In healthcare organizations’ ongoing march toward value-based care, one of the core challenges in this “new healthcare” is that cost pressures have significantly increased. As such, the burden falls on patient care organization executives to innovate and work towards further enhancing the quality of care, while keeping costs in check.This is precisely what Centra Health, based in Lynchburg, Va., providing care with four hospitals and 64 locations in all, has set out to do. Two of the health system’s executive leaders— Matthew A. Johnson, vice president of medical affairs, and Karel Bemis, director of accountable care, recently spoke with Healthcare Informatics about Centra Health’s value-based care journey and how IT is playing a key role. Below are excerpts of that discussion.
Where do things stand right now regarding Centra Health’s value-based care progression? At a high level, how fast is the train moving?Johnson: We are located in Central Virginia, and we have about 8,200 employees with a 2018 projected revenue of $1.3 billion. We have both legacy and best-of-breed data systems, and we are expecting to go live with Cerner on September 1st. Some of the at-risk programs that we have been involved with for a while now are both on the private and public payer side.
Starting with the private side, Anthem has a Quality Insights Incentive Program, and we have been on the hook for this for about six or seven years. It’s a robust program that looks at a lot of metrics such as readmissions, to hospital-acquired conditions, to infection rates, to patient experience. It’s a large program that we pay lot of attention to because Anthem is our largest payer. That’s what got us started.
In 2013, Centra decided to go into the payer business and purchase a [local] health plan located in our region, Piedmont Community Health Plan. In the plan, we are at risk for Medicare Advantage [beneficiaries], the [insurance] exchange population, and then we have our own employees and independents. It was in 2013 when we started to step on the gas and realized it was important to not just take in the premium dollar, but drive value in a population, and understand what’s going on, how patients are accessing care, and what data can we collect on them to manage physician performance. This was the catalyst for a lot of our work.
As far as the government programs at Centra, in 2017, about $10.2 million of the revenue we took in from CMS [the Centers for Medicare & Medicaid Services] for the services we provided was at risk. That money is broken down between the hospital-acquired conditions program, which is a penalty-only program at 1 percent [reimbursement penalty], the value-based purchasing [program], which is a two-sided risk model, at 2 percent, and then the readmissions [reduction program], a penalty-only program, at 3 percent. So those programs got our attention as well.
All of this is just on the acute care side, and when we started to learn about MACRA [the Medicare Access and CHIP Reauthorization Act], we realized that we had a risk corridor of almost $2 million either way, depending on how well we performed under MACRA. So long story short, this was one of the reasons we became a Track 1 ACO [accountable care organization]. We are not on the bleeding edge of change or the lagging edge; I think we are somewhere on the front end of that change continuum. And I would say we are moving along at a moderate pace.
Drilling down, what are the greatest challenges? What needs to happen for more progress in this area? Where do the biggest gaps lie?Bemis: Our greatest challenge is becoming a high-value provider network in the area. To do that we need to put our network at risk, combine that with business intelligence, look at dashboards, information coming out of EHRs (electronic health records), and take all that and roll it with physician change management. We need to work with physicians, educate, and figure out their workflows while hearing their needs. Once we understand their needs, we can put that with the data and work with our health plan, which will give our provider network super insight, almost making them subject matter experts so they can do the best job out there for population health. The biggest challenge is getting physician change management to work, and taking those slow steps by walking a mile in their footsteps.
What type of innovative technologies are on the horizon, or are already being deployed at Centra, that can help your organization on this journey?Bemis: Technology is my game; I love it. I cannot wait for AI [artificial intelligence] to get stronger and better. In the meantime, what we have to do is take the data we have and understand it better. We don’t want garbage in, garbage out. We need to keep it clean. When we paired with [health IT vendor] CitiusTech, they were able to create a dashboard for us, and we had dozens of legacy programs, different EHRs, and they blended it all together for us, so we could see how a physician was performing. Whether the patient went to our cardiac team or down the street to another location, we could keep track since CitiusTech paired it all up. And we can can see that for this quality measure, you are at 82 percent, for instance, and we are confident in that since you’re not leaving out all these other systems.
The holy grail we’re going to now is one EHR—Cerner—and once that comes online, it will help us see our physician data and claims data, and help us do great things to help break down those siloes.Johnson: When I look at Centra, where we are on our journey, thinking about descriptive analytics, to diagnostic analytics, to predictive analytics, to prescriptive analytics, I would say we are at the diagnostic level now. We can determine where we are at a particular point in time and drill down to see where we can drive particular cost or quality metrics.
As a Track 1 ACO, what are your thoughts on a possible ACO rule coming that may force providers into two-sided risk models?Johnson: We are unsurprised by it. The data shows that if you stay in Track 1, you never achieve those shared savings that CMS is so interested in. It’s the more advanced models that drive that. We are all now used to the idea that CMS can change the rules, and they’re doing so more frequently. Being in the health plan business, we had every intention early on in our ACO [journey] to take on full risk in the Next Generation model, but it was our Cerner transition that made us look in the mirror and realize that the timing was not right. But we plan to move toward a more advanced ACO model.
Can technologies like AI and machine learning help with what you are looking to do?Johnson: We believe it can help, absolutely. But right now, in our own company’s life cycle, there is blocking and tackling we have to do as we are mining to a Cerner system of services. We need to survive that before moving onto AI and machine learning. But we do see a future with [these technologies] and we are completely aware of what’s out there.Bemis: We are all trying small side things, like telehealth. We have a large area to cover, so telehealth can help us quite a bit. We are also taking on new surveys to reach out to patients and making sure they know to take their medications, and following up with them to see if they need to be in touch with our nurse navigators.Johnson: Our journey to value has helped us embrace data more. Looking at our work, I break it down into three buckets: creating an engaged physician network, which can be an ACO, clinically integrated network, or even an insurance network. Then, you add business intelligence so you have data at your fingertips that is actionable and meaningful to providers. And we think it’s the EHR-mined data that has driven the most change. That data is the closest we can get to what the physicians are really doing so that we can influence them to change behavior in their practices. Overall, we are proud of the work, but we have a long way to go.