Quality Centered Patient CareA New Strategy to Patient Centered Care

With the healthcare industry only growing, and the payouts moving away from volume and toward value based, it is going to be key that analytics and data management be at the forefront of all medical organizations. Organizations need the knowledge of all high cost, high risk patients and the ability to keep track of quality measures throughout the year, all while tracking every individual patient directly down to the patient level. These three benchmarks are only a snippet of what needs to be done in order to help your organization make money and make your life easier in the process. This can seem like a daunting task, but with the right analytics platform, it is not. The main problem faced by organizations is that many companies are moving forward with an analytics platform without having the basics (infrastructure, interoperability and IT leadership) in place. This leads to a serious lack on Return on Investment in the healthcare realm. To be profitable, an organization’s platform needs to focus on the Triple aim, Quality measures set by CMS, and Data Liquidity.

THE TRIPLE AIM In 2008, Donald Berwick and colleagues wrote an article called “The Triple Aim: Care, Health, And Cost”. This article defines the three opportunities that are going to better the healthcare industry as it moves forward. Those aims are improving the experience of care, improving the health of population and reducing per captia costs of health care. The great thing about each of these opportunities is that they are interconnected. When one improves, the other two may improve. But when one declines the other two may just

as soon decline. 8 years after this article was written we have yet to perfect these aims. It seems as though we know the problem, but we have just found the answer. The answer is analytics, but it must be analytics that track every one of these aims and more. With CMS looking to shift Medicare to value based care rewards from (around 30% in 2016 to 50% in 2018) it is imperative that organizations have an analytics platform that is tracking everything down to the patient level. Now why would an analytics platform need to focus on this? That is for providers to worry about right? Wrong! Providers need to show that they can take action based on the data presented, but it is key to have the proper data sent to the doctors. This is where Quality Centered Patient Care comes in. In order for patients to be cared for properly, there first needs to be a downstream flow of data for the provider to access. In the healthcare world, population management software has been able to point you in the direction of patients, but never right to the patient. To start a proper Provider/Patient dialogue, you need proper patient data. Patient centered care is one thing, but, just like providers, patients are human and cannot relay 100% of the correct information 100% of the time, which leads to much greater problems. This is really where you can increase the experience of care. When a patient does not have to think about what medication they are on, or when they were last given a physical etc. when they get to the doctor’s office, you are going to have a happier patient. The data flow will allow for you to pin point the sickest and most expensive patients,

hopefully allowing for a reduction in costs. It just simply is not enough to know that you have 1000 diabetics, your analytics platform needs to know that Mrs. Smith is a diabetic, with 3 comorbidities, has to be tracked throughout the year on certain quality measures, is on 5 medications, (2 of which she doesn’t need) her average cost per visit is X, her total cost is Y, etc. An analytics platform in this day and age needs to do that and a lot more. In order for your organization to make shared savings, and properly care for its patients, you need to have data at the top flowing down. We are entering the arena where one patient can mean more than one thousand patients and where a patient needs to be known by name in order for your organization to succeed. Patient centered care starts with quality centered care.

QUALTY MEASURES Quality health care is a high priority these days. Quality health care is “the right care for the right person at the right time, the first time.” In this day and age, we are seeing more and more underuse, overuse and misuse of health care services. There are around 120,000 readmissions per year because of adverse drug events not caught by providers. There are around 700,000 emergency department visits each year and the health of millions of Americans is in danger because they either receive care that is unnecessary or don’t receive the necessary care. An estimated 98,000 people die each year due to medical errors. The list goes on. This leads to overuse of tests and procedures that are not required that can put the patient in further danger. These issues are not only costing money for your organization, but costing the lives of many.

We need to start treating every patient like our mother. If it was my mother in my office, I would want to know everything about her. I would not walk in ask a few questions and walk out. I would take my time, I would look at the data and I would come up with a care plan that would save her life. I would not want her to have an adverse event or end up in the hospital because she wasn’t tracked properly. I would make sure

I was on my P’s and Q’s and every little bit of information was treated with such diligence that there was no doubt that she would have the best treatment humanly possible. That is value based care. That is quality health care. Treating every patient like your mother is not only going to put money in your pocket, at the end of the day it is going to save lives. The problem here is that what I just mentioned seems like a story more than reality. The sad truth is that it is just a story now. We have the answer and the answer

is analytics and population health software that tracks the patient’s every move. The analytics need to ensure that a doctor is providing recommended screenings, explaining his or her treatment options and increase the overall rate of survival. This all starts with data. The use of quality measures in healthcare is essential to ensuring that the patient experience is improving and more importantly, that the quality of care is improving. It is not enough to just maintain your quality because in reality, your quality is not good enough. A proper analytics platform tracks these measures and tracks the providers. Providers may face financial penalties or have payment bonuses withheld if they cannot meet these quality benchmarks. The provider incentive programs are not paying for volume of care, they are paying for the quality of care. That means if you spend 2 hours on one patient that

has the best care possible in this day and age that is better than spending 5 minutes with 22 patients who end up back in the hospital. With that said, in 2014, 92 ACOs received Shared Savings for a grand total of $341 Million. In 2013, 58 ACOs received Shared Savings for a grand total of $315 Million. Now when you see that, you see that not only did the number of ACOs that improved increase, but so did the payout. What I see is a large discrepancy in quality. Some would say I have a glass half empty mentality. You see CMS incrementally increased the amount of quality measures required to be tracked by ACOs year after year. Medicare ties ACO financial performance to zero measures in year one; 19 measures in year two and all 33 measures in the final year. In year one, none of the measures had to be reported. In year two, 19 of the measures had to be reported. In year three, all 33 quality measures needed to be tracked and reported by the ACOs. In order for ACOs to receive full credit for a measure, they need to be above the 90th percentile. Not one of the top ACOs ranked in the 90th percentile, which means quality was less than expected and money was left on the table. In fact, Medicare reduced financial rewards for 65 ACOs by $41 Million based on quality mea-sures. So that $341 Million should have been at least $382 Million. If your analytics platform doesn’t track Quality Measures, then drop that platform and find one that does.

CONNECTIVITY Data Liquidity. Which has turned into a buzz word in the healthcare industry. The truth is that this new technological age is allowing providers to collect data and analyze it from anywhere at any time. This in turn should improve outcomes and improve the health of the patients involved. Data liquidity is defined as the ability of data to flow throughout the healthcare system easily and securely. This makes the information needed to be easily accessible to providers, payers and even patients. The problem with this is that not only is it unrealistic to have providers open up their entire patient portal to an organization, but the organizations are receiving unneeded data from everywhere that they are not prepared to

manage. For an organization to be successful, you need to have a multi directional pathway that distributes information; but not just any information, rather it distributes only needed information. Think about an ACO for a minute. Let’s say there are 20 providers in the ACO, which could mean a possibility of 20 different EHR systems. When we talk about interoperability and connectivity, that right there really doesn’t sound like it. The goal is to have an analytics system that can connect each and every EHR onto one platform. There needs to be a focus on the consolidation of unstructured data that allows your platform to act as a central repository. This will improve the interoperability of data within an organization and further drive the exchange of data across health systems. Sounds impossible? Wrong. Your analytics platform does not need to connect to every EHR and doesn’t need to get every single bit of information from the EHR. What the platform needs to do is take in information without connecting to the database.

There is no reason that a doctor should open up his entire EHR; that would be extremely dangerous to the data involved. In this day and age, to keep data safe and to save money, you send what you need and then sign off. It takes 20 seconds and it is completely safe and HIPAA compliant. That is the goal when you hear interoperability. The goal shouldn’t be to create a common EHR, but to produce a properly operated Health Information Exchange that shows all data needed to the decision

makers. There are too many negative theories on data connectivity and it is the job of the software architects and the Health IT teams to get it right. It is the job of the ACO to integrate the data and information into their system, but it is the job of Health Analytics teams to build a platform that truly allows what I have talked about today. Connectivity and Interoperability are not just buzzwords, they are necessities for the healthcare industry.

HALOSThe goal of this paper is not to seem like a fairy tale, but to open your eyes to a new wave of IT that can really affect the way the healthcare industry operates. There needs to be a new wave of IT centered on quality based care. The beginning of this care starts with the data that flows through an organization. This data MUST track all quality measures, give knowledge of all high risk and high cost patient activity, guide future patient care through electronic patient history, and most importantly coordinate ALL care down the patient level.

To truly reach Quality Centered Patient Care, you need to have a platform that allows for it. One that seeks quality over quantity. A platform that betters the health of others from day one. Data is what saves lives. Information on a single platform accessible to your organization is going to be what saves you money.

HALOS is a proprietary system that systematically analyzes and manages actual patient data. The system pinpoints high risk/high cost patients and their activity to allow a provider to intervene before a medical event, hospital admission or an unnecessary cost occurs. HALOS currently tracks all quality measures set by CMS. This in turn allows for ACO’s to track all patients at an even deeper level, leading to total patient wellness, as well as maximizing your Shared Saving.