Value-based Care and the Role of Health Information Technology Andrew Hamilton, RN, BS, MS, Chief Informatics Officer
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
Insert slide on payment reform
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.
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
Savings by Provider Type
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
Clinical Decision Support Tools
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
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
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
Data Sources EMR Claims/Enrollment Pharmacy Data ADT Public Health Patient Reported Outcomes Social Determinates of Health
How do I Organize All this Data?
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
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
Tasks that need action show up in red
Filtering Can apply multiple filters
Adding Patients to a Program Note - the Workflow Checklist shows you your patients and where they are in the process
Outreach assignments creating automated to do lists
Point of Care Tool From Centricity, use the Care Management Form in a visit encounter to add to Program
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
Total Cost of Care Goal: Understand cost of care in order to decrease as appropriate Data: Universal Claims, Pharmacy Data
Hopkins ACG
What Determines Health? Envrionment 5% Genetics 30% Pt Choices 40% Social 15% Medical Care 10% McGinnis et al, Health Affairs Vol 22(2)
50 % of last year s high cost claimants spend less than $5000 in the previous year
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.
Most Common Social Determinant Actionable RISKS
Public Health (open) Data
Questions & Thoughts