Leveraging Data for Performance Improvement

Jack Millaway, LPHIChatrian Kanger, AHL

Why is it Important?

• Data has always been important in healthcare, but its scale continues to expand– Individual patients– Chart Sampling– Patient Registries– Organization-wide– Whole population (community and beyond)

Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives

In the past few years, data and its impact on payment has expanded drastically:– ACO’s and other shared savings or incentive

contracts with payers– UDS Quality Awards– Patient Centered Medical Home– Meaningful Use

Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives

• And its impact will only continue to expand!– Medicare payments• 30% of contracts by the end of this year• 50% by the end of 2018• MIPS and MACRA

– Meaningful Use Stage 3– UDS whole population reporting– Grants and other initiatives

Electronic Health Records and Data Timeline

THE FUTURE

Image source: SAS Analytics (blog.SAS.com)

Source: bobdylan.com

Healthcare Analytics Evolution

Best Practices to adopt today

1. Evaluate your current environmenta) Active payer contractsb) UDS, PCMH, Meaningful Use, and other Quality

Incentive programs2. Make a plan

a) Where does it make sense to target efforts?b) Capacity to implement change

3. Make it a prioritya) Regular monitoringb) Integrate data into all QI projects

DATA IN PRACTICE

Chatrian Kanger, MPHQuality Assurance Manager

Access Health Louisiana

Who We Are

• Established as St. Charles CHC in 2002• 27 practice sites (CHCs + SBHCs)• 9 parishes• 92 providers total• 40k patients & ~125k visits / year

Internal Structure:

Care Teams

Support Teams Training Department,

QA/Reporting/ EMR staff, Call Center

Athena

Current Performance / Quality Improvement Process

• Collect and review data from multiple data sources

• Prioritization of Quality Measures• Categorize by roles • Leverage internal structures & technologies

when feasible (e.g. EMR, call center, training team, etc)

Priority Area – Care Coordination

AHL focus: Ensure timely access to follow-up care after a hospital discharge

Emergency Dept / Hospitalizations

GNOHIE

Issues with Current Flow:

Introducing RISK: – Losing patients to timely f/u care– Increasing likelihood for readmission or

inappropriate ED usage againLosing $$$Ability to document & track:

- Scheduler (appt types)- Pre-built Templates - Pre-built Reports

What’s on the Horizon?• Patient load in GNOHIE is about to increase

once our interface completes with Athena• Additional patient load & awareness of ED /

hospital visits w/ other interfaces + payers

• Reducing ED/ hospital visits• Incentive $$$ focus on ensuring timely access

to f/u care • Care coordination

Emergency Dept / Hospitalizations

GNOHIEScheduling: Add drop down

for appointment reason

Clinical Documentation: Rx reconciliation HPI template –

“Emergency F/U Record”

Reporting Templates: Use “ED Followup

Report” & “Hospitalizations Report”

Other Systems

Considerations:

• Added workload on Nurse Care Managers:– Explore opportunities to reduce inefficiencies• Suggestion: Triage to Medical Records?• Give lookup access to Patient Care CoordinatorsTraining Nurse Care Mgrs on Scheduling?

• Leverage templates within Athena– HPI Template: “Emergency F/U Record”– Report: “ED Followup” & “Hospitalization Report”– Scheduling: Add in drop-down for “appt reason”

RECAP:• “Data” can be quantitative and qualitative• Work backwards• Steps or Tools:– Review data reports to id trends against targets– Workflow mapping of current state & future state– Explore options within our EMR system to automate

functions:• Scheduling• Documentation • Reporting

– Deliver training / update protocols accordingly