Value-based Care and the Role of Health Information Technology. Andrew Hamilton, RN, BS, MS, Chief Informatics Officer

Transcription

1 Value-based Care and the Role of Health Information Technology Andrew Hamilton, RN, BS, MS, Chief Informatics Officer

2 HHS Core Strategies 1. Improving payment process to incentivize quality and value of care over simply quantity of services 2. Improving care delivery by providing clinical practice support, data and feedback reports to guide improvement and better decision-making 3. Making data more available and enabling the use of certified EHR technology to support care delivery

3 Insert slide on payment reform

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7 Why does MACRA matter to Health Centers? The Federal Government uses the Medicare program as a lever to drive change across all Health System sectors MIPS measures will become a widely accepted benchmark for healthcare providers Penalties may adversely affect providers serving Safety Net populations MACRA will drive many Health Systems and Providers to alterative models.

8 Improving revenue under different reimbursement models Fee for service: Increase number of patients seen by provider Capitation: Increase number of patients managed by provider Quality incentives: Increase quality of care provided by provider Shared savings/shared risk: Decrease volume of specialty care, emergency room visits, and hospitalizations seen by provider

9 Savings by Provider Type

10 Mechanisms for Clinician Engagement Provide Clinical Decision Support Tools Embed learning activities within delivery systems Expand the scope Quality Improvement activities QI as research Incentives for Quality of Care Create access to and promote utilization of diverse data Respond to Engaged Patients and Further Engage Allow providers to embrace the Point of Care Clinical trial model of research Validation of New Technologies Embrace the concept of Living Clinical Guidelines

11 Clinical Decision Support Tools

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14 Key HIT Functionality Mobile Health & Alerts Care Coordination Patient Engagement Quality Analytics Business Analytics Ad Hoc Reporting Data/Analytics Infrastructure Electronic Health Record Practice Management System

15 Data & Analytics Strategic Plan More than just reporting Requires alignment with other organizational plans (especially quality plan) Challenging to balance today s issues with planning for tomorrow s need

16 Data & Analytics Functions Preventive and Chronic Disease Management Risk Stratification Provider Empanelment ED, Hospital, and Specialty Utilization Total Cost of Care Business/Financial Operations Management Required Reporting Ad Hoc Research Data Predictive Modeling Innovations

17 Data Sources EMR Claims/Enrollment Pharmacy Data ADT Public Health Patient Reported Outcomes Social Determinates of Health

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19 How do I Organize All this Data?

20 SSRS & Power View Data Marts SAS Enli Others *TBD ArcGIS Microsoft BI Tools Statistical Programming Pop Health Other Tools Microsoft s Big Data Solution Microsoft SQL Server 2012 Microsoft Analytics Platform System (APS) Microsoft HDInsight (Hadoop): Unstructured, Free Text Data SAP Data Services SSIS Sqoop (Scoop in to Hadoop) Data Ingestion Layer

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22 Population Health Goal: Identify gaps in care in order to deploy appropriate interventions in a timely manner Data Sources: EMR, Claims, Pharmacy, PROs, and Public Health Data

23 Tasks that need action show up in red

24 Filtering Can apply multiple filters

25 Adding Patients to a Program Note - the Workflow Checklist shows you your patients and where they are in the process

26 Outreach assignments creating automated to do lists

27 Point of Care Tool From Centricity, use the Care Management Form in a visit encounter to add to Program

28 ED/Hospital Utilization Goal: Ensure timely notification of ED visits and inpatient admissions/discharges to provide appropriate follow-up Data Sources: ADT, Claims, and EMR

29 Total Cost of Care Goal: Understand cost of care in order to decrease as appropriate Data: Universal Claims, Pharmacy Data

30 Hopkins ACG

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33 What Determines Health? Envrionment 5% Genetics 30% Pt Choices 40% Social 15% Medical Care 10% McGinnis et al, Health Affairs Vol 22(2)

34 50 % of last year s high cost claimants spend less than $5000 in the previous year

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36 PRAPARE (funded by NACHC) To create, implement/test, and promote a national standardized patient risk assessment protocol to assess and address patients social determinants of health (SDH). Document the extent to which each patient and total patient populations are complex. Use that data to: improve patient health, affect change at the community/population level sustain resources and create community partnerships necessary to improve health.

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40 Most Common Social Determinant Actionable RISKS

41 Public Health (open) Data

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45 Questions & Thoughts