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Using Electronic Health Information and Strategic Analytics to Enhance Value Based Health Solutions, Improve Care Delivery and Advance Care Coordination
The document discusses the role of electronic health information and strategic analytics in enhancing value-based healthcare solutions and improving care delivery through clinical integration. It highlights how Texas Children's Health Plan leverages these technologies to achieve significant improvements in pediatric care, including reduced emergency department visits and hospital admissions. Additionally, it addresses the ongoing challenges in data sharing and collaboration among healthcare providers post-Affordable Care Act implementation.
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Using Electronic Health Information and Strategic Analytics to Enhance Value Based Health Solutions, Improve Care Delivery and Advance Care Coordination
- 1. 1© 2014 ValenceHealth. All rights reserved. Clinical Integration Using Electronic Health Information and Strategic Analytics to Enhance Value Based Health Solutions, Improve Care Delivery and Advance Care Coordination HFMA Texas Gulf Coast & HIMMS South Central Texas Chapter Joint Meeting September 26, 2014
- 2. 2© 2014 ValenceHealth. All rights reserved. Clinical Integration Objectives 1 Understand What’s Fueling “Big Data” Discussions in Healthcare 2 Learn How Texas’ Children’s Health Plan is Using Electronic Health Information and Strategic Analytics 3 Address Your Questions
- 3. 3© 2014 ValenceHealth. All rights reserved. Clinical IntegrationACA is Providing Incentives for Providers and Hospitals to Overcome Distrust and Align for Common Gain Lack of Shared Incentives Lack of Physician Governance Fragmented Structure • Long term contracts offered with no productivity terms or quality incentives • Physicians were promised a greater say that was never delivered • Hospitals failed to organize multiple physician groups into a cohesive units • Lack of communication tools Pre-ACA Implementation1 Post-ACA Implementation3 Aligned Incentives Demand for Coordinated Care Technology Incentives2 • Bundled payments • Shared savings / risk arrangements • Must manage care together • Safe harbor for physicians and hospitals to operate • Penalties for poor quality scores for hospitals • Staying on top of quality scores means improving physician relationships • Meaningful Use initiatives provide incentives for investment in technology that improves coordination • Overcome data issues $ 1) Deloitte Center for Health Solutions. “Physician-hospital employment: This time it’s different.” 2013. http://www.deloitte.com/assets/Dcom- UnitedStates/Local%20Assets/Documents/Center%20for%20health%20solutions/us_lshc_PhysicianHospitalEmployment_090313.pd 2) Centers for Medicare & Medicaid Services. 2014 Definition of Stage 1 of Meaningful Use. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html 3) PwC Health Research Institute. “From courtship to marriage: A two part series on physician-hospital alignment.” 2011. http://thehill.com/images/stories/blogs/pwc%20trust.pdf
- 4. 4© 2014 ValenceHealth. All rights reserved. Clinical Integration What We Are Seeing in the Market Model ↑↓ Trends Clinically Integrated Networks • Major momentum in many/most markets • Drivers different by market “type” • Some cross-system collaborations • Some IPA/Physician lead models, but mostly hospital / system supported ACOs and Full Risk Contracts • Commercial and Medicare ~50/50 • Latest batch of MSSP about to be released to applicants • Data reporting/sharing often still problematic • Seeing selected expansion of full-risk contracts – some provider inspired • Medicaid risk contracts in some states Provider- Sponsored Plans • Some marquis growth (Sutter, NSLIJ) and smaller players (CHOMP, Florida Hospital, solutions • ABCO says 1 in 5 systems to be payors by 2018 Bundled Payments • Still limited in total application • Still focused around cardio, ortho and birth episodes/procedures • Illinois Bone and Joint - Leader PCMH • ~5000 accredited sites • New growth has slowed • Funding from commercial payors may be focused elsewhere 41 138 356 606 0 100 200 300 400 500 600 700 Q4 2010 Q4 2011 Q4 2012 Q4 2013 Rapid Growth of ACOs Year Over Year1 Number of ACOs by Referral Region1 1) Leavitt Partners Center for Accountable Care Intelligence, 2014
- 5. 5© 2014 ValenceHealth. All rights reserved. Clinical Integration Inputs and Outputs that Support Quality and Risk Management Clinical Measures and Quality Improvement Population Analytics for Risk Stratification Programmatic Risk Management Portal Inputs: Multiple Sites and Data Sources Outputs: Population Management with Decision Support Functionality • National measures (e.g. HEDIS) • CI measures • Risk measures – and how they are different • Population health reporting • Identification of gaps in care and high-risk patients • Proficient and proactive performance management • Physician report cards • Registries and action lists for each patient (e.g. overdue care) Physician Offices Practice Management Systems, EHRs Hospital Data ADT, Billing Data, Demographics Lab Data Quest, LabCorp, Other PBM Data Post-Acute Data Claims Based Payor Data Eligibility, Paid Medical Claims 360o Clinical Information for Affiliates • Virtual medical records support POC risk management • ED and Hospitalization alerts • Encourages in-network referral
- 6. 6© 2014 ValenceHealth. All rights reserved. Clinical IntegrationAttribution of Members to Providers is Critically important for Population Health Management Attribution assignment can be… • Assigned by the payor or EMR • Based on number and type of E&M codes • Assigned using ranked specialists • Triggered by Dx or Px • More customized, if client wishes Attribution is key to creating joint accountability for risk and quality. Configuration can be based on: • Provider type: specialty type, PCP, PCP subtypes • Single or multiple attribution: including groups as defined by geography or specialty • By encounter detail: counts, types, and diagnoses specific • Configurable at the measure level • Any permutation of the above Member matching capabilities reliably and accurately link unique individuals across EMRs, PMS, labs, Rx data, professional services, hospitals, and other institutions. Algorithms are: • Tuned to enhance specificity and avoid false negatives • High matching rates with capabilities for manual clinician directed merging • Incorporate advanced statistical methodologies including probabilistic matching, Bayesian algorithms, and deterministic logic Attribution Member Matching
- 7. 7© 2014 ValenceHealth. All rights reserved. Clinical Integration Objectives 1 Understand What’s Fueling “Big Data” Discussions in Healthcare 2 Understand How Texas’ Children’s Health Plan is Using Electronic Health Information and Strategic Analytics 3 Answer Your Questions
- 8. 8© 2014 ValenceHealth. All rights reserved. Clinical Integration The Center for Children and Women Texas Children’s Texas Children’s Hospital Texas Children’s Pediatrics Texas Children’s Physician Services Organization Texas Children’s Women’s Specialist Texas Children’s Health Plan Texas Children’s Health Plan— The Center For Children and Women TCH Insurance Company, LTD Texas Children’s Hospital Foundation
- 9. 9© 2014 ValenceHealth. All rights reserved. Clinical Integration Background • Located in the community of Greenspoint and soon Southwest. • Both areas with large Medicaid populations
- 10. 10© 2014 ValenceHealth. All rights reserved. Clinical Integration Access
- 11. 11© 2014 ValenceHealth. All rights reserved. Clinical Integration Integration • Pediatrics • Obstetrics • Behavior Health • Pharmacy • Optometry • Dentistry • Laboratory • Diagnostic Imaging • Speech Therapy
- 12. 12© 2014 ValenceHealth. All rights reserved. Clinical Integration Coordination
- 13. 13© 2014 ValenceHealth. All rights reserved. Clinical Integration Alignment
- 14. 14© 2014 ValenceHealth. All rights reserved. Clinical Integration HEDIS Metrics
- 15. 15© 2014 ValenceHealth. All rights reserved. Clinical Integration Valence Reporting Population Management
- 16. 16© 2014 ValenceHealth. All rights reserved. Clinical Integration TCHP Utilization Performance Relative to Peers
- 17. 17© 2014 ValenceHealth. All rights reserved. Clinical Integration • Eligibility • Member Eligibility o Member months from 2011-2013 o Ages 1-18 o Exclude newborn, pregnant women, TANF adults, and SSI members • Claims Eligibility o Claims incurred from 2011-2013 • Utilization: defined as rate per 1,000 members per year • Numerator: sum of events • Denominator: sum of member months • Rate: 12,000 * (Numerator / Denominator) Peer Comparison Methodology for Texas Medicaid Children
- 18. 18© 2014 ValenceHealth. All rights reserved. Clinical Integration TCHP is the Highest Performing System, Achieving a 61% Reduction in ED Visits Relative to its Peers Medicaid Pediatric ED visits, by Provider system Rate per 1,000; Payor data; 2011-2013 average 348 435 721 577 894A C B Average 595 D -61.1% TCHP 2011-2013 average
- 19. 19© 2014 ValenceHealth. All rights reserved. Clinical Integration TCHP pediatric admission rate is 36% lower that its cohort Medicaid Pediatric Admissions, by Provider System Rate per 1,000; Payor data; 2011-2013 average 19.2 29.9 27.7 18.5 22.4 D A B TCHP Average 24 C -35.8%
- 20. 20© 2014 ValenceHealth. All rights reserved. Clinical Integration Objectives 1 Understand What’s Fueling “Big Data” Discussions in Healthcare 2 Learn How Texas’ Children’s Health Plan is Using Electronic Health Information and Strategic Analytics 3 Answer Your Questions
- 21. 21© 2014 ValenceHealth. All rights reserved. Clinical Integration Contact Us • Nathan Gunn MD, President of Population Health, Valence Health • NGunn@valencehealth.com • Ph: 312-526-7395 • Heidi Schwarzwald MD MPH, Pediatric Director Texas Children’s Health Plan Center for Children and Women; Vice-Chair for Community Pediatrics, Baylor College of Medicine Department of Pediatrics at Texas Children’s • hlschwar@texaschildrens.org • Ph: 832-828-1538