In the October 2013 Healthcare Informatics cover story, HCI Editor-in-Chief Mark Hagland interviewed a wide variety of physician group leaders and industry experts regarding the journey toward population health management, which encompasses numerous vehicles and organization structures, including accountable care organization (ACO) development, care management, patient-centered medical home (PCMH) development, and avoidable readmissions reduction work, among other types of initiatives. His story noted that medical group leaders attempting to move forward in the population health management arena face greater resource challenges than do hospital leaders, as well as incentive alignment and strategic IT issues.
Fortunately, many medical group leaders moving forward in the population health/accountable care arena are figuring out quickly where the key gaps, both process-wise and technology-wise, are, and are working to bridge those gaps. Not surprisingly, physician organization leaders are adopting a variety of different strategies in that regard. One of the organizations moving forward into the realm of collaboration with private health plans while not participating in the Medicare Shared Savings Program (MSSP) ACO program is Prevea Health, a 200-physician, 1,500-staff member multispecialty medical group with 18 care sites, based in Green Bay, Wisconsin. Ashok Rai, M.D., president and CEO of Prevea Health, says of the private-payer ACO that he and his colleagues have created in collaboration with three local hospitals, “Probably the largest insight is that there’s a lot of opportunity with the right infrastructure, to change how we traditionally practice medicine, to start to make populations healthier. In a patient-centric rather than provider-centric model, where everyone’s working to the highest level of their license, we find it a much better and more effective model in terms of preventive and primary care,” Rai says. “So we’ve seen a definite bending of the curve upward on the quality side and downward on the cost side. The biggest challenge is that with the majority of our revenue still being fee-for-service—we’ve essentially been financially disincented to make the progress we have; but it’s the right thing to do.”
Rai spoke this summer with HCI Editor-in-Chief Mark Hagland regarding the progress he and his colleagues have made so far in accountable care and population health. Below are additional excerpts from that interview.
Are you doing population health within your group?
We’re not doing the Medicare demonstration project, but we’re partnered with St. Mary’s Hospital and St. Vincent’s Hospital in Green Bay and St. Nicholas Hospital in Sheboygan; and we’ve launched our own health plan, Prevea 360, in partnership with the Dean Health Plan this January. So we are essentially a commercial ACO, where we take risk; and we’ve been involved in population health now for over five years since we started our PCMH pilots, which have rolled out to all of our primary care sites and now two cardiology sites. St. Mary’s and St. Vincent’s own 50 percent of the common stock in Prevea 360, and the doctors own the other 50 percent. We’re partnered at the hip and make strategic decisions together. But we’re not owned by the hospital. Meanwhile, St. Nicholas Hospital is part of Hospital Sisters Health System with the other two, based out of Springfield, Illinois.
When you look at electronic health records and the other tools of automation available to support your journey into accountable care and population health, what do you see as the biggest challenges right now?
The challenge is in trying to effectively leverage EHRs as population health management tools. If you look at how EHRs were designed, they were designed to interact with the provider, not the patient, number one; and they were designed to document what was going on in the room during a patient visit; they weren’t designed to work on population health proactively. So if you’re changing your processes to say that the patient visit never ends, to care for their health, and changing your processes so that you’re trying to work with patients who haven’t come in, you end up scrambling for tools or jimmying existing tools to give you what you need.” As a result, he and his colleagues are still using manually created and maintained patient registries for the high-risk patients they’re caring for.
One core problem, obviously, is that right now, there are no off-the-shelf tools available to facilitate population health and accountable care, right?
Yes; if you look at how EHRs were designed, they were designed to interact with the provider not the patient, number one; and they were designed to document what was going on in the room during a patient visit; they weren’t designed to work on population health proactively. So if you’re changing your processes to say that the patient visit never ends, to care for their health, and changing your processes so that you’re trying to work with patients who haven’t come in, you end up scrambling for tools or jimmying existing tools to give you what you need.
So what have you and your colleagues done to bridge that tools gap?
We’ve done what a lot of groups have done; we’ve gone to manual patient registries—you pull up a list of patients and you ask someone to call those patients and bring them in. That of course creates waste in the system. So we’re trying to fight through that right now.
Are you using anything like dashboards?
We’re trying to move down that road right now. We’re attempting to move towards a dashboard look for everybody, but we’ve had to try to find third-party vendors like Phytel, that can automate what we were doing manually, which was essentially pulling the data from our EMR and automate it.
So you’re trying to automate the gathering of data on patients in your panels?
Right, exactly.
What are you going to be doing in the next year, strategic IT-wise?
I think we’ll continue down that pathway of mining our data and making it more actionable, and looking at ways we can deliver that data down to the staff data, below even the physician level. Every member of that team is going to need additional data to care for patients.
You’re doing it through report-writing?
We’re doing it in a manual way; it’s not so much IT products, it’s what we’re doing with our own internal processes to leverage the IT products we already have.
You have to downstream, as appropriately as you can, tasks from physicians?
Yes, you have to help people work at the highest level of their degrees, and to do that, you have to give them the tools and the data.
How big is the population group in Prevea 360?
It’s pretty new, so it’s a small number, something like 5,000, but growing quickly.
What would your advice be for fellow medical group CEOs, CMOS, CIOs, CMIOs, and other leaders, in all this?
My advice would be that so many people are focused on, I’ve got to find a way to get paid for this first before I do this, and that just puts you behind an eight-ball, because you need to perfect your tools and processes first anyway. And do it because it’s right. So for executives to say, I’m not going to do this because I don’t yet get paid for it, that’s incredibly short-sighted, because this is where healthcare is going.
