The Secrets of Accountable Care Revealed -- Right In Your Very Own Organization

Transcription

1 The Secrets of Accountable Care Revealed -- Right In Your Very Own Organization a complimentary webinar from healthsystemcio.com, sponsored by OTTR Chronic Care Solutions

2 Housekeeping WebEx ActiveX Webex may need to install an ActiveX control on your computer. If so, and your pop-up blocker is on, you will need to allow this by clicking on the bar that appears across the top of your screen. Ask A Question - We will be holding a Q&A session after the formal presentations. You may submit your questions any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck - If you would like to download today s presentation, you can also do that right from your viewing console. Just select the file from the transfer window on your screen.

3 Housekeeping View the Archive - An Archive will be available within 24 hours after the webcast has ended. You will receive an notification when it s ready. Please note that separate registration is required. Get Help If you experience difficulties, please contact WebEx Technical Support at and reference event #

4 Objectives To learn from those who through trial and error have found success To leave today s presentation with specific, actionable advice which can immediately be put into practice To absorb the underlying principles which have made a win possible, so they may be applied in your facility

5 Agenda Panelists John Halamka, M.D., CIO, Beth Israel Deaconess Medical Center Beth Lindsay-Wood, SVP/CIO, Tampa General Hospital

6 Agenda Continued A Word from our Sponsor Paul Markham, COO, OTTR Chronic Care Solutions Q&A With Panelists Moderated by Anthony Guerra, Editor-in-Chief, healthsystemcio.com

7 The Secrets of Accountable Care Revealed John D. Halamka, M.D., CIO, Beth Israel Deaconess Medical Center

8 The 5 IT Components of an ACO Universal adoption of EHRs Healthcare Information Exchange Business Intelligence/Analytics Universal availability of PHRs Decision Support for Care Management

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10 BIDMC s EHR Strategy Online Medical Record developed in 1980 s First web version (webomr) piloted in 2004 webomr rollout eclinicalworks Community rollout Meaningful Use mandated in 2010

11 Rollout Approach Phased Roll Out included the following standard steps: 1. Intense planning and customization with each department 2. Group and Individual Training 3. Presentations to Faculty by Physician Super Usersinteractive presentation/discussion 4. On-line Tutorial and Self Help modules 5. On site support at Go-live for 2 weeks 6. Refresher training as needed 7. Governance groups developed - focus to improve and prioritize updates to electronic record for clinician users

12 WebOMR Users Group Implemented March 2007 Multidisciplinary membership - providers, practice administrators, IS Sets priorities for future development WebOMR Advisory Group Multidisciplinary team incorporating Legal and Compliance Created by the user group guiding body for decision making and policy development Aligns providers, ambulatory administration, IS Primary vehicle to ensure that webomr meets the needs of the clinicians and ensure good communication, education & support

13 Patient Profile Screen

14 Patient Profile Screen, cont d

15 Problems

16 Medications

17 Medication History and Reconciliation

18 Reports

19 External Reports

20 Orders

21 Sheets

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23 Care Plans

24 Private HIE View - CareWeb (1997)/webOMR lite (2005)/Magic Button (2009) Push - NEHEN (2009)/State HIE (2012) Pull - State HIE (2014) 24

25 Public HIE MassHealth Partners BIDMC DPH EOHHS NEHEN ecw EHX NwHIN Statewide HISP Direct gateway services PKI/certificate mgmt Web portal Provider/entity directory Audit log Atrius MD SafeHealth MD MD MD Fallon Clinic UMass Memorial MD MD MD MD MD MD

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28 Project schedule Initiative Submit IAPD and SMHP to CMS Submit updated SOP to ONC EHR/HIE Vendor Roundtable Network Users Roundtable Eastern MA Network Users Roundtable Western MA CMS approval of APD-U/SMHP (all signs indicate) ONC approval of SOP and SOP budget (expected) RFR for Phase 1 services released to Infrastructure Vendors Completion date Complete Complete Complete Complete Complete Complete Complete Complete Infrastructure Vendor selected Late April, 2012 Infrastructure Vendor under contract Late May, 2012 Go-live for phase 1 Information Highway (Direct Gateway) Oct 15, 2012 Go-live for Last Mile program Oct 15, 2012 Go-live for Impact program Oct 15, 2012 Go-live for phase 1 Public Health Gateway (CBHI, SS) Dec 14, 2012

29 Analytics via Expert Query Hospital Analytics group Community Practice Analytics group Includes data cleansing, validity checking and creating repeatable queries Databases and data marts governed by a multistakeholder governance committee Primarily for Care Management, Government reporting, and Population Health

30 Analytics via Self Service Web-based graphical tool to query BIDMC s Clinical Data Repository Includes 2 million patients and 200 million facts (e.g., demographics, diagnoses, medications, lab tests, and procedures) from 1997 to the present Aggregate counts (e.g., preliminary data for grant proposals, population studies, etc.) do not require an IRB protocol With IRB approval, data sets can be obtained with help from the Decision Support team

31 Self Service Web Interface

32 Analytics via Repeatable Reports Parameter driven web-based reports in Performance Manager Acceleration of business intelligence capabilities with SQL Reporting and Analysis Services Dedicated expert consultant devoted to implementation Primarily for clinical and administrative operational support

33 Analytics via Outsourced Community Quality Repository and Claims Registry Combines BIDMC, HMFP, BIDPO, APG, API data into a single clinical care respository Used for all our Meaningful Use Measures, PQRS reporting, and AQC contract Also creates data marts of clinical data to support all payer claims data warehouse run by HDS Primarily for Pioneer ACO and Managed Care efforts

34 Patient-Level Information Assets BIDPO QDC - -

35 Provider Metrics and Measures Measure sets: 35 Contract Incentive Measures 44 NQF Meaningful Use Measures 24 PQRS Measures 31 Pioneer ACO Measures Qualified registry for the CMS 2010 PQRS program Certified as an ONC-ATCB (CCHIT) certified as a modular EHR for Eligible Providers for all 44 MU Stage 1 measures - -

36 Provider Measure Scorecard Slide title Massachusetts ehealth Collaborative MAeHC. All rights reserved. - -

37 Analytics via Innovative Pilots Natural Language Processing for intelligent searching of free text QueryHealth PopHealth

38 Universal Availability of PHRs Tethered (Patientsite and ecw Patient Portal) Non-Tethered (Healthvault and others) OpenNotes

39 Required PHR Functionality Secure Messaging with Provider Access to all records Convenience Transactions Request Appointments Medication Refills Referrals to Specialists Education Disease specific content Links to medication information Diagnostic test explanations

40 Decision Support Service Providers

41 Questions?

42 Beth Lindsay-Wood, SVP/CIO, Tampa General Hospital The Secrets of Accountable Care Revealed Right In Your Very Own Organization

43 About Tampa General Hospital Private, Not-For-Profit 1,018 licensed beds Level 1 Trauma Center Serves population of over 4 million in West Central Florida Approximately 6,900 employees, over 1,000 Medical Staff Primary teaching affiliate of the University of South Florida College of Medicine. Tampa General Medical Group (TGMG) is a growing employed group of providers made up of primary care and specialty physicians.

44 Our Transplant Story TGH rated #4 overall busiest transplant center in the U.S. Our Organ Procurement partner, Lifelink, is next door Did have a physician group of Hepatologists, Nephrologists, Cardiologists, and Transplant Surgeons How is transplantation programs like Accountable Care Organizations? Data Across the Continuum of Care Must track extensive data, upload subset to the UNOS database to place patient on transplant list. Pre-Transplant patients suffer from chronic conditions that amass large amounts of clinical data to be collected and trended over time. Analysis of this data can determine whether the patient is eligible for transplantation Transplant patients often live in other states. Collection of data pre- and post-transplant is often manual but must be in one repository for patient monitoring and outcomes reporting. Bundled payment structure requires all care environments to work closely together

45 The Perfect Storm 9/2009: The TGH Strategic plan identified the need for automation, both in Transplantation and across the Hospital. Approval to purchase and implement comprehensive EMR solution across hospital and clinics (~$120m over 5 years) in less than 2 years from contract signing. Need to replace self-developed transplant database. Lifelink physicians would also use this product with us creating a more robust database (hospital and practice data combined). 1/2010: Determined need for separate best of breed solution for Transplantation TGH EMR Transplant solution immature and would not meet needs Approval to purchase and implement a separate Transplant database solution ($1m) and use for both Lifelink and TGH in order to move to one system across the continuum of care. 9/2010: TGH acquisition of Lifelink Physician Practice Maintain existing systems for 1 year on TGH infrastructure Convert to TGH Transplant database in early 2011 Scramble to Convert to TGH EMR in October, 2012

46 What Happened In 18 months: Complete all elements of physician acquisition Design and implement Transplant system to include some EMR functionality that existed in home-grown solution Design an EMR and Revenue Cycle solution at the same time Design new workflows for all staff multiple times to accommodate different system go lives Re-implement Transplant system for integration with EMR at go live

47 Lessons Learned for Us, Possible Guiding Principles for Others Avoid the perfect storm if you can Ensure strong project management Establish a robust Data integrity process (involve Clinicians!) Redefine workflows for day to day work

48 Next Steps for TGH Complete stabilization and optimization of our technologies and our workflows. This is a journey. Begin to use more sophisticated tools for outcomes reporting Begin advanced data modeling efforts to support contracting with payors based on capitation model What is the cost per phase of care? What is best system design to accomplish aggregation of all data related to Transplantation (Product Modeling). How do we use this model for other chronic care patients?

49 Paul Markham, COO, OTTR Chronic Care Solutions The Changing Marketplace The Accountable Care Company The Transplant Difference The Flexible Solution The Future

50 The Changing Marketplace Government Accountable Care a necessity not a fad 15.9% GDP Patient Centered Portable Health Records driving meaningful use Critical Interoperability and Disease Management driving Quality of Care Business Payers The system doesn t work, it s broke today. The end of insurance companies, the way we ve run the business in the past, is here. Aetna CEO Payers (Bertoloni, 2012) Comprehensive IT needs of ACOs extend beyond an electronic medical record system that links a hospital and physician practice Medical Director Wellpoint (Linares, 2012) Providers Accountable Care asks how organizations can take on risk that encourages them to focus on caring for the population, reaching beyond just providing healthcare to look at the needs of the community and support initiatives that can improve the overall health of the population. Jack Wolf, Chief Information Officer. (Wolf, 2012) Vendors In addition to an electronic health record that spans the continuum of care, the following six key technologies will enable the core accountable care processes Siemens CEO Health Services (Glaser, 2012) Community Facebook meets EMR

51 OTTR The Accountable Care Company Heritage Back to the Future 20 years of national patient centered digital records Corporate Mission Oceans 13 Committed to changing Healthcare Outcomes Strategic Vision Education not marketing Coincidence of disease state management and needs of customers Customer Segment Got OTTR? 80 large-scale complex environments Technological Fit Change is constant Flexible software platform

52 Transplant The Guiding Light in Accountable Care Accountable Care Software since inception Highly regulated environment Patient Centered Technology Model National Health Information Technology National Lab interoperability Available to all other CMS Accredited Programs some examples CHF Advanced Heart Failure BSC Advanced Bariatric Surgery LVC Advanced Lung Volume Reduction PSC Advanced Primary Stroke Care COPD Chronic Obstructive Airway Disease VAD Advanced Ventricular Assist Device BMT Bone Marrow Stem Cell

53 The Future Towards Predictive Healthcare Beyond Transplant Towards Disease Management Solutions VAD/BMT/CHF/LVR/BMT/BSC etc Beyond Episodic EMR National Interoperability Gateway (EMR/Ambulatory/Lab) Beyond Provider Payers based Accountable Care Agents nodes protecting programs Beyond Data Aggregation Population Based Management

54 Q&A Click on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. John Halamka, M.D., CIO, Beth Israel Deaconess Medical Center Beth Lindsay-Wood, SVP/CIO, Tampa General Hospital Anthony Guerra, Editor-in-Chief, healthsystemcio.com

55 Closing Within 24 hours, you will receive an notification that our archive recording is ready. (Separate registration required) As we close our event, your browser will be taken to OTTR Chronic Care Solutions Web site ( and we hope you ll take a few moments to review the additional information our sponsor has to offer on this and other related topics.

56 Thank You! We hope you will join us for more healthsystemcio.com Webinars in the future Questions/Comments Anthony Guerra