Population Health Advisors COVENANT HEALTH Lubbock Texasbased Covenant Health ( Covenant ) started using IBM s Explorys Platform for a deep dive into data analytics. The next step: figuring out how to use it to its full potential.
Seth Crouch, Covenant s vice president of ambulatory IT services, said, Some of us become a bit presumptuous with new technology and believe the sky is the limit. Later, it is discovered it is almost impossible to get off the ground. Your plans of presenting new revelations that could potentially improve your communities population health initiatives become more of a humbling task. With so much information at your fingertips you become overwhelmed trying to determine which bits of data are just informative, a nice to know, and which ones can actually help our care givers make a positive impact on our patients lives. Covenant turned to Dallas-based Population Health Advisors ( PHA ), which has experience leveraging the Explorys platform. PHA s valuable expertise allowed Covenant to bypass the growing pains many experience with a new technology system fraught with digital complexity.
PHA leverages the experience acquired in developing Baylor Scott & White Health s accountable care organization ( ACO ), Baylor Scott & White Quality Alliance. Baylor Scott & White is the largest not-forprofit health system in Texas. The ACO includes a network of more than 4,600 physicians, 49 hospitals and post-acute care facilities. Brandon Pope, Ph.D., PHA analytics senior consultant, said, We see many organizations struggling with analytics and the evolution from volume- to valuebased care. The reality is this is as much a symptom of strategy and operations as data and technology. The PHA analytics approach is to not only advance from a data and technology perspective, but also to elevate the ability of population health organizations to wield data and methodologies to educate, translate, and deliver insights through deeper integration and alignment with core business functions (network, clinical excellence, contracting and performance, care management) operating as a system. Covenant has a wholly owned subsidiary called Covenant Medical Group, a multi-specialty group with 170 physicians. Its ACO is Covenant Health Partners ( CHP ). Covenant is the most comprehensive health care network serving West Texas and Eastern New Mexico. Covenant is a member of Providence St. Joseph Health, one of the largest not-for-profit health systems in the U.S. Covenant was founded in 1998 through the merger of two of Lubbock s most venerable heath care facilities, St. Mary of the Plains Hospital and Lubbock Methodist Hospital System. The system serves a 62-county area with a population of more than 1.2 million people. H 62 county-area population of more than 1.2 million people
Crouch said, PHA came to Lubbock and reviewed our current state and what we wanted for our future state. They shared their experiences, both successful and unsuccessful which made a big difference in our decision making. Baylor Scott & White is so similar to us, we chose to mimic rather than recreate. Covenant s goal was to create Crouch said, We wanted our a digital foundation that could own data warehouse so we serve as what is known as could control the reporting a single source of truth processes, regardless of what where we were confident system we used. PHA taught us in its accuracy and could how to do that. We didn t want be accessed by all of our to be dependent on a vendor s population health care givers. turnaround time and its standard reporting capabilities. control the reporting processes... As a highly regulated industry, health care generates large amounts of data for record keeping, compliance and regulatory requirements and patient care. Health care data warehouses allow analysts to draw from a variety of sources to acquire meaningful insights on populations. Population health analytics draws from both provider and payer data, including the electronic medical records for clinical observations and ancillary services results; claims data from the payers to help provide a complete picture of each patient s utilization of healthcare services outside of the network; billing data to identify cohorts using diagnosis and procedure codes, charges and revenue; and cost data to gauge the effect of greater efficiency on profit margins. Benefits include data to drive value-based contracts, informing clinical decision-making, better care coordination, prediction of patient outcomes and improving overall patient health. CHP participates in the Medicare Shared Savings Program (MSSP) with 15,000 patients. CHP earned $2.5 million in shared savings in 2014. It had no shared savings in 2015 despite improved quality metrics because the Centers for Medicare and Medicaid Services raised the performance benchmarks. CHP is now in MSSP s Track 3, which is a two-sided risk model that allows providers to share in 75 percent or more of program savings or losses.
Crouch said the data warehouse allows the system to monitor performance at the physician level and make course corrections on a monthly basis. The ACO also has five commercial contracts with Blue Cross Blue Shield of Texas, United Healthcare and FirstCare Health Plans with a total of 48,000 lives. The data warehouse was invaluable in negotiating realistic permember-per-month rates. Crouch said, Payers sometimes ask for targets on quality metrics that seem impossible to measure during the negotiation process. Without the proper technology, you could end up agreeing on measures or PMPM rates that are unachievable. Now we only agree to financial and quality targets that we have the capability to accurately measure. It helps level the playing field. He said, CHP tries to set a profit margin for each contract. Like a budget, we figure out what actions we need to take to perform at the highest level. We can estimate what we need to do on a monthly basis to hit those benchmarks down to the patient level due to real time clinical data.
Crouch said he was surprised to discover how engaged providers were in the clinical dashboards. Our care givers now have the technology that allows them to determine gaps in care, take action, and inevitably save lives. Deirdre Marek James, PHA vice president, said, Data and analytics are the foundation for insight on population health. They allow identification of opportunities for actionable interventions and performance improvements. Many organizations aggregate data and metrics, but struggle with data deployment in a way that can be easily accessed and implemented by providers to benefit patient care. Crouch has been so pleased with PHA s involvement that Covenant recently amended its contract with PHA to develop network dashboards for post-acute care. He said Covenant executives have been digging into the administrative and finance dashboards to discover trends and gaps. (PHA) showed us report after report, and we said we wanted them all to the point that we didn t remember why we wanted them in the first place. PHA helped us sort out what we did and didn t need. Because of their experience, PHA was able to suggest which reports would be the most impactful, he said. Crouch said that although its contract with PHA involved data analytics, Covenant was able to draw on the larger population health lessons PHA learned through Baylor Scott & White s development of its ACO.
(PHA) discovered things through trial and error. They helped fit to scale what Baylor Scott & White s ACO does with patient navigation, work flows, care coordination and shared governance processes. They offered direction on every avenue and what s worked for them to reduce costs. That has proven invaluable. We ve used their advice for every aspect of what we do, he said. Crouch said, I would recommend PHA to anyone in population health, not just anyone on a similar platform but anyone needing assistance operationalizing workflows, data governance, and communication. Our CEO has been ecstatic (with PHA). Otherwise we wouldn t have continued to add services to our contract. PHA s James said, For a consulting engagement to be successful, it takes willing participants on both sides. Covenant has been a great client. We were able to work together as a team to develop solutions to address specific needs. Their executives have taken what they have learned from our resources, tools, and experience to advance their population management capabilities. Crouch said he is pleased with the shape of his source of truth, a catch phrase he heard the first time meeting with Brandon Pope. We will maintain our system equity no matter the direction we choose. Adding applications or changing vendors will no longer be a major endeavor. We now have the flexibility to move fluidly with this ever changing environment, he said. I would recommend PHA to anyone in population health...
2017 Baylor Scott & White Health. No Number 07/17 Rook