MIT Enterprise Forum Innovation Series Event: Healthcare Innovation After ObamaCare, April 30, 2014


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Christina Severin, President & CEO, Beth Israel Deaconess Care Organization presentation on healthcare technology for the MIT Enterprise Forum Innovation Series Event: Healthcare Innovation After ObamaCare

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MIT Enterprise Forum Innovation Series Event: Healthcare Innovation After ObamaCare, April 30, 2014

  1. 1. MIT Innovation Series Christina Severin, President and CEO April 30, 2014
  2. 2. About BIDCO • BIDCO is a value-based, physician and hospital network and an Accountable Care Organization (ACO).  Located in Westwood, Mass.  Employs more than 80 staff members  Contracts with 2,100 physicians, including nearly 450 primary care physicians and 1,700 specialists and 6 hospitals  Contracted by Centers for Medicare and Medicaid Services (CMS) as a Pioneer ACO • $1B in risk revenue management • Our highest level goal is to promote the best quality and value of care to patients, providers, health insurers, and employers. 2
  3. 3. BIDCO structure 3 BIDCO Confidential Physician LLC Hospital LLC
  4. 4. High-level goals • Grow the business  Creates virtual cycle of opportunity  Ensures needed scale • Effective risk contracting  Moves away from fee-for-service (“click-fee”) model  Manages total cost of care for populations • Beating budgets to earn surplus (or not)  Offers financial opportunity for improved quality (P4P) • Provide governance structure needed to support legal and business requirements of an ACO 4
  5. 5. Essential business functions • Ensure business processes that support cost management and quality improvement goals  Financial management of risk contracts  Care management  Disease management  Quality improvement  Clinical integration • EHR hosting and support • Data interchanges  Provider support services  Risk contracting with CMS and other managed care companies 5
  6. 6. Highest level challenges • Manage total cost of care (“TME”) budgets  Effectively manage risk contracts to return value to Members (>$1B)  Right care in the right place at the right time • Improve quality  Effectively earn quality dollars to return value to Members  76 unique ambulatory goals over four major contracts; only two goals appear in all contracts 6
  7. 7. Technology limitations • Inherent complexities of data-sharing in an environment of minimal interoperability  Patient information in silos (e.g., stand-alone EHRs)  Limitations in moving information along a system of care • Clinical integration  Fragmented access to data (access to some EHR data)  Cumbersome user experience for physicians and care management teams (multiple vendors, products, and modules)  Limited ability (claims data) to access “full view” of care experience • Therefore, there are several ways in which new technology could help solves for these limitations 7
  8. 8. Innovation need #1 • One-stop, comprehensive physician performance reporting  Performance metrics, improvement suggestions  High-risk, high-cost members  Patient rosters, including location, diagnosis, ED visits  Gaps in care assessment  Prescription status  Coding improvements  Predictive tool to identify needed intervention, suggests intervention based on circumstance algorithm 8
  9. 9. 9 Quality report Efficiency report EHR Financial performance Patient list Check email High-risk patient registry Current state: Performance reporting Login to Application #1
  10. 10. Future state: Performance reporting Comprehensive physician performance reporting tool Single login 10 BIDCO Data repositories Claims Lab/ Rad Care mgmt. EHR Clinical data
  11. 11. Innovation need #2 • ACO care record that travels with patient to site of care  Move fully integrated health information across care continuum  A fully connected clinical ACO community that leap frogs inter-operability by generating a clouded-based HIX for fully integrated data capture of all experience regardless of the site of care 11
  12. 12. Current state: BIDCO data exchanges BIDCO Community EHR Integrated EHR, PMS & Billing 100+ databases Electronic Health Exchange Longitudinal Community Health Record Quality Data Center Clinical Quality Data repository of BIDCO member EHR Clincal data Payors Lab/ radiation Claims Data Warehouse Data Warehouse: Consolidation of claims, labs & clinical data for reporting CMS ACO reporting tool High-risk patient identification and stratification tool WebOMR BIDMC EHR Other Community Systems Centricity NextGen Other Risk- flagging database Hospital HIS 12
  13. 13. PCP Office Surgical Center Pharmacy Skilled Nursing Facility Physical Therapy MRI Center Orthopedics Future state: BIDCO data exchange 13 Community Medical Record Inpatient
  14. 14. Summary • The majority of new innovations being offered to ACO’s, are developed based on a concept that an ACO has simple data architecture  Data mining (how can you mine data if you can’t access the data?)  Predictive modeling (how can you predict if you can’t access all the data?)  Population management (how can you tell a doctor a patient needs a Ha1C if you don’t have access to all lab data?) • Payer claims data remains the most straight forward way to perform all analytics  However, this leaves EMR data – the primary source of clinical data – out of the picture • The reality is that our architecture is incredibly complex and diverse • Therefore, the most important solutions need to focus technology that can solve our complexity issues 14
  15. 15. Questions 15