accountable care transformation - mahealthdata.org

Arcadia Solutions Proprietary & Confidential 1 Advanced healthcare simplified

Mass Health Data Consortium – Data Palooza

October 2, 2012

LuAnn K. Kimker RN MSN, Arcadia Solutions

Jeremy Davis, Mount Auburn Cambridge Independent Practice Association

Accountable Care Transformation: How Arcadia Solutions and MACIPA used EHR Data to Improve Provider Engagement


Agenda

• Introductions

• Methodology

• Results and Challenges

• ACO next steps

• Summary

• Q and A

"We are all faced with a series of great opportunities - brilliantly disguised as insoluble problems"

– John W. Gardner, US Secretary of Health, Education, Welfare, 1965-1968


About Arcadia Solutions

Who is Arcadia?

A healthcare technology consultancy uniquely situated in the healthcare market to help Providers and Payers capture, manage, exchange, and leverage data to improve the quality and affordability of care – all designed to scale.

Focus We leverage a flexible and pragmatic platform, combining clinical and claims data to drive behavioral change in providers and health insurers that delivers on the shared goal of effective, safe, and low-cost healthcare

Background Founded in 2002: Arcadia is a 200+ strong national healthcare services firm headquartered in Boston, MA, with offices in Austin, TX, New York, NY and Seattle, WA

Financial Stability: Owned by the Pohlad Family of companies (also own the Minnesota Twins)

Accolades: Named by Inc. as one of America’s 500 Fastest Growing Private Companies, Recognized on the Healthcare Informatics Top 100, CRN Top 100 Healthcare Solution Provider


MACIPA

• 520 Physician Membership Organization

• Pioneer Accountable Care Organization

• Affiliated with Mount Auburn Hospital and Cambridge Health Alliance

• Employed and Private Practice Physicians

• Majority of groups are made up of 1-3 physicians


Why Did We Bring in Arcadia?

• Standardize – Efficiently and Effectively

• Reporting Capabilities – To Augment our Data Warehouse

• External Perspective

• Continually enhance the quality of care our community provides

• Identify areas for improvement –at the organizational, practice and provider level


Arcadia EHR Optimization Approach

• Framework to deliver consistent results

• Standardized, specialty driven clinical content

• Arcadia’s EHR Analytics to standardize and measure

• Apply interventions to remediate providers and practices

– Application configuration changes

– Workflow modifications

– Retraining

– Identification of technology barriers

• Monitor for continuous improvement


MACIPA EHR Optimization

Physician Leadership

Ongoing Program Governance

Recruitment

Pro

gram In

itiation

Optimize Assess

EHR Diagnostics

EHR Optimization

Program Management

Steering Committee

Design

Outreach

Assess/Discover

Application

Implement

Measure Dev.

Program Standup

Co

ntin

uo

us Im

pro

vemen

t

Specialty CAC

Specialty CAC

Specialty CAC

Recru

it

Pilot

Optimize Assess

EHR Diagnostics

• Validate approach

and get reporting results for initial set of practices

• Phased optimization of entire market/region

Pilot

EHR Diagnostics Evaluate/Scale Pilot


Program Standup

Program Standup:

• Define MACIPA organizational goals of adoption

• Develop recruitment and outreach plan to enroll practices and providers into EHR optimization program

• Survey practices and physician champions to determine needs and optimization approaches

• Analyze current EHR application configuration and management to determine required changes

• Update EHR Analytics across groups to begin capturing baseline data

Optimization Steering Committee:

• Identify clinical advisory participants and members and establish physician leadership

• Define measures for quality and proficiency/efficiency

• Identify and prioritize practices/specialties for optimization rollout

• Validate primary care/specialty content

Optimization Steering Committee

Design

Assess/Discover

Package


EHR Optimization Pilot

• Pilot of EHR optimization approach to representative sample of practices

• 2 pronged assessment approach:

– Data driven results from EHR Analytics

– Clinical Workflow Assessment

• Implementation of EHR Analytics

• Implementation of clinical configurations

• Optimization services to assist practice users in adopting new content, feature and workflow processes

• Evaluation of pilot results to determine approach, resourcing and timeline for general rollout


EHR Analytics Reporting | Overview

Data Asset Validation

• Validate integrity of data in the EHR database used as a basis for calculations (Dx, labs, VS)

Baseline Performance Management

• Maintaining MU Stage 1 for full year

• Prep for Stage 2

EHR Usage Analysis

• Performance Indicators for Provider Efficiency (Order Sets, template, locked encounters)

• Performance Indicators for Practice Efficiency (Result review, cycle time)

Quality Performance

• Clinical Quality Measurement

• Other Quality Program Measurement


Clinical Approach to Optimization

• Assessment – Define goals of optimization – Define success criteria – Identify Reporting requirements

• Quality Measures

– Meaningful Use

– PCMH

– Pioneer ACO

– Other P4P

• Practice and Provider Efficiency/Proficiency

• Design – Validate Primary Care content – Prioritize content needs

• Implement – Build – Optimize


Intervention

• Conduct standardized practice assessment

• Create a practice optimization plan (POP) – Clinical /Usage Measure – definition and baseline

– Results and recommendations – practice and system

• Registration, scheduling, eligibility • Access, care coordination, patient outreach • Management of referrals and orders • User proficiency, barriers and concerns • Leadership and culture

• Strengths • Communication • Decision Support • Workflow • EHR system capability


Intervention – Results and Recommendations


Intervention – Baseline Results


Intervention

• Training – elbow support

• Monitor improvement through reporting and follow up support


Challenges

• Selecting and modifying reporting measures

• Deciding specialist responsibilities

• Measuring user satisfaction

• Logistics

• Orchestrating and executing the project in a tight timeframe

• Maintaining a sustainable model for excellence


Provider Satisfaction Survey

Assess provider proficiency and satisfaction with EHR and support pre and post optimization

Use to guide future support and optimization of EHR

• 123 providers surveyed with a 92% completion rate

• Years using this EHR

3-5 yrs = 58%

1-2 yrs = 28%

<1 yr = 13%

• Proficiency with EHR functionality* = Median of 3

• Comfort using EHR to document clinical notes*= Median of 4

• Overall satisfaction with support*= Median of 3

*(Scale of 1 – 5 where 5 is highest score)



• Providers always or almost always are responsible for the following activities

0

20

40

60

80

100

Medication List Problem List Allergy List

Pe

rce

nta

ge

Medication List

Problem List

Allergy List



• Provider use of key functionality that could save time is low

• Functionality that is only sometimes or never used

– 78% alerts

– 79% order sets

– 54% templates

– 35% right chart panel and carets


Measure Results


ACO – Next Steps

• Decide on Short Term and Long Term Reporting Needs

• Execute on the remaining ACO measures

• Reconcile ACO measures and goals with other contracts

• Utilize POP data to boost user satisfaction

• Maintain Momentum


Summary

“Transforming to an accountable care organization is a marathon, not a sprint. It takes time to evolve the vision, values, incentives and operations around a very different paradigm” Craig E. Sammitt, MD, MBA, CEO,Dean Health System

• Provide leadership and governance to develop the culture

• Create the infrastructure – technology and tools so support the work – EHR, Quality Data Warehouse, Reporting integration

• Change Management - use the data in a meaningful manner

accountable care transformation - mahealthdata.org

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