Why Workflow Matters
How does that translate into what IT implementation can do to support performance improvement?
Jim Venturella: It gets to the workflow and efficiency issues that Dr. Solano talked about. In some of the practices, the doctors are well-educated, and our tools may not be as efficient as they could be, so we’re trying to figure out how to make the tools more efficient; because some of the tools actually make their day less efficient. The other area is looking at devices: how do we use devices more efficiently? How will we use the new mobility tools more efficiently in the clinic setting?
Terrell: Also, you can’t treat every patient the same way anymore. You basically have to divide your patients into the generally healthy versus the chronic with one illness, versus the poly-chronic, versus those in end stages of illness; and you have to treat each category differently. With poly-chronics, you have to work on poly-pharmacy and managing those patients more intensively. With the end-stage people, it will be about getting them to the lowest-cost, best-outcome setting for care. The patient who is terminal with cancer actually lives longer, and at much lower expense, in hospice, versus in the hospital.
In addition, you have to create disease registries. You have to figure out who your most frequent flyers are, and why; and who your most expensive patients are, and why. You have to figure out exactly what your clinical performance is at the individual provider level. The same thing is true regarding patient satisfaction, by provider. You’ll need the analytics to understand the processes at each clinic, to know which things work for each patient and which don’t. You need analytics to determine how you’re performing on your quality-based contracts.
Data Integrity Issues
Mamary: Among other things, we’re trying to move forward on data integrity issues. Some of the issues in that area include making sure that people understand the meaning of the data we’re capturing, and that people are trained to correctly capture the data. Fortunately, we’re all on the NextGen system, so the capture element isn’t that difficult on the practice side. It’s on the hospital side where I find that we have some issues, because of multiple systems and vendors.
The other thing is that, in the hospital, I have to provide data to over 30 outside sources, whether state or federal. They come up with these little state-level names of pieces of data that mean something to New Jersey, for example; and then the information systems are required by our contract to capture those data elements. Inevitably, New Jersey calls something by a name that is different from what it’s called in another state. There are so many points of data entry into the system.
Capturing a piece of data in a consistent way is a challenge, and is one of the lessons we’ve learned. We’ve gone back and made more fields required fields, so people don’t just skip by them. We’re required to say that a patient doesn’t actually have a referring physician, if they don’t. We needed more analytics people to find things out. We’ve got tons of data, but we’re really trying to turn that data into information. We’re using the Ensemble solution in that area. Having a financial systems analyst, a clinical systems analyst, and also working with the customers, you need to put all those systems in place, to make sure you have good data integrity, and to make sure that all your processes are correct.
ACO Challenges and Opportunities
Dr. Cuddeback, when you talk to leaders of medical groups that are your organization members, what are you hearing right now?
John Cuddeback, M.D., Ph.D.: Accountable care organizations are very much a focus for our member organizations, and ACOs are exactly what our association has been focused on. Of course the Medicare Shared Savings Program was based on the Medicare group practice demo that several of our member organizations participated in.
Weren’t most of the practice demo groups AMGA members?
Cuddeback: Yes, nine of the 10 were, and the tenth was not an actual medical group, it was a community coalition. When I first came to AMGA five years ago, medical directors and CIOs of medical groups were talking about the issues around creating patient registries and supporting population health. That’s essentially been the theme, just because this is so important to AMGA members.
Accountable care is about medical groups working collaboratively with insurance partners—not just on their own. With regard to the infrastructure issues, it’s about being able to understand a patient’s entire healthcare experience. If you look at AMGA members, we’re seeing an increase in integrating organizations; and most of these are mergers of different groups. Five years ago, in the heart of the PGP demo [the federal Medicare Physician Group Practice accountable care demonstration, which helped create the model for the Medicare Shared Savings Program under healthcare reform], only about one-third of our members were integrated delivery systems; but now, two-thirds are. Still, data integration remains a huge focus.
What should your colleagues in medical group organizations across the country be doing right now?
Solano: First, you have to get an electronic record in place, one that will support your organizational and national goals, because if you pick a vendor that can’t do that, that will create problems down the road. Then you need to get a leadership group together with strong, forceful, directional leadership, so that you can try to define what your priorities are, which is crucial. You can wander into areas that will just waste your time and resources.
You have to make sure you hit all the national benchmarks for quality. It’s very easy to get sidetracked into pursuing projects that bring your organization very little value and don’t fulfill any of the national objectives. Instead, you need to look at the national objectives of accountable care, the medical-centered home, and value-based purchasing, and align your organization with those, both on a national and local-area level. Aligning with those goals is crucial. Because if you fall off the path, it can be fatal. Anyone who says they’ve never fallen off the path is lying! We’ve fallen off the path many times along the way.