As the shift from volume-based to value-based payment models evolves forward in healthcare, the connection between reimbursement and clinical performance is becoming increasingly explicit; and some pioneering patient care organizations are using advanced tools to help them improve clinical performance and patient outcomes. One that is actively doing so is Health Quest, a four-hospital health system based in New York’s Hudson Valley. The LaGrangeville-based Health Quest Health Quest was formed through an affiliation of four hospitals: Northern Dutchess Hospital (Rhinebeck, N.Y.), Putnam Hospital Center (Carmel, N.Y.), Sharon Hospital (Sharon, Conn.) and Vassar Brothers Medical Center (Poughkeepsie, N.Y.). Health Quest also includes affiliated healthcare providers Health Quest Medical Practice and The Heart Center; and is a partner with long-term care facilities, a free-standing radiation oncology center, urgent care centers, a multi-specialty medical practice, and a home care service, all in the area.
In their journey forward, the leaders at the Health Quest integrated system have been partnering with the professionals at IBM Watson Health (Armonk, N.Y.), leveraging artificial intelligence and other related tools provided by IBM Watson Health, to help them achieve their goals. As described in a recent case study provided by that company, “A not-for-profit, four-hospital health system with locations throughout Connecticut and New York’s Hudson Valley, Health Quest has plunged headlong into quality improvement initiatives, participating in the Patient-Centered Medical Home (PCMH), Merit-based Incentive Payment System (MIPS), and Comprehensive Primary Care Plus (CPC+) programs, as well as a number of the Healthcare Effectiveness Data Information Set (HEDIS) performance measurement programs administered by private health plans. In committing to these programs, Health Quest agreed to make its Medicare and health plan reimbursements contingent upon hitting certain clinical, financial and patient satisfaction performance thresholds throughout the health system. MIPS, for example, assigns payment based on how well providers perform against national peer benchmarks on six quality measures. To succeed, practices are assessing their opportunities to improve on these measures which may lead to proactive management of chronic conditions, and/or assigning responsibility for individual patients to care teams. That incentivizes health systems to take a population view of the health of the people for which they care. But in order to deliver on these goals, hospitals and health systems need to know where they stand today and how they are performing on an ongoing basis. That means developing an integrated quality dashboard that provides detailed insights into an organization’s performance on specific quality measures for the entire population, individual provider performance, and the care gaps that need to be addressed for individual patients. By developing this type of scorecard, providers and quality managers are able to compare performance across the organization relative to targets and benchmarks to accurately determine the current state of play.” Health Quest leaders have been leveraging the Watson Health suite of population health management solutions to consolidate disparate data from across practice and departments, in order to identify gaps in care, track individual touchpoints, and refine their care processes to improve population health organization-wide. According to that case study, “ Health Quest closed gaps in care, generating $3.7 million in total billing revenue; received a final MIPS score of 93.32 out of 100, resulting in a 1.65 percent payment bonus in year 1 and met the care management requirements of CPC+ Track 2.”
Recently, Anthony D’Ambrosio, M.D., who practices family medicine at Health Quest’s Fishkill location, and who is among the clinician leaders of the initiative, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, regarding the initiative, and what’s been learned so far on the journey around leveraging business and clinical intelligence tools to turbocharge progress in this important area. Below are excerpts from that interview.
Tell me about Health Quest’s involvement with IBM Watson Health, and the context of that involvement?
We began by working on quality reporting, focusing initially on individual diabetic and hypertension metrics, and MIPS measures. We’re involved in the Comprehensive Primary Care Program with CMS, and we’re using IBM for our quality reporting. We’re in year 3 of the Comprehensive Primary Care Program. And for five years prior to that, we were in the original CPC, now it’s called CPC Plus.
What are some of the key reporting issues that you and your colleagues have been working through?
The biggest issue we all have continues to be getting timely, accurate data. Getting data directly from EHR [electronic health record] systems—we try to do that, but it’s often not timely. With IMB, we get updated quality dashboards every week. In our old EHR systems, we relied on the EHR vendors, and we can update our reports ourselves weekly. We’re in our third year with IBM, too, as far as reporting. This is the third year we’re using it.
What has your journey around the data been like?
Originally, our reporting was connected to the meaningful use program. We originally attempted to do that out of our EHR system, and then the PQRS reporting got merged into the MIPS reporting; and we were medical home-certified. And all the private insurers are also involved in quality measure reporting.
Understanding your data, being able to report it accurately and use it for performance improvement, are clearly key, correct?
Documentation and workflow issues are always present. You’ve got to order a lab, say. And what do you about the things that you don’t actually do? Some goes for a mammogram, for example. If something comes into my system electronically, I can count it, but if it sits outside our system, what do I do? If paperwork that comes in that can be scanned, I can report it. So IBM helps us pick up all sorts of data.
Does your organization have a CIO or CMIO, on the physician group side?
We had a practice transformation team that encompassed data analysts and quality leaders. And we had IT trainers who fell under us, who crunched and built data. And we had people, including myself, who would go out and in effect retrain physicians, if we had workflow issues. We do have a CMIO, but more for the system, so that person really didn’t get involved with our outpatient reporting system; it was really myself, as the chief quality officer, at the time.
What have been the big transitional and process challenges?
There are so many different quality programs we’re involved in, and everything requires some kind of reporting; so it depends on how you package it. We’ve packaged the entire thing—not just patient-centered medical home or CPC-Plus or MIPS, we package it as a global population health approach. And we’ve found that by doing that, we make it more understandable. And we get physician buy-in. But that requires new ways of documentation, and that requires physician buy-in, and staff buy-in, too, including from nurses.
And can you drill down on the governance and management structures involved?
We had a quality committee and an EHR committee; and both of those committees report to our physician practice board. So it was between the quality committee and the EHR committee.
What has been the representation on those committees?
It’s mostly physicians, along with some advanced practice providers. So it’s clinicians, and it’s always run by clinicians; and there’s always an administrator assigned to each committee.
How have your committees handled the policy transitions involved?
We’ve handled it on a team level and brought in our chief operating officer and chief medical officer, to govern the process. And the committees meet monthly, and they get things approved by the medical group board.
What have some of the hardest challenges been, in all that?
The hardest challenge is keeping up with everything. CMS makes their changes at the end of the year, but then sometimes additional changes are added, or there are changes with vendors when you’re in the new reporting period. But in general, getting physician buy-in, and changing workflow, those are always challenges.
How have you made reporting and measurement optimal inside the EHR?
Originally, we worked inside our regular EMR, and they had a process that we trained on. We just switched over to an EMR, and from the very beginning, we built our workflows from scratch, around quality. And we don’t have a quality training manual. But there’s a lot of training that goes along with these processes, and we post those training guides, we post everything for our practice—minutes, updates, training times, etc.
What is the hardest thing for practicing physicians to do?
There are a lot of things that we report on. Initially, we focused on a lot of measures, but now with CPC Plus, we focus on a small number of important measures. When there are multiple quality items to focus on, it becomes overwhelming. And we do a pretty good job of helping the nurses and other things, to address them. For example, asking about smoking cessation, the nurses are prompted to document into the system, or around falls, for example; someone has to document.
How does working with a vendor like IBM Watson Health make things easier for you?
Getting data from outside the system, I could never do that before, but now we can scan data from mammography reports, for example, and get them into the system. And because we update the system week to week, we can check data week to week, and can trend data, for example, over the last year, and can look at individual providers and officers, so we have a spread things over the next year and beyond.
How will things evolve forward in the next few years?
Some people are realizing that you need to v-for-service-oriented, but that is shifting nationally towards shared savings and at-risk payment.
What advice and lessons learned would you like to share with healthcare IT leaders?
You need good partnerships with your EHR vendors and outside vendors, but you also need good relationships with your clinician staff and leaders. We had done a pretty good job of that; we had pretty good relationships, where we were acting more like a team. We really try to be more team-based in general, and if you don’t take that approach, that’s where you run into problems getting into buy-in. So it’s about these approaches and working together.
How do you see data analytics evolving forward in the next few years, as organizations like yours move forward into value-based care delivery and payment?
It will probably go more into the artificial intelligence space; right now, it’s still based on structured data, where you’re looking for specific items in the EHR, to do reporting. And where it’s moving is that you need technology that will basically read through your notes. The technology needs to be able to go through what’s there and pick up on what you’ve done in your regular documentation, versus having to point and click and add in certain fields.
