Health IT Summit Denver 2014 - "Anatomy of a Health System"

Anatomy of a Health SystemJuly 23, 2014

Marc Lassaux, CTO, Quality Health Network

Justin Aubert, CFO, Quality Health Network

Kevin Fitzgerald, MD, CMO, Rocky Mountain Health Plans

Agenda for this session

Quick Overview

Technology to support Pop. Health

Sustainability consideration

Operationalizing Clinically

General Discussion

Formed in 2004

Two Hospitals, Physician Organization

Payer, Community Resource Organization

Over 200 organizations and 850 providers

HIE, HISP, eHealth Exchange participant

Data Aggregation and Applications

Incorporated as Non-profit 501 (c) 3 - August 2004

“Trusted, non-exclusive, and apolitical Organization”

Live Operations: October 2005Private Capital $2.75 million

Cash Flow Positive from Operations - 2007

The Start:

QHN’s Regional Connectivity - 2013

Including Providers

Copyright Quality Health Network

Connections In Development• The Memorial Hospital, Craig

• Yampa Valley Medical Center, Steamboat Springs

• VA Medical Center, Grand Junction

• CORHIO – Colorado eastern slope

Hospital & Lab Connections • St. Mary’s Regional MC

• Community Hospital

• Family Health West

• Aspen Valley

• Montrose Memorial

• Rangely District

• Delta County Memorial

• Gunnison Valley

• Grand River Health (Hospital)

• Valley View/Glenwood

• Pioneers/Meeker

• LabCorp

• Quest Diagnostics

• Grand Junction Diagnostics

• Internal Medicine Assoc.

• DCI

Hospice

PACE (Senior

Community Care)

Care Transitions

Home Care

DME

Respiratory &

Physical Therapy

Long-Term Care

Assisted Living

Connected

Providers.

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RMHP and QHN RMHP one of QHN’s five founding members

Colorado Beacon Consortium

• Rocky Lead, QHN Sub recipient

Practice Redesign and Quality Improvement

Population Health Tools

• Disease, Wellness, Risk

Care Coordination

Sustainability Considerations

Justin Aubert CPHIT, CPEHR

CFO, Quality Health Network

©2014 Quality Health Network (QHN) – All rights reserved, QHN proprietary and confidential not for further redistribution.

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Historical Funding of QHN

Initial Funding from Private Capital

Core Operations are Funded by Subscription Fees

Everybody Connected Pays

Self Sustaining Since 2007

Development Fund• QHN initially Mesa County initiative

• New neighborhoods contribute to infrastructure

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Historical Funding of Technology

Grant from The Colorado Health Foundation• Expand HIT through out western Colorado

• Defray one-time costs to connect to the HIE

Colorado Beacon Consortium ONC ARRA Grant• Federal funding to procure technology

• Capital investment vs. operational

Increase Value to Participants• Population Health

• Quality Improvement Initiatives


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Considerations

New Technology is Expensive and Changing Fast

Open Source vs. Proprietary

Contracting Issues

• Vendor pricing typically ASP

• QHN negotiated contracts for perpetual licenses with

annual maintenance vs. ASP model

- Larger up front costs with lower recurring

- Sustainability plan for post grant funds


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Considerations

Population Based Pricing

• Western Colorado’s population less than 500K

• First tier pricing typically up to 1M lives

- Non-starter in rural areas

- Not economically feasible unless partnering or revised tiers

Partnering with Other Organizations

• Cheaper to incrementally increase existing license

• Take advantage of economies of scale

• Create similar initiatives across geographic areas


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Looking Forward

Value Add to Participants of HIE

• Data delivery moving towards a commodity

• Longitudinal patient record is key value

• Use the data to increase value to providers and patients

What Role Does the HIE Play

• EHR’s will/could have functionality

• Workflow, workflow, workflow


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Clinical Aspects When Operationalizing QI and PH- 7/22/14 Anatomy of Health System Panel Presentation

- Institute for Health Technology Transformation (IHT )

Kevin R. Fitzgerald, MD

Chief Medical Officer

Rocky Mountain Health Plans

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Disclaimers

• Family Doc

• RMHP CMO

• Doctors On Call

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Anatomy of a Health System- Where We’re Focused

Focus Region

- Approximately 850,000

Residents

- RMHP Key Markets

- RCCO Service Area

- QHN Footprint

- Distinct Patterns of Care

(Dartmouth Atlas)

RMHP Initiatives

• Office Record Review (ORR) since the 90’s

• Chronic Disease Management since the early 2000’s

• Beacon 2009

• CPCi/Practice Transformation 2013 and ongoing

• Medicaid RCCO (ACO) Region 1 2013 and ongoing

Primary Care Practice Transformation

• Top RMHP Priority and Investment Area

• Maximize Primary Care Population Management Capacity− Data Use and QI Competencies

– Adopt New Tools

– Integrate New Staff

– Team Based Care

• Five Active Learning Tracks– Foundations

– Masters 1

– Masters 2

– PCMH Recognition

– CPCi

Barriers To Change

• Non-integrated delivery system

• Frontier communities (IPA’s)

• Evolution of their delivery systems

• Improve communication in their communities

• Create a culture of innovation in the medical community

Accountable, Population-Focused Care- Technology is a Cog in the Machine

Population-Focused Care

Payment

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Measurement

Boots on the Ground

- Practice Transformation

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A Rising Tide

• 2012: 51 Practices (Beacon).

• 2013: 102 Practices -- 50% growth or doubling of the number of

practices we supported in 2012.

• 2014: 95 Practices to date -- with 50 practices in queue for

recruiting into any one of the program tracks.

Our Goals

Small tests of change emphasizing the triple aim through

population health management:

• Population management through registries

• Practice case management

• Risk rating and patient stratification

• Referral systems/continuity in transitions

• Community care management of the person

• Community care plans

• Community surveillance models

Whole Person Support

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• Comprehensive Assessments

• Health, Behavioral, Social, Functional Domains

• Coordinating the Coordinators

RMHP Statewide RCCO Report

• Practice Transformation

• Measurement & Feedback

• Workforce (Human Capital)

• Payment

• Technology

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Anatomy of a Health System- Key Drivers in an Accountable Community

Global Outcomes Score

(“GO Score”)

1. Comprehensive and Continuous

2. Guidelines and Predicted Risks

3. Net Benefit Focus - Counterintuitive Results

What is the“GO Score”

Predicted # events prevented by PCP

Opportunity BenchmarkGO Score =

• In example above GO Score = 100/180 = 55

•The opportunity captured is 55% of total

benchmark

0

20

40

60

80

100

120

140

160

180

200

Opportunity Benchmark Current Treatment

5-Year CVD Events Prevented

180 events

100 events

How is the GO Score different?

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The Global Outcomes Score measures CVD risk reduction in populations

• Credits providers for reducing risk not just meeting a treatment target or process measure

Corrects problems with current simple performance measures such as the blood pressure guidelines:

• Credit is given to reduced SBP from 142 to 138

• No credit is given for reducing SBP from 200 to 142

• Other patient risk factors are largely ignored

• Leaves little room for physician discretion

NCQA is testing the GO Score as a performance measure

• PCP will be one of the first groups in the country to test this new approach

Oversimplified guidelines impact care

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Mrs.

Smith

Mr. Jones

SBP = 142 SBP = 138age = 45age = 42

LDL = 116 LDL = 178

HDL = 35HDL = 61

FPG = 116FPG = 89

weight = 244 weight = 345

height = 5’6’’ height = 5’11’’

GO Score will give more credit for treating Mr. Jones

1.2%Risk of MI or stroke in 5

years7.1%

0.4%Absolute risk reduction if

lower BP2.1%

What actions increase your GO Score?

Prescriptions (15 month grace period for incentive)

• Statins

• Thiazides

• ACE/ARB

• CCBs

• Beta Blockers

Smoking (cessation during the year)

Weight loss >5% during the year (BMI>25 at

outset)

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Future versions may include other interventions and

other diseases provided data quality is sufficient

Contact

Kevin Fitzgerald, MD

Chief Medical Officer

Rocky Mountain Health Plans

[email protected]

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mailto:[email protected]

Health IT Summit Denver 2014 - "Anatomy of a Health System"

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Transcript of Health IT Summit Denver 2014 - "Anatomy of a Health System"