MassTLC PCHI presentation: Care Redesign, IT needs
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Alex Baker, COO, Partners Community Healthcare, discussed the shift from volume to value and the technology implications.
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- 1. Care Redesign: Information Systems Needs Alexander K. Baker
Chief Operating Officer Partners Community Healthcare, Inc.
September 22, 2011
- 2. What is PCHI?
- P artners C ommunity H ealthCare, I nc.
-
- Provider Network consisting of ~6,400 physicians and 9 acute
care hospitals organized into 17 Regional Service Organizations
(RSO)
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- Management Services Organization (MSO) providing performance
improvement infrastructure for the network.
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- 100% EHR adoption as of 12/31/2009
- 3. Care Redesign Conceptual Model HEALTH OUTCOMES COST VALUE
FOR PATIENTS Health Outcomes Value Metric = Cost of Delivering
Outcomes
- 4. Network Characteristics needed to succeed in Population
Management
- 5. Care Redesign Themes Take a condition-specific approach
Focus on outcomes that matter to patients and their families
Develop value metrics to track performance Identify pause points
Coordinate care delivery Increase reliability Population
Management
- 6. Care Redesign Themes Take a condition-specific approach
Focus on outcomes that matter to patients and their families
Develop value metrics to track performance Identify pause points
Coordinate care delivery Increase reliability Population Management
Patient Portals
- 7. Care Redesign Themes Take a condition-specific approach
Focus on outcomes that matter to patients and their families
Develop value metrics to track performance Identify pause points
Coordinate care delivery Increase reliability Population Management
Patient Portals Business Intelligence and Data Warehousing
- 8. Care Redesign Themes Take a condition-specific approach
Focus on outcomes that matter to patients and their families
Develop value metrics to track performance Identify pause points
Coordinate care delivery Increase reliability Population Management
Patient Portals Business Intelligence and Data Warehousing Decision
Support Systems
- 9. Care Redesign Themes Take a condition-specific approach
Focus on outcomes that matter to patients and their families
Develop value metrics to track performance Identify pause points
Coordinate care delivery Increase reliability Population Management
Patient Portals Business Intelligence and Data Warehousing Decision
Support Systems Referring Physician Solutions
- 10. Five Elements of Population Management
- Identify members of the cohort
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- Leverage multiple data sources: EHR, billing, claims, ADT
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- Develop algorithms to identify cohort members
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- Consider clinicians (including referring physician) and patient
as sources
- Gather information on the cohort into a database or
registry
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- Organize relevant clinical and financial data
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- Present tabular views and visual representations of data
- Develop logic to highlight cohort members in need of
follow-up
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- Fail to meet a process standard
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- Fail to meet a clinical outcome standard
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- Fail to meet a measures that matter standard
- Develop population management software to track patient
interventions
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- Document attempts to contact patients
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- Capture results of contact and interventions
- Gain insight through reporting and analytic tools
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- Population reports to describe the population and its
status
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- Operational reports to quantify the services provided
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- Outcome reports to assess the impact of services
- 11. Business Intelligence and Data Warehousing
- Quality and quantity of Partners data are rapidly
improving
- Much of this data resides in our transactional systems
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- Transactional systems are not organized for efficient
reporting
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- Reporting off transactional systems drags down their
performance
- Critical need for coordinated, enterprise data warehousing
strategy
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- Build on current data warehousing islands
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- Enterprise coordination of multiple activities
-
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- Data governance, access and security policies
-
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- Data extraction from transactional systems
-
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- Analytic tool selection and user support services
- Success tied to multiple strategic initiatives
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- Accountable Care Organization
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- Payment reform (e.g., global risk, bundled payments)
- 12. Decision Support
- Pause points Decision support opportunities
- Increase depth and sophistication of decision support
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- Focus on condition-specific care redesign teams
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- Express decision support at pause points
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- Incorporate checklists and other guidance
- Increase breadth of decision support
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- Leverage financial and administrative data
- 13. Patient Portals
- Online engagement of patients and their families
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- Access to patient medical record
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- Access to library of health information
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- Message with physician practice
- Tools to support more efficient care delivery
- Platform for alternative care delivery strategies
- 14. Referring Physician Solutions
- Referring physician portal
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- Delivery of consult information
- Regional Health Information Exchange (HIE)
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- Platform to support health information exchange at scale
- 15. Care Redesign: Information Systems Needs Alexander K. Baker
Chief Operating Officer Partners Community Healthcare, Inc.
September 22, 2011