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“ACO & The CIO”

A Complimentary Webinar From healthsystemCIO.com

Sponsored by Tribridge

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Thank You!


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Housekeeping

• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com

• Ask A Question• We will be holding a Q&A session after the formal presentations. • You may submit your questions at any time by clicking on the QA panel located in the

lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”

• Download the Deck • Go to: http://healthsystemcio.com/presentation/ACO-Gordon-webinar.pdf• Shortened link below appears on most slides.

• View the Archive• You will receive an email when our archive recording is ready. • Separate registration is required.

http://healthsystemcio.com/presentation/ACO-Gordon-webinar.pdf


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Agenda — 45 Minutes

• 20 minutes: Tom Gordon, SVP/CIO, Virtua Health System

• 5 minutes: A Word From Our Sponsor: Damon Auer, VP of Healthcare, Tribridge

• 20 minutes: Q&A w/Tom Gordon


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ACO & The CIO


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Background

Virtua – A leader in southern New Jersey

6

4 Hospitals

4 Major Outpatient Centers

3 Urgent Care Centers

280+ Employed Physicians

308 Skilled Nursing Beds

2 Home Health Agencies

9 Ambulatory Surgery Centers

3 Fitness Centers

Sponsor of Regional HIE

$1.2 Billion - Revenues

Virtua 2013 Plan on a Page

Mission

Virtua helps you be

well, get well and stay

well.

Vision

Virtua will be the

premier choice in

health and wellness.

ValuesIntegrity

Respect

Caring

Commitment

Teamwork

Excellence

Strategic Imperatives Operational Priorities

People Improve Customer Loyalty

With An Engaged

Workforce

1. Define outstanding experience across continuum (patients, guests, employees,

physicians, customers, families, volunteers)

2. Align education and development

3. Align rewards and recognition

4. Strengthen talent pool

5. Validate and measure “loyalty” across the continuum

QualityAchieve Highest Safety &

Quality and Ensure Access

to Services

6. Align with clinicians based on quality outcomes and patient experience

7. Care re-design (re-distribution of resources to support improved access to patient

care with focus on be well, get well and stay well)

8. Develop systems to capture, measure, report and improve outcomes for ACO

patients and employees

9. Top decile performance in publicly reported data

10. Quality structure redesign from siloed to longitudinal across the continuum

Community

HealthImprove Community Health

in a Cost Effective Manner

11. ACO implementation

12. Community health needs assessment

13. Align philanthropy and support all functions to leverage integrated approach

14. Realign health services in the south to meet community needs

15. Aggressive management of employee wellness/education/cost reduction

Growth

Pursue Strategic Growth

Opportunities that Support

a Comprehensive

Continuum of Care

16. Optimize business portfolio

17. Expand women's’ health program

18. Evaluate and establish collaborative provider networks and partnerships

19. Redefine and hardwire the strategic and annual planning process

20. Increase access to care


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Virtua Paper-Lite/CIS Transformation Strategy – “technology building blocks to a connected health record”

2006 20122008 20092007 2010

Expanded Fiber-optic Network and Wireless System

Installed New Ancillary Systems: Lab, PACS, others

New ED System

CIS – Course Correction: Siemens EMR/McKesson HIM

New HIM System & Data Center

Soarian Results Viewing & Meds Administration

New Telephone System & “Recovery” Data Center

Clinical Documentation, Plans of Care, Device Integration

CPOE, Physician Documentation, SSO/Provision,RFID

Ambulatory EMR, Health Information Exchange, PHR, MU Program (Amb./Acute)

2013 +

Connected Health Records for Population Health


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“Reformed”

Healthcare

The Backdrop to any Healthcare Talk: Healthcare Reform

. . . Are we on diverging or converging paths?


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The Challenge We All Face Today……

Cost

Quality

Access

. . . Balancing cost,quality and access


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Virtua’s Response to this Challenge

Re-design Care Around

Accountability and Lower Cost

Address Health Preservation, as well as Traditional

Disease Management

Be Preferred for Quality & Safety

Invest Wisely in Technology


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• Don’t measure ROI purely in monetary terms

• Real question: “What is the Return on Value?”

• What to look for: “Does IT…..

Improve the quality of care and patient safety?

Support evidence-based care?

Support clinical integration?

Increase patient engagement and responsibility?

Contribute to a culture of continuous improvement and excellence?

Understanding “Return on Investment” for IT


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Transforming Care - A Coordinated Effort


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Transforming Care - A Coordinated Effort• January 2013, Virtua entered into an Accountable Care

Organization (ACO) contract with the Federal government (CMS)

• ACO is branded as “VirtuaCare”

• Four implementation teams were formed:• Transition of Care

• Quality Metrics

• Care Redesign

• Patient Engagement

• Policies, Procedures, Workflows and IT infrastructure were developed

VirtuaCare Today – Contracts with payers

Self-Funded Health Plan for Employees & Dependents

Medicare AdvantageCare Coordination Services

Third-Party Claims Administrator

13,700 lives

1,600 lives

17,000 lives

12,500 lives


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VirtuaCare: Infrastructure

• Community-Based Health Management (CBHM)• 1 Director of Case Management/Clinical Integration

• 1 Operations Manager of Clinical Integration

• Community-Based Health Managers (CBHMs)

• 4 Registered Nurses

• 2 Licensed Social Workers

• Interviewing for 2 additional CBHMs

• 6 more slated to be hired this year


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Community-Based Health Manager (CBHM)

• CBHM caseload is 100 – 150 patients

• Patients selected utilizing reports and physician input:• Historical High Cost (from claims history)• High Utilization (from claims history)• Complex Case Management (from medical history)• Current issues – both medical and social

• Patients are evaluated, and Plans of Care are developed

• Evaluation and continuous monitoring:• Post-Discharge from Acute Care or Emergency Room• During scheduled physician office visits • Visits to patients’ homes• Via the telephone


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Reporting - 3-Year Period• Year 1 (2013) Reporting Year

• Year 1 baseline attestation started January 27, 2014

• Attestation cohort has 4,000 patients, selected by CMS

• Estimated 840 person-hours to complete data-collection activities for the attestation

• Year 2 (2014) Shared Savings Begin – 22 Quality Metrics

• Year 3 (2015) Shared Savings Begin – 33 Quality Metrics

Breakdown of Metrics

7 based on patient experience

4 based on claims data (from Virtua and other providers)

22 based on health metrics (chronic disease + prevention measures)


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Information Technology

New IT Landscape

Health System’s Data Warehouse

Physician Office EMR

Patient Demographics

Acute Care EMR

ER EMR

Pharmacy

Laboratory

Patient Billing

Radiology

Sample of information systems for independent health care providers

Physician Office EMRs

Nursing Home EMRs Commercial Laboratory DataDentist Office EMRs

Commercial Pharmacy DataDiagnostic Imaging Centers

He

alt

h In

form

ati

on

Exch

an

ge

State Registries

Other HIEs

Sample of Virtua information systems

Amalga (clinical data)

Datamarts/Cubes (Clinical, Access-Nav, Financial, HIE,

etc) – Refreshed regularly **

Feed

Feed

Feed Feed

Feed Feed

Framework/Rules/Guidelines

DSS/Embedded Analytics (bus/clin data)

Feed

Feed

Access Navigation (CRM)

Dynamics CRM * Health Information

Exchange

NextGen EMR

Clinical Views & Care Coordination Tools,

including Access Navigation

CC

D

Analytics

Clin

ical,

Fin

an

cia

l &

Cla

ims d

ata Foreign Risk Strat. Claims

data *

Fra

mew

ork

fo

r str

ati

fied

data

,

CR

M, an

d R

ule

s/G

uid

elin

es

acro

ss s

yste

m

MPI matching

MPI matching

Opt in/out Mngt. Cohort Mngt.

CRM Portal for POC personnel

Outside CCDs

Care Coordination Protocols/Templates

Care Coordination Platform

Amalga(clinical data)

Data Marts & Cubes – Refreshed regularly

Soarian

EDIS

Picis OR InvisionDocuMgt

NextGen

MisysCompu-

data

Pharmacy Lab

GE IDX Other

OtherOther

Acute Care Community

Care

Recovery, Rehab, Sub-Acute

Internal Framework/Rules/Guidelines

Novius DSS(business data)

Clinical Views, Care Coordination Tools, Analytics, & Access-Navigation

Misc OtherSQL Tables

Access-Nav System

Claims DataTelemed

Data

Other

Telemed Data

SQM (Soarian Quality

Measures)

QualityDashboardsCommunity

Physician Data

Patient Portal

Home Device Data

Third-Party Data (Lab, Rx, LTC, etc.)

Virtua’s New IT Landscape

Accountable Care OrganizationACO – Overall Workflow & System Diagram


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ACO Workflow Version 1 –circa November 2012

The Virtua ACO


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The Virtua ACO


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• ACO Patients were to be assigned to Virtua

• Patients to be identified and “Flagged” in Virtua System

• Corresponding Claims files needed to be associated with each patient

• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications

• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)

The Virtua ACO


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Accountable Care OrganizationInformation Workflow Summary

• Beginning with patient identifiers provided by

non-Virtua sources, Amalga identifies, matches and

“flags” ACO patients. Using real-time data feeds,

Amalga shares ACO patient alerts with all downstream

ACO applications. Amalga also parses associated

claims data for assigned ACO patients.

Accomplishments • Identify patients using non-Virtua identifiers

• Assign “flag” to identify and monitor ACO patient

• Monitor ACO patient ADT

• Monitor patient scheduling

• Medicare patients in program

Implementation/Architecture and Design • Using existing Amalga system, a shared DB was

modeled and created using a SQL shared DB for all

downstream data processing

Work To Be Done• Validate delivered Analytics

• Identify and build requested Analytics

• Add new ACO program patients

• Horizon

• Aetna

Risks/Mitigation• Risk – each new ACO has different identifiers and

workflows

• Mitigation – develop custom logic & solutions for each

ACO


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Scope – Lessons Learned


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Scope – Process Area Requirements

11

222

33

44

66

910

111111

1415

1719

2224

35

Integration - Access Navigation

Integration - Amalga

Cohort Management

Care Plan Administration and Management

Patient Management

IT

CBCM - Care Team Documentation in NextGen

Integration - Engage

System Wide

CBCM - Patient Access Specialist-Services

Integration - NextGen

Security

CBCM - Care Team Process Map

Quality Metrics

CBCM - Patient Identified as High Risk and Admitted

Access Navigation

Cohort Administration

Reports and Dashboards

Consent

Contract (ACO) Management

Opt In/Opt Out

CBCM - Daily Worklist

CBCM - Enrollment


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CRM Data FlowAcute

Ambulatory Amalga

• Registration

• Appointments/Schedules

• Admission

• DischargesHIE

• Admission

• Discharges

• Registration

• Lab

• Rad

• ED

CRM

Claims 13,000 +

CBHM’s Dashboard

Alert Module

Patient List

Contract Management


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Sample of Participants in the Virtua HIE• Virtua Hospitals• Virtua Medical Group (+300 physicians and NPs)• Children’s Hospital of Philadelphia (CHOP)• Kennedy Health System• Marlton Rehabilitation Hospital• Genesis HealthCare• CareOne• CVS• Quest Diagnostics• LabCorp• South Jersey Radiology Associates• Larchmont Imaging• RxHub/SureScripts• Regional Cancer Care Associates• Meetinghouse Physicians• Several Other Private Physician Practices

As of Jan. 2014, over 700,000

unique patients are represented in the

HIE’s dataset

47

1. ADT (Patient Demographics)2. Problems3. Allergies4. Medication Orders5. Family History6. Social History7. Immunizations8. Procedures9. Vital Signs10. Encounter Documentation (Practice EMR)11. Lab Orders & Results12. Radiology Orders & Results13. Discharge Summaries & Transcribed Reports14. RxHub/SureScripts

Data Available in the Virtua HIE


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• Care Coordination functionality• Growth of existing Health Information Exchange• Care Management & Engagement tools for Care Managers/ACO

• Expansion of Clinical Analytics• Predictive modeling• Extensive measurement of outcomes

Major IT investment projects now underway


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• Tele-health• Expansion of Home Monitoring – 500 new devices• E-Visits technology

• Personalized & social-media-based communication• New Patient Portal for 2-way communication• www.VirtuaBroadcastNetwork.com

Major IT investment projects now underway

http://www.virtuabroadcastnetwork.com/


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ACO & The CIODamon Auer, VP of Healthcare, Tribridge

the Personalization of Care

ACOs and the CIO

Who’s Tribridge?

team members

customers

years in business

Microsoft Partner of the Year

customer satisfaction

6503700

+15

98%

4X

What if

healthcare services were

patient-centeredand

personalized?

Enabling proactive

patient engagement

and care coordination

for your ACO …

… and a personalization

platform for your healthcare

enterprise

Manage ACO Members/Contracts/Performance

Manage Patient and Provider Relationships

Engage Patients in their Care Plans and Compliance

Manage Transitions of Care

Proactively Manage Readmissions

Personalize the Care Experience

“Our ACO initiative is enabled by several

technologies…we chose Tribridge because

they have a vision for coordinating care that

aligns with ours, as well as deep experience

with Microsoft Dynamics CRM …”

Al Campanella,

Executive VP, Virtua

www.tribridge.com/CareCoordination


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Q&AClick on the Q&A panel located in the lower right corner of your screen,

type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”


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Thank You!

• You will receive an email when our archive recording is ready. (Separate registration is required)

• Thanks to our sponsor: Tribridge!

• Don’t Forget To Claim Your CHIME CHCIO Credits – Attending healthsystemCIO.com Webinars = 1 CEU

• Questions/Comments – Anthony Guerra [email protected]

Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see the last 12 months of archived events.

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A Complimentary Webinar From healthsystemCIO.com Sponsored ... · Virtua 2013 Plan on a Page...

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