The document summarizes the needs and goals of BIDCO, a physician network and Accountable Care Organization. BIDCO employs over 80 staff and contracts with 2,100 physicians and 6 hospitals. It aims to promote quality care while managing $1B in risk revenue. Key challenges include managing total cost of care budgets and improving quality across different contract requirements. The document outlines BIDCO's current limited data sharing capabilities between different IT systems and identifies two main innovation needs: 1) a comprehensive physician performance reporting tool for consolidated data access and 2) an ACO care record that can travel with patients across sites to improve clinical integration and data sharing.

1. MIT Innovation Series
Christina Severin, President and CEO
April 30, 2014

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.
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3. BIDCO structure
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BIDCO
Confidential
Physician
LLC
Hospital
LLC

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
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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
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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
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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
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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
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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. Future state: Performance reporting
Comprehensive
physician
performance
reporting tool Single
login
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BIDCO
Data
repositories
Claims Lab/
Rad
Care
mgmt.
EHR
Clinical
data

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
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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
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13. PCP Office
Surgical
Center
Pharmacy
Skilled
Nursing
Facility
Physical
Therapy
MRI Center
Orthopedics
Future state: BIDCO data exchange
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Community
Medical Record
Inpatient

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
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15. Questions
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