Single entity ACO  April 2012: MSSP participant  December 2012: NCQA ACO Accreditation  25,000 commercial lives at risk  MSSP  10,400 attributed beneficiaries  82% primary care services within ACO
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare The mission of Crystal Run Healthcare is to improve the quality and availability of, and satisfaction with, health care services in the communities we serve. To accomplish this goal, the practice emphasizes both traditional medical excellence as well as responsiveness to consumer needs through service excellence and patient empowerment.
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright ACOs – National Trends • Explosive growth in the number of Accountable Care Delivery (ACO) organizations nationally • In 2014, there were a total of 626 public and private ACOs in the US1 • ACOs now cover an estimated 20.5 million lives in the US1 • Strong physician involvement • 51% led by physicians and another 33% jointly led by physicians and hospitals.2 • This is probably not surprising giving that a focus on value means a focus on the process of care. • Strong, effective leadership from physicians is indispensible • Crystal Run—physician led and physician owned 1. Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from http://leavittpartners.com/wp-content/uploads/2014/06/Growth-and-Dispersion-of-Accountable-Care-Organizations-June2014.pdf 2. Colla, C., et.al. (2013). First national survey of ACOs finds that physicians are playing strong leadership and ownership roles. Health Affairs, 33(6): 964-971.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Growth of ACO Covered Lives Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from http://leavittpartners.com/wp-content/uploads/2014/06/Growth-and-Dispersion-of-Accountable-Care-Organizations-June2014.pdf
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright ACO Penetration by Hospital Referral Region Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from http://leavittpartners.com/wp-content/uploads/2014/06/Growth-and-Dispersion-of-Accountable-Care-Organizations-June2014.pdf
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright A World in Transition • Majority of reimbursement still fee for service (~80%) but beginning to see a shift toward value-based reimbursement (now ~20%) • In anticipation of this new future, we are implementing a strategy focused on: • Rapid growth (to better manage risk) • Aligning physician reimbursement with favorable patient outcomes
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Key Challenges To effectively execute on growth and population management strategies, need to continuously improve on: • Reducing clinical variation, enhancing operational efficiency, and positioning the organization to better manage risk • Supporting informed decisions by providing clinical and operational decision-makers efficient and effective access to all necessary information • Using data from a “single source of truth” integrated from several disparate source systems • The use of “self service analytics” by decision-makers to avoid unnecessarily prolonged decision-making processes
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Current Areas of Focus Growth and practice expansion Risk-based contracting Physician compensation Population health management
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright The Need for Data Because data is a prerequisite for the data-driven future, Crystal Run implemented: • An enterprise data warehouse (EDW) • Key foundational analytical applications to mine and view data in order to answer key questions and identify important trends Key Process Analysis Cohort Builder Comorbidity Analyzer Population Explorer
  15. 15. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Poll Question 2. If you receive claims data from at least one payer, how do you currently use this data for population health management? 191 responses a. We use an internally developed application – 34% b. We use a third party application – 25% c. We do not use the claims data we receive – 13% d. Other – 28%
  16. 16. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Poll Question 3. For those of you who do not receive claims data, how do you determine the cost of care for your patients, particularly for services outside of your network? 106 responses a. We use summary reports provided by our contracted payer(s) and estimate costs – 22% b. We attempt to extrapolate costs based on costing information within our organization – 20% c. We do not have insights into the costs of care outside of our network – 23% d. Other – 35%
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example – Growth & Practice Expansion To support growth, Population Explorer helps: • Identify growth opportunities • Visualize population characteristics in a certain geographic area • Population size, demographics, case counts, readmission rates, charges, revenue, length of stay, likely visit types, etc. by zip code • Assist physician hiring and placement decisions • Marketing
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Population Explorer
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Population Explorer Animate with circled ar
  20. 20. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example – Risk Contracting To support growth, applications like Cohort Builder and Comorbidity Analyzer are used to: • Ensure the conversations with payers are more data-driven and accurate • Justify a higher PMPM to support investment in additional care infrastructure • e.g., hiring more care managers to help coordinate better care for these patients
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Comorbidity Analyzer
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example – Physician Compensation To effectively and fairly address important physician compensation issues, foundational analytics applications are used to: • Accurately assessment of the care physicians actually deliver (volume, risk profile, subspecialty work, etc.) Example: A breast surgeon who also does general surgery can be more accurately benchmarked based on the volume of breast surgery compared to the volume of general surgery, and the risk profile of the patients they serve
  23. 23. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Cohort Builder
  24. 24. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example – Population Management To support population management, the Key Process Analysis (KPA) tool is used to: Can quickly visualize variation rates stratified by physician and adjusted by risk to decide what the biggest opportunities are so that the variation reduction initiatives can be prioritized Identify inappropriate variation 1 Enhance physician engagement 2
  25. 25. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright KPA Tool
  26. 26. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright KPA Tool
  27. 27. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright KPA Tool
  28. 28. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example –New Revenue Opportunities The KPA and Cohort Builder tools were used to identify new revenue opportunities (not previously available) • Example: CMS DSRIP incentive program • Although Crystal Run as a practice did not exceed the 35% threshold for Medicaid and uninsured visits, using Population Explorer and Cohort Builder, we were able to show that individual specialties and individual providers surpassed the threshold • This allowed Crystal Run to apply for a waiver to be included in the funding for the grant program. • Application in process
  29. 29. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Example – Improved Budgeting To improve the budgeting process, Crystal Run used data and analytics to manage and predict productivity: • Example: A seasonally adjusted budget (“snow days”) • In 2014, Crystal Run experienced a profound negative financial effect from snow days that impeded the ability of patients to come in for care • This necessitated a more proactive and accurate seasonal budgeting and physician productivity plan
  30. 30. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Results –Time Savings Office expansion ● The analysis would have taken a developer about 3 days to complete; now completed in about 2 hours ● This informed a $30M go/no-go new office construction decision ensuring optimal ROI Physician compensation ● Aligned physician compensation with their actual work effort ● Ensures that personnel costs are properly matched to the clinical costs, but also ensures the physician feels fairly compensated improving satisfaction and retention. ● The specialty assessment previously would take half a day to conduct, and is now completed in just 5 minutes .
  31. 31. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Results –Time Savings Medicaid grant petitioning ● Previously, the BI team would need to have spent approximately one week to collaborate and design multiple SQL queries to create a useful report. ● With the foundational applications this analysis was complete in just one hour. ● This identified a multi-million dollar Medicaid grant revenue opportunity. Annual budgeting and productivity planning improvements ● Created a more accurate seasonally adjusted budget and productivity plan ‒ Avoid having thousands of patients who need care to not be seen during the months of severe weather, and ‒ Allow physicians to better balance their professional and personal lives.
  32. 32. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Results – Improved Contracting More effective negotiations on risk-based contracts ● Crystal Run is now able to bring new information to the table to drive more data-focused and accurate conversations ● Crystal Run needs to capitalize on each shared savings and risk contract they have ‒ Comorbidities and risk profiles will ensure transparency around the financial risk associated with those patients and more appropriate per member per month rates can be negotiated
  33. 33. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Results – Best Practice Facilitates reduction in inappropriate clinical variation while ensuring utilization of evidence best practice ● Clinical variation initiatives are more easily prioritized ● Priority areas are identified within the KPA tool and discussed with providers serving a specific domain (e.g., diabetes care) ● Physicians have ownership in the development of best practices and are accountable for making changes in their individual practice to better align with evidence-based medicine ● Ultimately, aligning on best practices will result in less variation in care and ultimately lower costs
  34. 34. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright What’s Next? Goal – move quickly to value-based care ● Applying for HMO license to enable Crystal Run to become a health plan ( “Crystal Run Health Plan”) ‒ Health plan will overcome some of the MSSP limitations (providers still receive fee-for-service payments; patients free to be seen wherever they want) ‒ The health plan will be a narrow network product to better ensure that patient’s do not migrate inappropriately allowing accountability for their care over long periods of time ‒ For patients on the new health plan, the majority of the care would be performed by Crystal Run ‒ It is anticipated that this health plan will launch in January, 2015 ● In order to manage the plan population effectively, maximize quality and lower costs, will continue to leverage the EDW to conduct robust analytics ‒ Requires multiple levels of drill-down capability
  35. 35. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Placeholder, enter your own text hereQuestions, discussion, comments…
  36. 36. © 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright36 Thank You Greg Spencer, MD, CMO Crystal Run Healthcare www.crystalrunhealthcare.com Contact Information Scott Hines, MD Crystal Run Healthcare www.crystalrunhealthcare.com

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