Life is better healthy. ACO Data Aggregation to Support Population Health Dena M. Ragusa, MS ACO Manager of Informatics, DSRIP Project Manager
Agenda Introduction Data Aggregation ACO Patient Flagging Analytics and Regulatory Reporting Lessons Learned 2November 21, 2014
INTRODUCTION November 21, 2014 3
What is an Accountable Care Organization (ACO)? Definition: A group of payers, physicians, hospitals and other providers that collaborate to provide efficient, high quality and coordinated care for a select group of patients. 1 Better Health 2 Better Care Triple Aim 3 Lower Costs
Barnabas Health Accountable Care Structures Medicare Shared Savings Program (MSSP) Horizon BCBSNJ Medicare Advantage ~ 30,000 Beneficiaries ~ 800 Employed and community providers 6 BHS acute hospitals + external partner hospital November 21, 2014 5
Our Partnership with HEALTHEC (HEC) November 21, 2014 6
Partnership with the New Jersey Health Information Technology Center (NJ-HITEC) Accountable Care Organization (ACO) Meaningful Use (MU) Physician Quality Reporting Initiative (PQRS) ICD-10 Patient Centered Medical Home (PCMH) Comprehensive Primary Care Initiative (CPCi) Education November 21, 2014 7
DATA AGGREGATION November 21, 2014 8
Data Aggregation Plan Claims Data Beneficiary Data Pharmacy Claims EHR Lab Results Assessments Data Warehouse Care Plans Audit Reporting Patient Rosters Case & Disease Management Population Management Patient Dashboard Cost & Utilization Reporting November 21, 2014 9
Data Integration Multiple Systems, Organizations, and Sources Varying levels of integration makes data aggregation difficult. November 21, 2014 10
Data Integration Challenges CMS member rosters provide limited patient demographic information Establishing unique patient IDs and matching algorithm System query and filtering limitations Data not entered into structured fields, some EHRs do not have structured fields to store all information EHRs having multiple fields to store the same information, identify provider workflows Vendor participation in data extraction projects November 21, 2014 11
Member Rosters and Patient Identifiers Member Rosters Member Rosters BHS Inpatient System Payors Claims Data Data Warehouse External Vendor Database Partner Hospital System BHS Outpatient System BHS Outpatient System 2 Address, phone number, email Enterprise Master Patient Index (EMPI) Medical Record Numbers (MRNs) November 21, 2014 12
Electronic Health Record (EHR) - Clinical Data Summary: Clinical data extracts from Cerner and NextGen EHR systems including patient details, c visit information, medications, vitals, allergies & contradictions, lab & radiology results, and immunizations. Benefits: Fill in claim data gaps and claim lag Robust analytics and quality measurement Reduce the amount of manual extraction for annual reporting November 21, 2014 13
BHS Cerner and CentraState NextGen Data Cerner Ambulatory EHR ACO Patient PCP / Specialist Clinical Files Data Warehouse Nextgen Ambulatory EHR Analytics Care Management Patient Level ACO Dashboards Organizational ACO Dashboard Annual Reporting November 21, 2014 14
EHR Data Populates Evidence-Based Gaps in Care November 21, 2014 15
Lab Data Summary: Develop Observation Result Unsolicited (ORU) interfaces to collect lab results processed by Barnabas facilities. Focused on lab results to support ACO metrics Benefits: Fill in claim data gaps and claim lag Lab data for analytics and disease management Collect data for affiliate provider s patients where EHR data are unavailable Results are collected in real time November 21, 2014 16
Lab Results from BHS Laboratory Information Systems (LIS) ACO Patient Barnabas Lab ORU Barnabas Health Interface Engine ORU Data Warehouse Analytics Care Management Disease Management Care Management Reporting
ACO Patient Registration Events Summary: Implement Admission, Discharge, and Transfer (ADT) interfaces between HEC and Barnabas Health Hospitals to capture registration events for ACO patients. Registration events include Inpatient, Outpatient, and ED Visits Benefits: Provider alerts when ACO patients have a registration event Provides real time information Analytics November 21, 2014 18
BHS Registration ADT Events in Real Time ACO Patient Barnabas Inpatient Facility ADT Barnabas Health Interface Engine ADT Data Warehouse Analytics Care Management Provider alerts Follow up visit within 30 days Care coordination Reporting
Provider Alerts and Patient Registration Events Today s Activity: 25 patients got admitted 2patients got transferred 12 patients got discharged 8 patients received their lab reports November 21, 2014 20
ACO PATIENT FLAGGING November 21, 2014 21
Identify ACO Patient in Inpatient Clinical Systems Summary: Flag ACO patients in Barnabas inpatient facilities and update flag status in real time as patients present. Benefits: Most timely notification process, captures new patients Supports ACO workflows in acute care facilities Data extract and reporting needs November 21, 2014 22
Real Time ACO Patient Notifications in BHS Inpatient Systems ACO Patient Barnabas Inpatient Facility ADT Barnabas Health Interface Engine ADT ACO FLAG ACO FLAG Data Warehouse Barnabas Inpatient Cerner Clinical Staff Transition of Care ED workflows Care Coordination Clinical Staff November 21, 2014 23
ACO Patient Flag in Outpatient EHR Systems Summary: Identify ACO patients in Barnabas outpatient EHR systems. Benefits: Facilitates ACO workflows in outpatient setting Supports clinical data extraction and reporting needs November 21, 2014 24
Outpatient Cerner ACO Flag Payors Member Rosters Barnabas Outpatient Cerner Individualized Care Plans *Identify Problems, Barriers, Goals and Interventions *Identify Risk Levels through Stratification *Evidence based Gaps in Care ACO Patient ACO Providers *Subject, Objective, Assessment, and Plan (SOAP) Notes *Claim Details November 21, 2014 25
Care Plans and Claims Data November 21, 2014 26
Summary of ACO Data Flow November 21, 2014 27
DATA ANALYTICS AND REGULATORY REPORTING November 21, 2014 28
Claim Based Analytics Provider > Non Emergent ER Visits Provider > High Cost Members 51.5 51 50.5 50 49.5 49 48.5 48 47.5 47 46.5 51 48 Member Name Sex Primary Diagnosis Group Total $ XXXX M Cancer of colon 55,400 XXXX F Chronic kidney disease 31,201 XXXX M Syncope 29,358 XXXX M Chronic kidney disease 26,396 My % Non Emergent Rate Speciality Group % Non Emergent XXXX F Diabetes mellitus with complications 26,091 Monthly Patient Panel Admits/1000 ER Visits/1000 t Imaging Costs and Utilization Financial Efficiency Ranking Bed Days/1000
Claims Based - Population Stratification Population Stratification Tier Category # of Patients % of Total Patients Total Cost % of Total Cost Average Cost Per Patient Average Risk Score 1 Complex Case Management 800 3% 30,000,000 25% 40,000 3.64 2 Disease Management (CHF,CAD,COPD,DM,ASTHMA) 9000 39% 55,000,000 30% 6771 2.7 3 Wellness/Prevention 6000 28% 15,000,000 10.% 2485 4.3 Tier 1 Complex Case Management Verisk Critical Risk score (DxCG) > 5.00 Amount Paid >$100k >3 admits >6 ER visits within 12 months
Quality Reporting MSSP Annual quality reporting to CMS 22 Metrics Subset of population 6000+ Patients in sample Horizon Quarterly quality reporting 5 Metrics All patients November 21, 2014 31
NJ-HITEC and Quality Reporting Patient Sample received for audit Claims and clinical data (EHR and Lab) are matched against audit sample Data populates metrics in NJ HITEC s Quality Data CAPTURE Tool and remaining gaps are identified Once abstraction is complete, XML data file is generated and submitted electronically Pre populated data can be viewed and/or edited where applicable Chart abstractors receive automated work lists to complete chart abstraction November 21, 2014 32
LESSONS LEARNED November 21, 2014 33
Lessons Learned and Future Goals Extracting unique data files from multiple systems has many challenges, consider utilizing CCDs EHR Optimization is key as data must be stored in a structured format Grand amounts of data can be valuable, but a plan to educate and engage providers is imperative Technology should not be a solution, but an enabler November 21, 2014 34
THANK YOU Dena M. Ragusa, MS ACO Manager of Informatics, DSRIP Project Manager DRagusa@barnabashealth.org November 21, 2014 35