MIT Innovation Series

Christina Severin, President and CEO

April 30, 2014

About BIDCO

• BIDCO is a value-based, physician and hospital

network and an Accountable Care Organization (ACO).

Located in Westwood, Mass.

Employs more than 80 staff members

Contracts with 2,100 physicians, including nearly 450 primary

care physicians and 1,700 specialists and 6 hospitals

Contracted by Centers for Medicare and Medicaid Services

(CMS) as a Pioneer ACO

• $1B in risk revenue management

• Our highest level goal is to promote the best quality

and value of care to patients, providers, health

insurers, and employers.

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BIDCO structure

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BIDCO

Confidential

Physician

LLC

Hospital

LLC

High-level goals

• Grow the business

Creates virtual cycle of opportunity

Ensures needed scale

• Effective risk contracting

Moves away from fee-for-service (“click-fee”) model

Manages total cost of care for populations

• Beating budgets to earn surplus (or not)

Offers financial opportunity for improved quality (P4P)

• Provide governance structure needed to support

legal and business requirements of an ACO

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Essential business functions

• Ensure business processes that support cost management and quality improvement goals Financial management of risk contracts

Care management

Disease management

Quality improvement

Clinical integration • EHR hosting and support

• Data interchanges

Provider support services

Risk contracting with CMS and other managed care companies

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Highest level challenges

• Manage total cost of care (“TME”) budgets

Effectively manage risk contracts to return value to

Members (>$1B)

Right care in the right place at the right time

• Improve quality

Effectively earn quality dollars to return value to

Members

76 unique ambulatory goals over four major contracts;

only two goals appear in all contracts

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Technology limitations

• Inherent complexities of data-sharing in an environment of minimal interoperability Patient information in silos (e.g., stand-alone EHRs)

Limitations in moving information along a system of care

• Clinical integration Fragmented access to data (access to some EHR data)

Cumbersome user experience for physicians and care management teams (multiple vendors, products, and modules)

Limited ability (claims data) to access “full view” of care experience

• Therefore, there are several ways in which new technology could help solves for these limitations

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Innovation need #1

• One-stop, comprehensive physician performance

reporting

Performance metrics, improvement suggestions

High-risk, high-cost members

Patient rosters, including location, diagnosis, ED visits

Gaps in care assessment

Prescription status

Coding improvements

Predictive tool to identify needed intervention,

suggests intervention based on circumstance algorithm

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Quality report

Efficiency report

EHR Financial

performance

Patient list

Check email

High-risk patient registry

Current state: Performance reporting

Login to

Application

#1

Future state: Performance reporting

Comprehensive

physician

performance

reporting tool Single

login

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BIDCO

Data repositories

Claims

Lab/ Rad

Care mgmt.

EHR

Clinical data

Innovation need #2

• ACO care record that travels with patient to site

of care

Move fully integrated health information across care

continuum

A fully connected clinical ACO community that leap

frogs inter-operability by generating a clouded-based

HIX for fully integrated data capture of all experience

regardless of the site of care

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Current state: BIDCO data exchanges

BIDCO Community

EHR Integrated EHR,

PMS & Billing 100+ databases

Electronic Health

Exchange Longitudinal

Community Health Record

Quality Data Center

Clinical Quality Data repository of

BIDCO member EHR Clincal data

Payors

Lab/ radiation

Claims Data Warehouse

Data Warehouse: Consolidation of

claims, labs & clinical data for

reporting

CMS ACO reporting

tool

High-risk patient

identification and

stratification tool

WebOMR BIDMC EHR

Other Community

Systems Centricity NextGen

Other

Risk- flagging

database

Hospital HIS

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PCP Office

Surgical Center

Pharmacy

Skilled Nursing Facility

Physical Therapy

MRI Center

Orthopedics

Future state: BIDCO data exchange

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Community

Medical Record

Inpatient

Summary

• The majority of new innovations being offered to ACO’s, are developed based on a concept that an ACO has simple data architecture Data mining (how can you mine data if you can’t access the data?)

Predictive modeling (how can you predict if you can’t access all the data?)

Population management (how can you tell a doctor a patient needs a Ha1C if you don’t have access to all lab data?)

• Payer claims data remains the most straight forward way to perform all analytics However, this leaves EMR data – the primary source of clinical data – out of

the picture

• The reality is that our architecture is incredibly complex and diverse

• Therefore, the most important solutions need to focus technology that can solve our complexity issues

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Questions

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