Cornerstone Health Care is a 340-provider multispecialty group practice (with nearly 240 physicians) that is physician-owned, and located in the Greensboro-Winston Salem-High Point Triad area of North Carolina. It was established in 1995. Tim Terrell has been CIO at Cornerstone since 1998. Terrell spoke this summer with HCI Editor-in-Chief Mark Hagland, as part of the process that created a virtual roundtable of medical group IT leaders, all interviewed regarding the top strategic IT issues facing medical groups in the current environment, for the October cover story. The entire cover story can be found here.
Meanwhile, below are excerpts from Terrell’s extended interview with Mark Hagland.
What are you seeing as the most significant strategic IT issues facing medical group leaders like yourself in the current at emerging operating environment at the moment?
Overall, for us [at Cornerstone Health Care], it’s the challenges presented by healthcare reform, in its broadest sense.
From your perspective, what unites all of thehealthcare reform-related programs in terms of the strategic IT foundations required for them?
Number one is analytics, and number two is integration. Those two things will be the biggest elements of it, and both are enormous.
And where are you on those two elements?
We're actually investing pretty heavily in analytics. And we’re working with Teradata, one of the three biggest data warehouse vendors (the other two are IBM and Oracle); also, we’ve got Humedica for the clinical analytics and clinical predictive modeling. And we’re in the process of implementing the OptumImpact suite from OptumInsight, to give us claims-based analytics.
Are you live on all three yet?
Right now, we’re live on one, Humedica; we’ll be live on Teradata by October, and will be very close on the Optum.
When you say healthcare reform, does that also include meaningful use?
There are a lot of regulatory changes that have happened, and I would put meaningful use out there as a regulatory change. If you address it early, you gain some advantage. We have attested for stage 1. Not all of our physicians qualify, for example, the hospitalists, and a number of our pediatricians and OB/gyns did not qualify; but we attested for meaningful use stage 1, for about 150 of them, in December 2011. That’s mostly because our EMR vendor was really fighting to get the capability for us to be able to attest. We’re Allscripts.
You’re going to participate in ACOs?
We were announced for the July start.
Are you involved in patient-centered medical homes or bundled payments?
We’re in the process of shifting to entirely value-based contracts with all our payers. We’re doing healthcare reform very intensively here. So we’re going to have a variety of flavors of contracts in place very soon.
What unites all these healthcare reform-related programs in terms of the strategic IT foundations required for them?
Number one is analytics, and number two is integration. And when you look at it, those two things will be the biggest pieces of it, and both are enormous.
And where are you on those?
We’re actually investing pretty heavily in analytics. And we’re working with Teradata, one of the three biggest data warehouse vendors (the other two are IBM and Oracle); also, we’ve got Humedica for the clinical analytics and clinical predictive modeling. And we’re in the process of implementing the OptumImpact suite from OptumInsight, to give us claims-based analytics.
Are you live on all three yet?
Right now, we’re live on one, Humedica; we’ll be live on Teradata by October, and will be very close on the Optum.
Will the three solutions have to talk to each other in some way?
No, not really with analytics. But we’re using each one to drive different types of analytics. Now, we probably will use one or more of them to drive data back into our warehouse. 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 each category you have to treat differently. With poly-chronics you have to work on poly-pharmacy and managing those patients more intensively. And 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.
And you have to create disease registries. And you have to figure out who your most frequent flyers are, and why; and who your most expensive patients are, and why. And you have to figure out exactly what your clinical performance is at the individual provider the level. The same thing is true regarding patient satisfaction, by provider. And you’ll need the analytics to understand the processes at each clinic, to know which things work for each patient and which don’t. And you need analytics to determine how you’re performing on your quality-based contracts.
And are you actually bending the cost curve on those contracts, so that you actually have some savings to share? And what if you have to set bundled pricing, or per-member, per-month pricing? You’ll need to use analytics to do all those things. And those things are all new for us. And you have to use analytics to understand the cost of care, with cost plus quality being value. You’ll have to figure out what the lowest-cost setting is where you can get equal or better outcomes, and who the lowest-cost provider is for providing those quality outcomes. If a nurse can provide something as well or better was a doctor, you have to look to that. And what is the difference between inpatient and outpatient settings. If we can provide equally good care in the outpatient setting, by providing transportation to patients, that might be an answer in that area.
What do you mean by integration?
Typically, in healthcare, we don’t do a great job of coordinating care across all the settings of care. So a large part of that is doing better coordination of care. So that may mean that there’s a person who coordinates the patient’s care in the hospital, or makes sure they get into a good nursing home, and that their records get transferred back into the electronic patient record. So we’re going to be using a lot of new tools to improve those processes. And the more we can use health information exchange, the better. We’re looking hard at several different HIEs. The problem that we have is that the HIE cannot be a unilateral decision; it really needs to be a community decision. So we’re not quite ready to proceed on this. There aren’t any active HIEs in the Triad yet; there’s a nearby health system that’s putting in an HIE for their own ACO network.
The other way I would think about integration is, trying to get the right information to the right person at the right time. And a great example is understanding where there are gaps in care, and getting the information to the doctor at the right point in care. And the EMR systems do a pretty lousy job of that today.
Also, there are some really non-traditional ways of thinking about integrating the healthcare environment as well. We’re looking into remote health, the home monitoring of patients. We’re also looking to how to get patients better engaged in their care; and a lot of that is IT-related, through tools.
What would your advice be for other medical group CIOs?
I would say that they need to look seriously at investing in information systems and analytics systems that are going to support healthcare reform.
It will take several years to lay the IT foundations for the new healthcare, yes?
Yes, it will, and there are a tremendous number of challenges. And the movement towards ACOs, and what is going to happen with the health insurance exchanges, will cause this change to happen faster than people think.
Obviously, the Supreme Court's ruling upholding the constitutionality of the Affordable Care Act provided some policy clarity, correct?
It did. And I think we’re starting to see some in the payer community beginning to respond to doing value-based contracts with a lot more interest than they had a few months ago.
