Many hospitals and health systems are looking at ways to improve the quality and efficiency of healthcare delivery. Rather than go it alone, seven Connecticut healthcare organizations have banded together to build a data warehouse combining claims data with electronic health record (EHR) data in order to harness the capabilities of real-time analytics to address gaps in care for effective population health management.
The Value Care Alliance formed in December 2013 and is comprised of St. Vincent’s Medical Center, Lawrence and Memorial Health System, Griffin Hospital, Middlesex Hospital and Western Connecticut Health Network, which is comprised of Danbury Hospital, New Milford Hospital and Norwalk Hospital.
In August, VCA partnered with Burlington, Mass.-based Arcadia Healthcare Solutions and is currently deploying the Arcadia Analytics platform to all member hospitals, unifying claims data from local and national health plans and hospital and ambulatory EHRs, to support real-time analytics which will be utilized by both VCA and hospital executives for strategic quality and cost improvement planning. The analytics also will be used by care management teams for patient monitoring, such as coordinating the care of diabetic patients.
The VCA anticipates the first results of this analytics work, which began earlier this month, in about 60 days. The Arcadia Analytics platform will serve as a central utility and dashboard capabilities will be used to compare cost, quality and efficiency metrics at the aggregate and individual hospital level, allowing VCA members to identify and share best practices between members.
Patrick Charmel, chairman of the VCA and CEO of Griffin Hospital, recently spoke with HCI Assistant Editor Heather Landi about the need for sophisticated data analytics in a value-based healthcare environment and the challenges of building a data repository with claims and EHR data across seven independent hospitals. In the second part of this two-part interview, Charmel will share the specific quality measures, what VCA will do with the results and how they got physicians on board.
How did the Value Care Alliance come together?
A number of hospitals were going through internal analysis and review looking at what kind of capabilities they were going to need in the future as healthcare began to shift from being volume-oriented to value-oriented. If we are going to take responsibility for a population of patients, we need to know a lot more about them, so we knew that we would have to develop more sophisticated information technology and capabilities. We would have to begin to gather both claims history data and medical records data to understand that population, to look at the underlying needs, or the chronic conditions that the population has, their claims history and then risk stratify them and develop strategies to intervene and try to manage the care of those patients more closely and more effectively. So that took a data repository and advanced analytics. Most of those traditional systems didn’t have that capability, and many still don’t. So, then the question is, how do you go about doing that? Do you do that as an individual hospital or do you come together with others? It’s a big investment. And that gets back to the question of what constellation of providers are you going to come together with? Are they efficient and are they producing good outcomes, meaning quality in terms of patient experience?
All of that analysis led us to say, let’s look for those high-performing hospitals that are capable and can execute and that understand how the environment is changing and are willing to embrace it, because not everyone is willing to embrace it. So, we tried to identify those organizations that were relatively low cost and producing high quality and that were forward thinking and wanted to come together in a less traditional manner that allows them to preserve their independence. There is a danger of bringing together fiercely independent people as they may not want to work together with others, so it’s a combination of being independent and also collaborative. Those were the kinds of folks that we were able to find and made sure we had a common vision with. We wanted to make sure that we all shared a philosophy and a common set of principles and then we set out from there.
Patrick Charmel
Were there any challenges to getting this started?
Yes, I think there were. It took us a little while to understand that sometimes we have to subordinate the interests of our individual organizations to the interests of the larger organization to really get the collective benefit of coming together. You have to get a few successes for organizations to believe that doing it together is more beneficial to doing it on your own; but once we get some early wins, it builds confidence that coming together was the right thing to do.
How did you choose a vendor?
So, within the alliance, there is a fairly formal structure. There are a series of advisory committees that are populated by our membership and content experts in each of our member organization. We had one looking at our information infrastructure needs, so that addresses the issue of the repository to collect claims and medical records information and then a set of analytical tools in order to use that information for decision making and turn that information into something that is actionable from a population health management standpoint. So, we’re talking about CIOs and population health data analytics experts and each of our members coming together and looking at what each of the member organizations already have, because some have already made investments in infrastructure. And then we looked at the products available in the marketplace and did a fairly detailed evaluation of the available options. At the end of that process, Arcadia was selected.
What are your goals with this partnership?
Our members have moved into a number of advanced payment arrangements with payers, with the Medicare program and the Medicare Shared Savings Program and now in relationships with commercial payers. [Editor’s note: VCA joined a co-branded ACO with Aetna and Hartford HealthCare last month.] So most of those arrangements have been upside only, but very quickly, probably as soon as next year, there will be upside and downside. So now we have risk for outcomes of care and we have risk for the cost of the care, and that means we have to develop new capabilities to manage cost and quality. That is what motivated us to build a data repository and to find a set of advanced analytical tools that could help us put all of our attributed lives, or those that we are responsible for, in various buckets by underlying disease, so to develop a disease registry—so we know who all the asthmatics are, who all the diabetics are, those patients with congestive heart failure and lung disease and then develop tailored interventions to help manage their disease more effectively. And then we focus on keeping them healthy. Next, we try to predict with advanced analytical tools who is likely to use resources in the future and, again, try to intervene to reduce the resource consumption. And, beyond that, we look at care variation. For example, of the orthopedic surgeons practicing in our alliance hospitals, look at the variation in terms of cost and quality, and then see if we can bring about more standardization around best practices. And, in order to do all that you need pretty sophisticated information tools and you need to have linkages through each of the hospitals’ electronic medical record systems and each of the participating physicians’ EMR systems to pull that information into a repository so that you can analyze it.
Going back to choosing a vendor, how did that impact your criteria?
That is where Arcadia shines. Almost anybody can build a repository that dumps claims data from the payer into the repository but actually being able to pull in medical record data and then merge that with claims data, that’s really challenging. I think our advisory committee that did this evaluation came to the conclusion that Arcadia has the best demonstrated ability to do both, be able to make those interfaces with disparate EMR systems, to normalize that data and be able to analyze it so that it becomes actionable by our providers. I think we see Arcadia as a real strong partner that understands the transformation that needs to happen and has developed some really unique capabilities, but it’s more the thought leadership that they have provide and the partnership they can form with us to help build the capabilities, I think that’s pretty unique.
What is the timeline for building your data asset and getting actionable data?
The repository is built and so the data is now being populated with claims data from both commercial payers and from Medicare, so the analytical tools are in place and we are beginning to do that analysis and create dashboards for providers so they can see the gaps in care, both at individual hospitals and across the VCA. So, the next step is to create those medical record linkages, which requires interfacing with each of the hospitals’ information systems, and more importantly, their affiliated physicians and their office EMR systems. Many of them are on different systems, if they were on one it would be really easy. Arcadia is making those connections with all of those EMRs, and [combining the claims data and EHR data] will likely occur over the next nine months to a year.
