How to Use Technology to Create Value

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How to Use Technology

to Create Value

David Kaelber, MD, PhD, MPH, FAAP, FACP

Chief Medical Informatics Officer The MetroHealth System

Amy Kramer, Pharm D

Senior Manager, Clinical Pharmacy Services HealthSpan

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Disclosure

Presenters reported no financial interest relevant to this presentation

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Objectives



Summarize the concept of value based health

care and ACOs.



Explore the role of EHR technology to report and

close care gaps especially.



Identify a new strategy to bring back to your

systems to enhance value based care.

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Outline



Introductions

 Who you are and affiliation

 What you hope to get out of this session

 Any example of health information technology to create value (optional)



Overview of Healthcare Value



Healthspan Examples



MetroHealth Examples



Value and Technology Take-home Points

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Outline



Introductions



Healthspan Examples



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Healthcare Value

Value = Quality/Cost

(maximize quality; minimize costs)

(how do we measure quality; how do we measure cost)

“Magic Quadrant”

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Payers Moving to Value



Payers starting to collect/look more closely at quality



Payers moving towards “pay for performance”



Measures consolidating and aligning (HEDIS, NQF, NCQA) Hospital Inpatient Quality Reporting Program PQRS CHIPRA ACO

MU

ACO – Accountable Care Organization

CHIPRA – Children’s Health Insurance Program Reauthorization HEDIS – Healthcare Effectiveness Data and Information Set MU – Meaningful Use

NCQA – National Committee for Quality Assurance NQF – National Quality Forum

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Outline



Introductions



Healthspan Examples



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Pop care at Healthspan



Lab outreach (Mychart, letters, IVR)



Focus on delinquent labs



A1c, LDL, MAU, BMP



4 LPNs



Disease management



( focus on DM control)



PharmD x 4



RNs

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Epic population care

(Healthy Planet)



Registries



Reporting workbench



Bulk Orders



Bulk Communication



Track Outreach

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Actionable Report



Follow up on individual patients or groups of

patients.



Review a patient's chart or open an

encounter to place an order for a patient.



When following up on several patients,

contact them all, or place a bulk order for a

procedure they all need.

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ACO: Diabetes Measures



A1c < 8 & within 12 mos



LDL < 100 & within 12 mos



BP < 140/90 & within 12 mos



No tobacco use



ASA/antiplatlet/anticoagulant/ASA allergy

 Among those w concurrent ischemic vascular disease [IVD]

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Diabetic Provider Level Report

Mem bers AIC <8 <100 LDL BP <140 /90 No Toba cco IVD on ASA D5 Aggrega te Score H/M Stati n > 40 D5* Aggregat e Score 179 69.8_% 69.3_% 75.4_% 87.7_% 92.1_{% 38.0%} 80.3_% 39.1% 133 66.2_% 66.2_% 86.5_% 86.5_% 90.0_{% 30.8%} 81.0_% 35.3% 89 68.5_% 61.8_% 75.3_% 85.4_% 95.5_{% 25.8%} 77.0_% 36.0% 296 76.0_% 65.5_% 78.0_% 85.8_% 91.3_{% 32.8%} 75.6_% 37.5% 8 50.0_% 25.0_% 75.0_% 100.0_% 100.0_{% 25.0%} 66.7_% 37.5%  Members: # of diabetics

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Outline



Introductions



Healthspan Examples



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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.

MetroHealth

• 1999 - Epicare (w/ Cadence, Prelude, and

Resolute)

• 2004 - ASAP

• 2009 - Inpatient Epic (w/ Willow)

• 2011 - CareEverywhere, e-Rx, MyChart

• 2012 - Epic Enterprise Contract, MU 1

• 2014 - ADT, Bedtime, OpTime, SBO

• Current Version – 2012 IU3

1st_{public healthcare system in the US to}

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Adolescent Immunization Reminders

26% 74%

Immunized Not Immunized

26% of adolescents messaged received at least one overdue immunization

(Need to message 4 adolescents to immunize 1) (~$0.50 to bring one person for immunization)

37% 47% 16% Texting Calling Post-cards

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Referral Completion

Consults/procedure orders written yesterday

not completed or scheduled today.

After 12 months (2/2012-2/2013) the 30-day consult and procedure completion/schedule rate

went from 48% to:

Answer: 61%

~6700/month additional initial consults (61,939) and procedures (18,936) completed/scheduled (and

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Personal Health Records

MetroHealth uses patient entered: • Weight

• Blood Pressure • Blood Sugar

MetroHealth shows preventative/health maintenance reminders to patients

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Technology Driven Value Paradigm



Use technology (data and tools) to identify value (↑quality and/or ↓costs) opportunities



Use technology to encourage/automate/self-service higher value activities:



Tests



Visits



Healthier behaviors/outcomes



Screenings/Preventative health services



Use technology to discourage lower value activities:



Tests



Visits

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Hepatitis C Screening – The Future?

CDC and USPSTF (2103) – recommends once lifetime screening for hepatitis C

for anyone born 1945-1965 (estimated 800,000 undiagnosed cases)

1. Data Mining - Use electronic health record data and tools to identify all

patients meeting screening criteria (based on DOB and no hepatitis screening or diagnosis and healthcare provider/system is “medical home”)

2. Automated orders - Automatically generate orders for hepatitis C screening

test on all identified patients.

3. Automated messaging - Automatically message identified patients (personal

health record, text, phone, letter/postcard) of need to hepatitis C screening test and how to get it.

4. Obtain blood sample - Patient comes to lab to have blood drawn.

5. Automated messaging of “negative” results - Automatically message

identified patients (and primary care provider?) with “negative” results.

6. Manual messaging of “positive” results - Route “positive” results to

hepatitis C clinic/providers (and primary care provider?) for personal follow-up with patient.

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Outline



Introductions



Healthspan Examples

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Exploiting Health IT to Improve Health Value!

Using technology to derive value



Data



Tools



People

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NEED OVERALL PLAN!

PLAN WILL BE RELATIVELY UNIQUE IN EACH

HEALTHCARE SYSTEM/SETTING!

Using technology to derive value



Data



Use health information systems to determine the right quality and cost data



Tools



Need the right technology tools to present the data



People



Need the right people using the tools to see the data



Processes



Need right processes for the people using the tools to see the data to realize the value