Data Driven Healthcare That Work: A Physician Group Perspective

Data-Driven Healthcare That Works –
A Physician Group Perspective
By Dr. Gregory Spencer, CMO & CMIO, Crystal Run Healthcare
© 2014 Health Catalyst
www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

To improve the quality, availability of, and satisfaction with healthcare
services in the communities we serve.
And we would do this with data.
The Journey to Data-Driven
Healthcare
For Crystal Run Healthcare,
the journey to data-driven
healthcare began in 2007.
We decided as a practice
we needed both a mission
statement and a vision.
The answer?

The Journey to Data-Driven
Healthcare
This was not our first foray into
data. Crystal Run was a relatively
early adopter of the electronic
health record (EHR).
Our vision quickly propelled us
forward in the quest for data-driven
care in our population health
management efforts.
Compare the Triple Aim today with
our 1997 mission statement, you’ll
see they align nicely.
We had unknowingly began prepping for Triple Aim by embracing
the need to improve care and make it part of our business.

Population Management Is Critical for Future
Viability and Population Health Improvement
Facing competitive pressure within our
community, it was imperative for Crystal
Run to quickly learn to navigate the
value-based world.
We learned the importance of putting in
place systems that enable population
health management.
It’s easier to manage risk within larger
patient populations so we knew we had
to expand in size, scope and geography.
We also needed to evolve and continue
to build the skill sets of the Crystal Run
team, so we would become the practice
of choice, for patients and physicians.

To accomplish our goals, here are a few examples of what we’re doing
to implement data-driven, value-based care.
Waste Reduction On-site Care
Managers
Crystal Run
Initiatives
Identification of High-
Risk Patients
Bluetooth-Enabled
Devices
Crystal Run Healthcare Quality Initiatives

1 – Waste Reduction
Crystal Run’s strategy for care
management is to provide high-quality,
value-based care that is
data-driven and evidence-based.
For example, if procedures and
tests have not been shown to
benefit the patient, then we try to
eliminate them.
As a result, clinicians review
every test and procedure to
ensure it will contribute to
advancing the patient’s health.

2 – On-site care managers
Registered nurse care managers
are located at each of our medical
homes. Their role is to meet with
patients and coordinate care as
needed.
There’s also a care manager in
the hospital — paid for on Crystal
Run’s dime — who coordinates
the transition of care.
In addition, a team visits with
patients in their homes if they
can’t make it to the office.

3 – Identify high-risk patients
Identifying high-risk patients and
those who need complex care
management is very important.
However, being able to identify
these patients is only possible
with systems in place to evaluate
risk and then create lists of
patient, also known as registries.
Then the patients in those lists
needing management are
evaluated by providers or sent to
care managers.

4 – Bluetooth-enabled devices
If a patient has multiple admissions
or identified as high-risk they
receive a Bluetooth enabled
monitoring device, such as a scale
or blood pressure device for home
use.
Should the device monitor and
record problematic changes it will
notify a nurse or care manager and
the patient can be quickly
contacted.
For example, if a patient with CHF
has a sudden weight increase, a
nurse can reach out and intervene.

Data-Driven Outcomes
We had been relying initially on a data
warehouse that we developed ourselves.
Applying the strategies mentioned above, we
achieved some relatively positive results,
including the following:
Reduction of admission rates overall by nearly
20 percent
Improvement of mammogram screening rates
from 60-65 percent to greater than 75 percent
Achievement of hemoglobin A1c rates of less
than 9 percent
Improvement of pressure control by more than
75 percent for hypertensive patients
Reduction of avoidable admissions down to
now less than 17 percent

Crystal Run’s avoidable admissions are down to less than
17 percent at this point.

Crystal Run improved mammogram screening rates for its patients
from 60-65 percent to greater than 75 percent. They achieved these
improvements by implementing a data-driven approach during the
second quarter of 2012.

While our results were solid, we wanted more. Our organization had
depended on data for years, but, recently, we were noticing how it
was becoming even more important in our quest to provide the best
care for patients, advance our mission, and maintain our quality
reporting requirements to outside entities.
But to be able to provide these services and achieve the types of
outcomes that are required, we wanted to be able to store and track
ever-increasing amounts of data in a more automated fashion.
Inability to Keep Up with
Accelerating Data Demands
13

In the past our analysts spent a
lot of time with manual entry and
extraction of the data.
We quickly learned the
importance of automated
processes for data presentation.
Inability to Keep Up with Accelerating
Data Demands

There’s also a need to marry
claims data with clinical data from
the EHR, so we can improve our
knowledge of patient care
provided outside our system.
We knew we needed to have an
enterprise warehouse for data
storage and be able to simplify,
automate, and scale the reporting.
We also needed dedicated
analytic applications to enable
analysts with actuarial science
and statistical expertise to help
sort through the data.
Inability to Keep Up with Accelerating
Data Demands

Crystal Run EDW Requirements
Crystal Run decided to find a partner
to develop a more modern enterprise
data warehouse (EDW).
Our requirements?
1. Quick integration and results
2. Short ramp up to actionable data
3. Included several analytical applications
4. Built with a healthcare data framework
5. Independence from vendor for self
sufficient data mining
6. Solid long term relationship with vendor

The nature and sheer volume of
healthcare data is much more
complex in the healthcare industry.
These days there’s a sense of
urgency for physician groups like
Crystal Run, payers, and providers to
get access to their data to provide
data-driven care.
As a result, we need to take over
ownership of managing, adding, and
expanding our data sources.
Yet, dependence on a vendor to make
changes hampers our ability to mine
data in-house.
It’s All About the Data

To date, Crystal Run has seen
positive results by implementing a
late-binding data warehouse and
analytics system.
The flexibility of the architecture and
the adaptable approach to mapping
data to business rules and definitions
when it’s most appropriate has given
us a solution that can keep up with
the complexity and rapid changes in
healthcare data.
From our perspective, data-driven
healthcare provides the much-needed
insight needed to achieve our mission
as well as the goals of the Triple Aim.
It’s All About the Data

How to Use an EDW and Analytics to Reduce 30-day Heart Failure Readmissions
A case study of how a health system used an EDW and analytics to achieve
incredible results
Population Health Management: Implementing a Strategy for Success (a white paper)
David Burton, MD, Senior Vice President and Former Executive Chairman
More about this topic
Data-Driven Care: The Key to Accountable Care Delivery from a Physician Group
Perspective (on demand webinar, slides, transcript)
Gregory A. Spencer, MD, FACP, CMO/CMIO at Crystal Run Healthcare
Late-Binding Data Warehouse: The Best Solution to Aggregate Healthcare Data
Eric Just, Vice President of Technology
A Landmark, 12-Point Review of Population Health Management Companies
(executive report)
Dale Sanders, Senior Vice President, Strategy

For more information:

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Dr. Gregory A. Spencer is the Chief Medical and Chief Medical Information Officer at
Crystal Run Healthcare and the 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 US 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.

Data Driven Healthcare That Work: A Physician Group Perspective

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Data Driven Healthcare That Work: A Physician Group Perspective