Effective population health management has made it imperative that patients have an equal footing in the matters of their health. Access to comprehensive, reliable data is one vital ingredient healthcare organizations require for effectively engaging patients. The challenge that lies before this foundational step is the lack of a unified healthcare data platform, a single source-of-truth connecting multiple healthcare data sources. The universe of healthcare data is dotted with individual EHRs, billing files, claims data- we are data rich, but almost paralyzed when it comes to collecting and analyzing this mound of data.
Following the same thought, engaging patients and improving the experience of care was one of the most-discussed sessions at the annual HIMSS conference this year. The 2018 conference witnessed an impressive number of over 43,000 attendees to the Sands Expo Center in Las Vegas, Nevada. Several industry pioneers and thought leaders shared their opinions on the transitioning healthcare and how the picture of patient-centric care looks like.
Sharing another such anecdote was VP and COO of Mercy Accountable Care Organization, Derek Novak. Based out of Iowa, Mercy ACO realized how unlocking value from data would enable their care teams to manage populations of thousands. With data at hand, physicians and care teams reduced healthcare expenditures for Iowans by more than $70 million since the ACO's inception in 2012. And Novak envisions even more savings in the years ahead- on the foundation of a fourfold, data-driven strategy to primarily engage patients.
Detailing Mercy ACO's strategy at the Patient Engagement and Experience Summit, Derek revealed the essence of their data-driven strategy in his session during the Patient Engagement and Experience Summit. Mercy ACO comprises of six regional chapters, 195+ participant organizations covering Nebraska and Wisconsin, 27 critical access hospitals, and more than 3,500 providers, therefore, it had almost 200 million records to streamline for information on patient population.
Mercy ACO incorporated a healthcare data platform to advance their integrated strategy by allowing them to bring all the disconnected data on a single source. The flexible platform facilitated additional insights into opportunities that would otherwise remain unknown; for example, gaps in care, prior diagnoses not currently reflected, and information on care that was provided out-of-network, among other items. Undertaking a proactive-reactive approach to enhance patient engagement, Mercy specifically zoned in on three measures out of all the value-based contracts, namely, annual wellness visits, ED utilization, and ADTs.
"We're connecting 14 different EHR brands at approximately 100 different clinical systems."
Derek spoke about how beginning with standardized and scheduled ADT reports, the ACO streamlined providers and ED workflows, identifying the high-risk patients and the frequent visitors. This brought down the ED utilization by 6.65%. Focusing extensively on increasing primary care visits, the ACO implemented multiple outreach strategies. To ensure that there were no gaps in care, the strategy had to expand beyond plain data management, and integrate care management with smart, automated methodologies. It also needed patient identification for the ones with multiple chronic conditions. The results of this strategy saw a 14.26% increase in primary care services a per 1000 patients.
"We have a fairly sizable amount of risk as an organization as we're transitioning more and more of our contracts to a downside scenario and ultimately... this allows us to better manage our clinical delivery system for our patients so, there's a standardized approach when a patient interacts with one of our health coaches," said Derek. "We have over 400 million different data points around patients in our system and across the state and we can perform predictive analytics and identify the rising risk populations or the patients that are going to be admitted, maybe, in a particular period of time."
The key, as Derek pointed out, was maintaining transparency across the network. With integrated records available in real-time, providers and care teams were extra-cautious of not letting patients fall through the cracks. With pioneering strategies such as 'social media-like patient care timelines,' 'virtual hand-offs' during transitional care, and linking with community resources, Mercy ACO could keep a close tab on measure-performance in real-time. Often it could take weeks or months for other systems to update to a new measure standard, challenging when that measure may change annually under a given contract, Novak explained. By having such flexibility, the platform provides a competitive advantage in value-based agreements and getting health systems to align with the frequent changes of payment reform, he said.