How to Use Technology to Create Value
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1 How to Use Technology to Create Value David Kaelber, MD, PhD, MPH, FAAP, FACP Chief Medical Informatics Officer The MetroHealth System Amy Kramer, Pharm D Senior Manager, Clinical Pharmacy Services HealthSpan
2 Disclosure Presenters reported no financial interest relevant to this presentation
3 Objectives Summarize the concept of value based health care and ACOs. Explore the role of EHR technology to report and close care gaps especially. Identify a new strategy to bring back to your systems to enhance value based care.
4 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
5 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
6 Healthcare Value Value = Quality/Cost (maximize quality; minimize costs) (how do we measure quality; how do we measure cost) Magic Quadrant
7 Payers Moving to Value Payers starting to collect/look more closely at quality Payers moving towards pay for performance Measures consolidating and aligning (HEDIS, NQF, NCQA) ACO Hospital Inpatient Quality Reporting Program MU PQRS ACO Accountable Care Organization CHIPRA Children s Health Insurance Program Reauthorization HEDIS Healthcare Effectiveness Data and Information Set MU Meaningful Use NCQA National Committee for Quality Assurance NQF National Quality Forum PQRS Physician Quality Reporting System CHIPRA
8 Need to measure to improve
9 Healthcare Value and Technology
10 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
11 Pop care at Healthspan Lab outreach (Mychart, letters, IVR) Focus on delinquent labs A1c, LDL, MAU, BMP 4 LPNs Disease management ( focus on DM control) PharmD x 4 RNs Typically one on one phone calls
12 Epic population care (Healthy Planet) Registries Reporting workbench Bulk Orders Bulk Communication Track Outreach
13 Actionable Report Follow up on individual patients or groups of patients. Review a patient's chart or open an encounter to place an order for a patient. When following up on several patients, contact them all, or place a bulk order for a procedure they all need.
14 ACO: Diabetes Measures A1c < 8 & within 12 mos LDL < 100 & within 12 mos BP < 140/90 & within 12 mos No tobacco use ASA/antiplatlet/anticoagulant/ASA allergy Among those w concurrent ischemic vascular disease [IVD]
15 Reporting Workbench (RWB)
16 Diabetic Provider Level Report Mem bers AIC <8 LDL <100 BP <140 /90 No Toba cco IVD on ASA D5 Aggrega te Score H/M Stati n > 40 D5* Aggregat e Score Members: # of diabetics # at all targets: # of pts meeting all 5 D5 metrics
17 CARE Manager Performance Report
18 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
19 MetroHealth Epicare (w/ Cadence, Prelude, and Resolute) ASAP Inpatient Epic (w/ Willow) CareEverywhere, e-rx, MyChart Epic Enterprise Contract, MU ADT, Bedtime, OpTime, SBO Current Version 2012 IU3 MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. 1 st public healthcare system in the US to install Epic in the outpatient setting
20 Risk Registries
21 Comparative Quality Measures
22 Adolescent Immunization Reminders Texting Calling Post-cards Immunized Not Immunized 26 of adolescents messaged received at least one overdue immunization (Need to message 4 adolescents to immunize 1) (~$0.50 to bring one person for immunization)
23 Consults/procedure orders written yesterday not completed or scheduled today. After 12 months (2/2012-2/2013) the 30-day consult and procedure completion/schedule rate went from 48 to: Answer: 61 Referral Completion ~6700/month additional initial consults (61,939) and procedures (18,936) completed/scheduled (and ~$1,000,000/month in new gross revenue).
24 Personal Health Records MetroHealth uses patient entered: Weight Blood Pressure Blood Sugar MetroHealth shows preventative/health maintenance reminders to patients (and allows self-scheduling).
25 Technology Driven Value Paradigm Use technology (data and tools) to identify value ( quality and/or costs) opportunities Use technology to encourage/automate/self-service higher value activities: Tests Visits Healthier behaviors/outcomes Screenings/Preventative health services Use technology to discourage lower value activities: Tests Visits Unhealthy behaviors
26 Hepatitis C Screening The Future? CDC and USPSTF (2103) recommends once lifetime screening for hepatitis C for anyone born (estimated 800,000 undiagnosed cases) 1. Data Mining - Use electronic health record data and tools to identify all patients meeting screening criteria (based on DOB and no hepatitis screening or diagnosis and healthcare provider/system is medical home ) 2. Automated orders - Automatically generate orders for hepatitis C screening test on all identified patients. 3. Automated messaging - Automatically message identified patients (personal health record, text, phone, letter/postcard) of need to hepatitis C screening test and how to get it. 4. Obtain blood sample - Patient comes to lab to have blood drawn. 5. Automated messaging of negative results - Automatically message identified patients (and primary care provider?) with negative results. 6. Manual messaging of positive results - Route positive results to hepatitis C clinic/providers (and primary care provider?) for personal follow-up with patient.
27 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
28 Using technology to derive value Data Tools People Processes Exploiting Health IT to Improve Health Value!
29 Using technology to derive value Data Use health information systems to determine the right quality and cost data Tools Need the right technology tools to present the data People Need the right people using the tools to see the data Processes Need right processes for the people using the tools to see the data to realize the value NEED OVERALL PLAN! PLAN WILL BE RELATIVELY UNIQUE IN EACH HEALTHCARE SYSTEM/SETTING!
30 Outline Introductions Who you are and affiliation What you hope to get out of this session Any example of health information technology to create value (optional) Overview of Healthcare Value Healthspan Examples MetroHealth Examples Value and Technology Take-home Points Discussion
31 Thank You!!! Questions/Comments/Discussion? Can you think of one new way you/your healthcare system can leverage technology to improve value?
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