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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Intervention – Results and Recommendations
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Intervention – Baseline Results
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Intervention
• Training – elbow support
• Monitor improvement through reporting and follow up support
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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
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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)
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Provider Satisfaction Survey
• 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
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Provider Satisfaction Survey
• 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
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Measure Results
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Measure Results
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Measure Results
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Measure Results
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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
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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