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Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
“ACO & The CIO”
A Complimentary Webinar From healthsystemCIO.com
Sponsored by Tribridge
Your Line Will Be Silent Until Our Event Begins
Thank You!
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Event #664 627 633
Housekeeping
• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com
• Ask A Question• We will be holding a Q&A session after the formal presentations. • You may submit your questions at any time by clicking on the QA panel located in the
lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
• Download the Deck • Go to: http://healthsystemcio.com/presentation/ACO-Gordon-webinar.pdf• Shortened link below appears on most slides.
• View the Archive• You will receive an email when our archive recording is ready. • Separate registration is required.
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Event #664 627 633
Agenda — 45 Minutes
• 20 minutes: Tom Gordon, SVP/CIO, Virtua Health System
• 5 minutes: A Word From Our Sponsor: Damon Auer, VP of Healthcare, Tribridge
• 20 minutes: Q&A w/Tom Gordon
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Event #664 627 633
ACO & The CIO
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Event #664 627 633
Background
Virtua – A leader in southern New Jersey
6
4 Hospitals
4 Major Outpatient Centers
3 Urgent Care Centers
280+ Employed Physicians
308 Skilled Nursing Beds
2 Home Health Agencies
9 Ambulatory Surgery Centers
3 Fitness Centers
Sponsor of Regional HIE
$1.2 Billion - Revenues
Virtua 2013 Plan on a Page
Mission
Virtua helps you be
well, get well and stay
well.
Vision
Virtua will be the
premier choice in
health and wellness.
ValuesIntegrity
Respect
Caring
Commitment
Teamwork
Excellence
Strategic Imperatives Operational Priorities
People Improve Customer Loyalty
With An Engaged
Workforce
1. Define outstanding experience across continuum (patients, guests, employees,
physicians, customers, families, volunteers)
2. Align education and development
3. Align rewards and recognition
4. Strengthen talent pool
5. Validate and measure “loyalty” across the continuum
QualityAchieve Highest Safety &
Quality and Ensure Access
to Services
6. Align with clinicians based on quality outcomes and patient experience
7. Care re-design (re-distribution of resources to support improved access to patient
care with focus on be well, get well and stay well)
8. Develop systems to capture, measure, report and improve outcomes for ACO
patients and employees
9. Top decile performance in publicly reported data
10. Quality structure redesign from siloed to longitudinal across the continuum
Community
HealthImprove Community Health
in a Cost Effective Manner
11. ACO implementation
12. Community health needs assessment
13. Align philanthropy and support all functions to leverage integrated approach
14. Realign health services in the south to meet community needs
15. Aggressive management of employee wellness/education/cost reduction
Growth
Pursue Strategic Growth
Opportunities that Support
a Comprehensive
Continuum of Care
16. Optimize business portfolio
17. Expand women's’ health program
18. Evaluate and establish collaborative provider networks and partnerships
19. Redefine and hardwire the strategic and annual planning process
20. Increase access to care
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Virtua Paper-Lite/CIS Transformation Strategy – “technology building blocks to a connected health record”
2006 20122008 20092007 2010
Expanded Fiber-optic Network and Wireless System
Installed New Ancillary Systems: Lab, PACS, others
New ED System
CIS – Course Correction: Siemens EMR/McKesson HIM
New HIM System & Data Center
Soarian Results Viewing & Meds Administration
New Telephone System & “Recovery” Data Center
Clinical Documentation, Plans of Care, Device Integration
CPOE, Physician Documentation, SSO/Provision,RFID
Ambulatory EMR, Health Information Exchange, PHR, MU Program (Amb./Acute)
2013 +
Connected Health Records for Population Health
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“Reformed”
Healthcare
The Backdrop to any Healthcare Talk: Healthcare Reform
. . . Are we on diverging or converging paths?
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The Challenge We All Face Today……
Cost
Quality
Access
. . . Balancing cost,quality and access
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Virtua’s Response to this Challenge
Re-design Care Around
Accountability and Lower Cost
Address Health Preservation, as well as Traditional
Disease Management
Be Preferred for Quality & Safety
Invest Wisely in Technology
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Event #664 627 633
• Don’t measure ROI purely in monetary terms
• Real question: “What is the Return on Value?”
• What to look for: “Does IT…..
Improve the quality of care and patient safety?
Support evidence-based care?
Support clinical integration?
Increase patient engagement and responsibility?
Contribute to a culture of continuous improvement and excellence?
Understanding “Return on Investment” for IT
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Transforming Care - A Coordinated Effort
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Transforming Care - A Coordinated Effort• January 2013, Virtua entered into an Accountable Care
Organization (ACO) contract with the Federal government (CMS)
• ACO is branded as “VirtuaCare”
• Four implementation teams were formed:• Transition of Care
• Quality Metrics
• Care Redesign
• Patient Engagement
• Policies, Procedures, Workflows and IT infrastructure were developed
VirtuaCare Today – Contracts with payers
Self-Funded Health Plan for Employees & Dependents
Medicare AdvantageCare Coordination Services
Third-Party Claims Administrator
13,700 lives
1,600 lives
17,000 lives
12,500 lives
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Event #664 627 633
VirtuaCare: Infrastructure
• Community-Based Health Management (CBHM)• 1 Director of Case Management/Clinical Integration
• 1 Operations Manager of Clinical Integration
• Community-Based Health Managers (CBHMs)
• 4 Registered Nurses
• 2 Licensed Social Workers
• Interviewing for 2 additional CBHMs
• 6 more slated to be hired this year
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Event #664 627 633
Community-Based Health Manager (CBHM)
• CBHM caseload is 100 – 150 patients
• Patients selected utilizing reports and physician input:• Historical High Cost (from claims history)• High Utilization (from claims history)• Complex Case Management (from medical history)• Current issues – both medical and social
• Patients are evaluated, and Plans of Care are developed
• Evaluation and continuous monitoring:• Post-Discharge from Acute Care or Emergency Room• During scheduled physician office visits • Visits to patients’ homes• Via the telephone
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Event #664 627 633
Reporting - 3-Year Period• Year 1 (2013) Reporting Year
• Year 1 baseline attestation started January 27, 2014
• Attestation cohort has 4,000 patients, selected by CMS
• Estimated 840 person-hours to complete data-collection activities for the attestation
• Year 2 (2014) Shared Savings Begin – 22 Quality Metrics
• Year 3 (2015) Shared Savings Begin – 33 Quality Metrics
Breakdown of Metrics
7 based on patient experience
4 based on claims data (from Virtua and other providers)
22 based on health metrics (chronic disease + prevention measures)
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Event #664 627 633
Information Technology
New IT Landscape
Health System’s Data Warehouse
Physician Office EMR
Patient Demographics
Acute Care EMR
ER EMR
Pharmacy
Laboratory
Patient Billing
Radiology
Sample of information systems for independent health care providers
Physician Office EMRs
Nursing Home EMRs Commercial Laboratory DataDentist Office EMRs
Commercial Pharmacy DataDiagnostic Imaging Centers
He
alt
h In
form
ati
on
Exch
an
ge
State Registries
Other HIEs
Sample of Virtua information systems
Amalga (clinical data)
Datamarts/Cubes (Clinical, Access-Nav, Financial, HIE,
etc) – Refreshed regularly **
Feed
Feed
Feed Feed
Feed Feed
Framework/Rules/Guidelines
DSS/Embedded Analytics (bus/clin data)
Feed
Feed
Access Navigation (CRM)
Dynamics CRM * Health Information
Exchange
NextGen EMR
Clinical Views & Care Coordination Tools,
including Access Navigation
CC
D
Analytics
Clin
ical,
Fin
an
cia
l &
Cla
ims d
ata Foreign Risk Strat. Claims
data *
Fra
mew
ork
fo
r str
ati
fied
data
,
CR
M, an
d R
ule
s/G
uid
elin
es
acro
ss s
yste
m
MPI matching
MPI matching
Opt in/out Mngt. Cohort Mngt.
CRM Portal for POC personnel
Outside CCDs
Care Coordination Protocols/Templates
Care Coordination Platform
Amalga(clinical data)
Data Marts & Cubes – Refreshed regularly
Soarian
EDIS
Picis OR InvisionDocuMgt
NextGen
MisysCompu-
data
Pharmacy Lab
GE IDX Other
OtherOther
Acute Care Community
Care
Recovery, Rehab, Sub-Acute
Internal Framework/Rules/Guidelines
Novius DSS(business data)
Clinical Views, Care Coordination Tools, Analytics, & Access-Navigation
Misc OtherSQL Tables
Access-Nav System
Claims DataTelemed
Data
Other
Telemed Data
SQM (Soarian Quality
Measures)
QualityDashboardsCommunity
Physician Data
Patient Portal
Home Device Data
Third-Party Data (Lab, Rx, LTC, etc.)
Virtua’s New IT Landscape
Accountable Care OrganizationACO – Overall Workflow & System Diagram
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Event #664 627 633
ACO Workflow Version 1 –circa November 2012
The Virtua ACO
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Event #664 627 633
The Virtua ACO
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Event #664 627 633
The Virtua ACO
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Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
Slide Deck: http://goo.gl/e7OiPZWebex Support 1-866-223-3239
Event #664 627 633
• ACO Patients were to be assigned to Virtua
• Patients to be identified and “Flagged” in Virtua System
• Corresponding Claims files needed to be associated with each patient
• ACO Patients and Corresponding claims data needs to flow to all ACO related services and applications
• Real-Time Data needed for active management of patients (Admits, Scheduling, Labs)
The Virtua ACO
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Event #664 627 633
Accountable Care OrganizationInformation Workflow Summary
• Beginning with patient identifiers provided by
non-Virtua sources, Amalga identifies, matches and
“flags” ACO patients. Using real-time data feeds,
Amalga shares ACO patient alerts with all downstream
ACO applications. Amalga also parses associated
claims data for assigned ACO patients.
Accomplishments • Identify patients using non-Virtua identifiers
• Assign “flag” to identify and monitor ACO patient
• Monitor ACO patient ADT
• Monitor patient scheduling
• Medicare patients in program
Implementation/Architecture and Design • Using existing Amalga system, a shared DB was
modeled and created using a SQL shared DB for all
downstream data processing
Work To Be Done• Validate delivered Analytics
• Identify and build requested Analytics
• Add new ACO program patients
• Horizon
• Aetna
Risks/Mitigation• Risk – each new ACO has different identifiers and
workflows
• Mitigation – develop custom logic & solutions for each
ACO
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Scope – Lessons Learned
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Scope – Process Area Requirements
11
222
33
44
66
910
111111
1415
1719
2224
35
Integration - Access Navigation
Integration - Amalga
Cohort Management
Care Plan Administration and Management
Patient Management
IT
CBCM - Care Team Documentation in NextGen
Integration - Engage
System Wide
CBCM - Patient Access Specialist-Services
Integration - NextGen
Security
CBCM - Care Team Process Map
Quality Metrics
CBCM - Patient Identified as High Risk and Admitted
Access Navigation
Cohort Administration
Reports and Dashboards
Consent
Contract (ACO) Management
Opt In/Opt Out
CBCM - Daily Worklist
CBCM - Enrollment
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Event #664 627 633
CRM Data FlowAcute
Ambulatory Amalga
• Registration
• Appointments/Schedules
• Admission
• DischargesHIE
• Admission
• Discharges
• Registration
• Lab
• Rad
• ED
CRM
Claims 13,000 +
CBHM’s Dashboard
Alert Module
Patient List
Contract Management
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Event #664 627 633
Sample of Participants in the Virtua HIE• Virtua Hospitals• Virtua Medical Group (+300 physicians and NPs)• Children’s Hospital of Philadelphia (CHOP)• Kennedy Health System• Marlton Rehabilitation Hospital• Genesis HealthCare• CareOne• CVS• Quest Diagnostics• LabCorp• South Jersey Radiology Associates• Larchmont Imaging• RxHub/SureScripts• Regional Cancer Care Associates• Meetinghouse Physicians• Several Other Private Physician Practices
As of Jan. 2014, over 700,000
unique patients are represented in the
HIE’s dataset
47
1. ADT (Patient Demographics)2. Problems3. Allergies4. Medication Orders5. Family History6. Social History7. Immunizations8. Procedures9. Vital Signs10. Encounter Documentation (Practice EMR)11. Lab Orders & Results12. Radiology Orders & Results13. Discharge Summaries & Transcribed Reports14. RxHub/SureScripts
Data Available in the Virtua HIE
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• Care Coordination functionality• Growth of existing Health Information Exchange• Care Management & Engagement tools for Care Managers/ACO
• Expansion of Clinical Analytics• Predictive modeling• Extensive measurement of outcomes
Major IT investment projects now underway
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Event #664 627 633
• Tele-health• Expansion of Home Monitoring – 500 new devices• E-Visits technology
• Personalized & social-media-based communication• New Patient Portal for 2-way communication• www.VirtuaBroadcastNetwork.com
Major IT investment projects now underway
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Event #664 627 633
ACO & The CIODamon Auer, VP of Healthcare, Tribridge
the Personalization of Care
ACOs and the CIO
Who’s Tribridge?
team members
customers
years in business
Microsoft Partner of the Year
customer satisfaction
6503700
+15
98%
4X
What if
healthcare services were
patient-centeredand
personalized?
Enabling proactive
patient engagement
and care coordination
for your ACO …
… and a personalization
platform for your healthcare
enterprise
Manage ACO Members/Contracts/Performance
Manage Patient and Provider Relationships
Engage Patients in their Care Plans and Compliance
Manage Transitions of Care
Proactively Manage Readmissions
Personalize the Care Experience
“Our ACO initiative is enabled by several
technologies…we chose Tribridge because
they have a vision for coordinating care that
aligns with ours, as well as deep experience
with Microsoft Dynamics CRM …”
Al Campanella,
Executive VP, Virtua
www.tribridge.com/CareCoordination
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Event #664 627 633
Q&AClick on the Q&A panel located in the lower right corner of your screen,
type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
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Event #664 627 633
Thank You!
• You will receive an email when our archive recording is ready. (Separate registration is required)
• Thanks to our sponsor: Tribridge!
• Don’t Forget To Claim Your CHIME CHCIO Credits – Attending healthsystemCIO.com Webinars = 1 CEU
• Questions/Comments – Anthony Guerra [email protected]
Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see the last 12 months of archived events.