On Oct. 10, Rick Schooler, the vice president and CIO of the seven-hospital Orlando Health integrated health system, gave an educational track presentation at the CHIME Fall CIO Forum, being held at the Westin Kierland Resort and Spa in Scottsdale, Ariz., titled “Building a Scalable and Automated Population Health Infrastructure for Clinical Integration and Care Management Under Value-Based Care.” Schooler spoke in depth about the broad initiative that his organization has been engaged in to move towards a population health and care management strategy as a core operating principle for the organization.
Indeed, as Schooler noted on Thursday morning, the strategy that he and his colleagues are embarked upon has been formally articulated in a statement of purpose, thus: “Orlando Health’s journey will create a patient-first, clinically integrated model of care in collaboration with our medical staff, to pursue seamless, quality outcome-driven, extraordinary care.”
Among the steps already taken, the health system’s leaders have:
> Formed a regional clinically integrated network with the University of Florida, encompassing 1,300 employed physicians
> Acquired the largest primary care group in central Florida, with over 38 locations and over 500 employed physicians
Initiated participation in a Centers for Medicare & Medicaid Services (CMS) patient-centered medical neighborhood
> Been approved as a Medicare Shared Savings Plan (MSSP) accountable care organization (ACO), beginning operations in January 2013
> Executed, or are negotiating, shared-savings contracts with Cigna (effective 2013), and with Aetna and Blue Cross Blue Shield (effective 2014)
> Selected and implemented the population management technology platform from the Dallas-based Phytel
Schooler and his colleagues are combining the risk stratification capabilities that they’ve been using for several years already, from the Jersey City, N.J.-based Verisk Health, with the care coordination and patient engagement capabilities available through the Phytel platform. Within the next several months, Schooler expects the programs to be fully live in operation together.
Among the results that Schooler reported to his audience, that have been documented as occurring between December 2012 and July 2013 are the following:
> An on-time, on-budget rollout of solutions across 100 physicians
> A 52-day implementation process, with 40 feeds across six inpatient and ambulatory information systems
> Facilitated the patient-centered medical home (PCMH) certification through the National Committee for Quality Assurance (NCQA) via Phytel’s NCQA auto-credit solution
> Enabled management to determine physician quality bonuses by tracking compliance with quality measures
> Achieved an 83.6-percent success rate of contact with at-risk patients, while closing 6,928 chronic and preventive gaps in care
> Enabled MSSP ACO reporting minimizing physician work and clinical documentation steps, providing dual documentation for ACO development and for meaningful use
> Increased net revenue for the organization while accomplishing all of the above
As Schooler told his audience, in order to succeed at population health, “It is going to take technology not available to us today, and you [CIOs and other senior healthcare IT executives] are going to have to make some investments, and you’re going to have to move in some different directions. And this is new to most of us.”
Indeed, Schooler told his audience Thursday that six barriers needed to be overcome in the drive to make population health and accountable care an overall organizational strategy:
> Alignment and commitment of physicians, i.e., clinical integration
> Shift of mentality to proactive care—e.g., the patient-centered medical home
> The need for technologies beyond the electronic health record (EHR) and practice management, and with a different perspective
> Appropriate data to proactively manage populations and to ultimately assume risk (analytics and predictive modeling)
> Patient engagement
> Short-term pain for long-term success
“Clinical integration is the foundation” for any population health management strategy,” he told his audience; and, he immediately added, some strategic and financial “alignment is essential,” whether it involves physician contracting or physician employment.
After the session concluded, Schooler spoke exclusively with HCI Editor-in-Chief Mark Hagland, and shared with him additional insights and perspectives. Below are excerpts from that interview.
When you look at this early phase of your organization’s journey into population health management and accountable care, what would you say are some of the biggest lessons you’ve learned so far?
Well, with regard to clinical integration, there’s a lot of difference of opinion across physicians, mainly, about what is reasonable and what is really required, to get to the outcome—what they’re willing to go at risk for. Of course, you’ll always have the question of the data, but beyond that, if you go into markets where the old fee-for-service is still dominant, which is still a lot of markets, doctors will need to get the message about the importance of hospital-physician alignment. And there will be some who won’t need to align, quite frankly—like my ophthalmologist, for example—some of the super-specialists, like orthopedic surgeons. But that’s hard work.
And then you have to decide, which of these do you we actually need to employ as part of our permanent health team? And for a lot of doctors, making that shift from entrepreneur to being part of the big mother ship, with the loss of control and autonomy—the smart ones are already getting it, though; they see the value of the long-term.
Tell me about your path towards creating an analytics and care management interface with two vendors?
Historically, we would work with the folks at our owned health plan, HealthChoice, to help us to monitor claims and to see who was utilizing us the most—for example, with human growth hormone utilization. That helps us understand where the money is going and how we’re utilizing the health system, using claims-based data. So you have that historical information, and now you couple that with the clinical data. For example, we need to be able to predict which patients whose care we’re managing, who is most likely to have a hospitalization or an ED visit. We now, with both types of data, can say, your a1c is off the charts; or your BMI is changing rapidly, you must be retaining water. When you can bring together your risk management and your care management, you’re now got both the material and the catalyst, in order to do interventions.
Are you live yet with the combined capability?
Well, we’ve been live for years with Verisk as an embedded system. We went live with Phytel in January and February. And we’re pushing to be able to use that capability, live, within a matter of months.
What advice would you offer to colleagues right now in other organizations beginning to move down the path towards population health management and accountable care?
If your organization isn’t talking about clinical organization, and they’re not actively engaging in aligning, either through contracting or employment (full integration), and if you’re not having discussions with payers about quality and getting incentives, and getting reimbursement for quality outcomes, and if you’re not actively pushing to really improve your organizations’ quality outcomes, you’d better find somebody who is.
Also, I really want to give credit to three senior executives in our organization for their assertive leadership in all of this: Wayne Jenkins, M.D., Jennifer Endicott, and Cynthia Powell, M.D. Dr. Jenkins is over our entire physician enterprise; Dr. Powell is over the medical group that includes our salaried physicians; and Jennifer Endicott is our vice president of clinical integration. They’ve really been pushing this thing forward.
