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ACOs Not Scaling Well, But Health IT Helps

Posted on March 13, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

ACOs were billed as the next big thing in healthcare, a model which would create economies of scale and tame rising costs of care. In theory, unifying hospitals and doctors into an overarching entity – and creating shared clinical and financial goals – should improve care and boost efficiency.

Of course, creating them doesn’t come cheap. In fact, creating even a modest ACO typically calls for between $1 million and $3 million in capital investment, according to Michael Deegan, MD, who recently developed a course on ACOs for the University of Texas at Dallas. It also takes 18 to 24 months to launch an ACO, Deegan told an interviewer at UT.

But once all of the Ts have been crossed and the Is dotted, ACOs can meet their stated goals, right? Actually, not so much, though health IT can help things along, according to Indranil Bardham, a colleague of Deegan’s at UT Dallas who serves as professor of information systems.

According to an article in HealthcareITNews, Bardhan recently completed a study on ACO performance which concluded that health IT had a measurable impact on their efficiency. The study, which drew on 2013-2015 data from CMS, reviewed the performance of 400 ACOs.

Among the key takeways Bardhan took from his research was that the larger an ACO was, the more likely it was to be inefficient. This flies in the face of conventional wisdom, which would suggest that bigger is better when it comes to improving efficiency.

On the other hand, health IT use had the effect its champions might hope for, though modest in scope. The study concluded that a 1 percent increase in HIT usage was associated with an 0.5 percent increase in ACO efficiency.

The thing is, these measures represent just a couple of ways to evaluate ACO performance, making it hard to tell just what is working, Bardhan told HIN. “Healthcare, with respect to ACOs, is fascinating because there is not just one single output measure that you are using to compare performance,” he told the magazine’s Bill Siwicki. “…It is difficult to measure the performance of organizations against each other when you have multiple outputs that cannot easily be transformed into a single dollar number.”

This squares with commentary by other ACO researchers, who seem to agree that the whole ACO evaluation process is a bit mysterious. As health policy analyst David Introcaso notes, in a review of ACO-based Medicare Shared Savings Program, CMS isn’t helping either. “While CMS details financial and quality performance results, the agency does not explain, at least publicly, how results, favorable or unfavorable, were achieved.”

Without knowing more about what we should measure, and why – much less what steps helped in achieving their results – it’s too soon to tell what type of health IT should be deployed in ACOs. But looked at more optimistically, once we have a better idea of what ACO success factors are, it seems likely that health IT tools will help execs address them. (For a look at one completely health IT-based ACO concept, see this piece on the Virtual ACO.)

Indiana Health System Takes On Infection Control With Predictive Analytics

Posted on February 22, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

At Indiana University Health, a 15-hospital non-profit health system, they’ve taken aim at reducing the rate of central-line associated bloodstream infections – better known to infection control specialists as CLABSIs.

According to the CDC, CLABSIs are preventable, but at present still result in thousands of deaths each year and add billions of dollars in costs to U.S. healthcare system spending. According to CDC data, patient mortality rates related to CLABSI range from 12% to 25%, and the infections cost $3,700 to $36,000 per episode.

Hospitals have been grappling with this problem for a long time, but now technology may offer preventive options. To cut its rate of CLABSIs, IU Health has decided to use predictive analytics in addition to traditional prevention strategies, according to an article in the AHA’s Hospitals & Health Systems magazine.

Reducing the level of hospital-acquired infections suffered by your patients always makes sense, but IU Health arguably has additional incentives to do it. The decision to attack CLABSIs comes as IU Health takes on a strategic initiative likely to demand a close watch on such metrics. At the beginning of January, Indiana University Health kicked off its participation in the CMS Next Generational Accountable Care Organization Model, putting its ACO in the national spotlight as a potential model for improving fee-for-service Medicare.

According to H&HN, IU Health has launched its predictive analytics pilot for CLABSI prevention at its University Hospital location, which includes a 600-bed Level I trauma center and 300-bed tertiary care center which also serves as one of the 10 largest transplant centers in the U.S.

Executives there told the magazine that the predictive analytics effort was an outgrowth of its long-term EMR development effort, which has pushed them to streamline data flow across platforms and locations over the past several years.

The hospital’s existing tech prior to the predictive analytics effort did include an e-surveillance program for hospital-acquired infections, but even using the full powers of the EMR and e-surveillance solution together, the hospitals could only monitor for CLABSI which had already been diagnosed.

This retrospective approach succeeded in cutting IU Health’s CLABSI rate from 1.7 CLABSIs over central-line days in 2015 to 1.2 last year. But IU Health hopes to improve the hospital’s results even further by getting ahead of the game.

Last year, the system implemented a data visualization platform designed to give providers a quick-and-easy look at data in real time. The platform lets managers keep track of many important variables easily, including whether hospital units have skipped any line maintenance activities or failed to follow-through on CLABSI bundles. It’s also saving time for nurse managers, who used to have to track data manually, and letting them check on patient trend line data at a glance.

The H&HN article doesn’t say whether the hospital has managed to cut its CLABSI rate any further, but it’s hard to imagine how predictive analytics could deliver zero results. Let’s wish IU Health further luck in cutting CLABSI rates down further.

Many Providers Still Struggle With Basic Data Sharing

Posted on February 15, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

One might assume that by this point, virtually every provider with a shred of IT in place is doing some form of patient data exchange. After all, many studies tout the number of healthcare data send and receive transactions a given vendor network or HIE has seen, and it sure sounds like a lot. But if a new survey is any indication, such assumptions are wrong.

According a study by Black Book Research, which surveyed 3,391 current hospital EMR users, 41% of responding medical record administrators find it hard to exchange patient health records with other providers, especially if the physicians involved aren’t on their EMR platform. Worse, 25% said they still can’t use any patient information that comes in from outside sources.

The problem isn’t a lack of interest in data sharing. In fact, Black Book found that 81% of network physicians hoped that their key health system partners’ EMR would provide interoperability among the providers in the system. Moreover, the respondents say they’re looking forward to working on initiatives that depend on shared patient data, such as value-based payment, population health and precision medicine.

The problem, as we all know, is that most hospitals are at an impasse and can’t find ways to make interoperability happen. According to the survey, 70% of hospitals that responded weren’t using information outside of their EMR.  Respondents told Black Book that they aren’t connecting clinicians because external provider data won’t integrate with their EMR’s workflow.

Even if the data flows are connected, that may not be enough. Researchers found that 22% of surveyed medical record administrators felt that transferred patient information wasn’t presented in a useful format. Meanwhile, 21% of hospital-based physicians contended that shared data couldn’t be trusted as accurate when it was transmitted between different systems.

Meanwhile, the survey found, technology issues may be a key breaking point for independent physicians, many of whom fear that they can’t make it on their own anymore.  Black Book found that 63% of independent docs are now mulling a merger with a big healthcare delivery system to both boost their tech capabilities and improve their revenue cycle results. Once they have the funds from an acquisition, they’re cleaning house; the survey found that EMR replacement activities climbed 52% in 2017 for acquired physician practices.

Time for a comment here. I wish I agreed with medical practice leaders that being acquired by a major health system would solve all of their technical problems. But I don’t, really. While being acquired may give them an early leg up, allowing them to dump their arguably flawed EMR, I’d wager that they won’t have the attention of senior IT people for long.

My sense is that hospital and health system leaders are focused externally rather than internally. Most of the big threats and opportunities – like ACO integration – are coming at leaders from the outside.

True, if a practice is a valuable ally, but independent of the health system, CIOs and VPs may spend lots of time and money to link arms with them technically. But once they get in house, it’s more of a “get in line” situation from what I’ve seen.  Readers, what is your experience?

ACO-Affiliated Hospitals May Be Ahead On Strategic Health IT Use

Posted on December 26, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the past several years I’ve been struck by how seldom ACOs seem to achieve the objectives they’re built to meet – particularly cost savings and quality improvement goals – even when the organizations involved are pretty sophisticated.

For example, the results generated the Medicare Shared Savings Program and  Pioneer ACO Model have been inconsistent at best, with just 31% of participants getting a savings bonus for 2015, despite the fact that the “Pioneers” were chosen for their savvy and willingness to take on risk.

Some observers suggested this would change as hospitals and ACOs found better health IT solutions, but I’ve always been somewhat skeptical about this. I’m not a fan of the results we got when capitation was the rage, and to me current models have always looked like tarted-up capitation, the fundamental flaws of which can’t be fixed by technology.

All that being said, a new journal article suggests that I may be wrong about the hopelessness of trying to engineer a workable value-based solution with health IT. The study, which was published in the American Journal of Managed Care, has concluded that if nothing else, ACO incentives are pushing hospitals to make more strategic HIT investments than they may have before.

To conduct the study, which compared health IT adoption in hospitals participating in ACOs with hospitals that weren’t ACO-affiliated, the authors gathered data from 2013 and 2014 surveys by the American Hospital Association. They focused on hospitals’ adherence to Stage 1 and Stage 2 Meaningful Use criteria, patient engagement-oriented health IT use and HIE participation.

When they compared 393 ACO hospitals and 810 non-ACO hospitals, the researchers found that a larger percentage of ACO hospitals were capable of meeting MU Stage 1 and Stage 2. They also noted that nearly 40% of ACO hospitals had patient engagement tech in place, as compared with 15.2% of non-ACO hospitals. Meanwhile, 49% of ACO hospitals were involved with HIEs, compared with 30.1% of non-ACO hospitals.

Bottom line, the authors concluded that ACO-based incentives are proving to be more effective than Meaningful Use at getting hospitals adopt new and arguably more effective technologies. Fancy that! (Finding and implementing those solutions is still a huge challenge for ACOs, but that’s a story for another day.)

Of course, the authors seem to take it as a given that patient engagement tech and HIEs are strategic for more or less any hospital, an assumption they don’t do much to justify. Also, they don’t address how hospitals in and out of ACOs are pursuing population health or big data strategies, which seems like a big omission. This weakens their argument somewhat in my view. But the data is worth a look nonetheless.

I’m quite happy to see some evidence that ACO models can push hospitals to make good health IT investment decisions. After all, it’d be a bummer if hospitals had spent all of that time and money building them out for nothing.

Should You Buy Pop Health Tools And EMRs From One Vendor?

Posted on October 17, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

According to a new story appearing in HealthITAnalytics, EMR vendors are increasingly moving into the population health management space. In fact, according to an IDC Research market report featured in the story, the lines between the EMR and population health management marketplaces are beginning to blur, with vendors offering products tackling both documentation and patient management.

While this is not news to anyone who’s attended a major industry tradeshow in the last few years, the extent of the transition might be. Apparently, half of the top population health management vendors featured by IDC – including athenahealth, eClinicalWorks and Allscripts — also offer EMR platforms. (According to HealthITAnalytics, other pop health vendors identified as leaders by IDC include Wellcentive, Medecision, Optum and IBM Phytel.)

Cynthia Burghard, Research Director with IDC Health Insights, says that providers want to integrate patient management and big data analytics to support their ACO deals and meet tregulatory requirements. In an IDC press release, she notes that providers need to manage both clinical and financial outcomes to survive under value-based reimbursement.

While all of this makes sense to me on paper, I’d like to raise a question here. Does buying both your EMR and your pop health tool from the same vendor have a meaningful downside? I’d argue that it might.

Yes, from a high level, buying an EMR and population health management engine from the same vendor is a good idea. In theory, the two are likely to work together more effectively than two platforms from two separate vendors, as there’s unlikely to be any conflict between the purposes of the EMR and the purposes of the population health tool.

But in practice, it’s worth bearing in mind that we haven’t yet evolved a standard feature set or business model for managing patients at the population level (though you might be interested in some of these emerging best practices). So this is a far bigger risk than buying, for example, a practice management tool and an EMR from the same vendor — after all, practice management software has been around long enough that it’s fairly standardized.

On the other hand, if you buy a population health tool and an EMR from, say, Allscripts, you’re buying not only technology but their view of how population health management should be done. And the two platforms are somewhat, for lack of a better word, inbred if they try to cover your entire scope of patient management. Whatever blind spots the EMR may have, the pop health management platform may have as well.

I guess what I’m trying to say here is that while it makes great business sense for the vendors to offer both EMR and pop health products, it’s not necessarily in the provider’s interests to pile both of those products onto their infrastructure. At this stage, I’d argue, it’s worth preserving your flexibility, even if you spend more or have to work harder to develop the business logic you need on the population health side.

But I’m willing to change my mind. Readers, what do you think?

Does Clinical Integration Call For New Leaders?

Posted on October 10, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For quite some time now, U.S. healthcare reforms have been built around the idea that we need to achieve clinical integration between key care partners. Under these emerging models of integration, it isn’t good enough for physicians and hospitals to have a general sense of what care the other is delivering. Instead, the idea is for independent entities to function as much as possible as though they were part of the same organization.

Of course, for these partners in an integrated system to work together, they have to share a great deal of data on a patient, if not necessarily every scrap of their lifetime medical record. In other words, some degree of data integration isn’t “nice to have,” it’s a “must have.”  In fact, I wouldn’t be the first to suggest that without data integration, effective clinical integration is basically impossible.

However, while readers of this publication aren’t ignorant of this fact, my sense is that some participants in such schemes are hoping to jump in with both feet first, and figure out data sharing models later. This is mostly a hunch, but I’m pretty sure it’s happening, and moreover, I’m convinced that the mediocre performance of most ACOs is due to a leap-before-you-look approach to data sharing.

I don’t know if any models exist that emerging integrated clinical entities can use to lay out data pathways before they’re under the gun. But my sense is that we spend too little time figuring this out in advance.

Generally speaking, my guess is that these ACO partnerships and other integrated care projects are being driven by old-school healthcare execs. By this I mean folks who understand very well how to build for cross referrals between entities, forge partnerships that help all hospitals and doctors involved do better in insurance negotiations, know how to negotiate with health purchases such as large employers and the like.

Having followed such folks for some 25 years, I have nothing but respect for their strategic skills. However, I sort of doubt that they are the right people to guide larger healthcare organizations into the age of clinical and technical integration. While they might be very smart, their intuition tells them to hold back data as a proprietary asset, not share it with partners who might be competitors again in the future. And while it’s understandable why they think this way, it’s not constructive today.

Don’t get me wrong, I’m not suggesting that CXOs with decades of experience have suddenly become dinosaurs. There’s still plenty of work for them to do, and most of it is vitally important to the future of the health system. But if they want to be successful, they’ll have to turn their thinking around regarding data integration with partners. And if they can’t do that, it very well be time to bring in some fresh blood.

Population Health Tech Will Lag Until Standards Emerge

Posted on June 22, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

There’s little doubt that healthcare organizations will continue to partner up with peers and acquire physician practices. The forces that drive healthcare network development are only intensifying as time goes by, particularly as the drive toward value-based payment moves ahead. But there’s a lot more to making such deals work than a handshake and a check. To make these deals work, it’s critical that networks become experts at population health management — and unfortunately, that’s going to be tough.

While merging health systems into ACOs or acquiring referring physicians has merit, this strategy won’t grow the steadily dropping pace of hospital admissions, notes William Faber, M.D., senior vice president of the GE Healthcare Camden Group. “Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base,” making it unlikely that the networks will grow admissions, he points out.

To make a clinically integrated network successful, it certainly helps to take the initiative – to get to market more quickly than competitors – and to do a better job of controlling costs of care and demonstrating higher quality and service. Where things get stickier, however, is in managing that care across a large group. “The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management,” he writes.

And this, I’d argue, is where things get very tricky. Well, judge for yourself, but I’d argue that the HIT industry is ill-equipped to support these goals. Despite many years of paper-chart experimentation with population health, and several with population health technology, my sense is that the tech is far behind what it needs to be. Health IT vendors won’t get far until providers do a better job of defining what they need.

A different mindset

The truth is, this generation of EMRs is designed to track individual patients across an experience of care. While CIOs can add a layer of analytics technology to the mix, that is a far cry from creating tools that natively track population health trends. Looking at populations is simply a different mindset.

Admittedly, vendors will tell you that they’ve got the problem licked, but if they were completely candid many would have to admit that their products aren’t mature yet. Until someone creates an EMR or other basic tool which is designed, at its core, to track group health trends, I foresee more half-baked hacks than results.

What’s more, I doubt the health IT business will be able to help until it has at least an informal standard to which such products must adhere. Should such tools measure costs of care by diagnosis code? Compare such costs to national standards? Highlight patients in outpatient settings whose tests or exams suggest a crisis is about to happen? If so, which settings, and what cutoffs should be tracked for test scores? Does such a system need natural language processing to scour physician notes for trigger words, and if so which ones?

Without a doubt, medical and business executives leading integrated networks will come together and develop more answers to these questions. But until they do, health IT vendors won’t be able to help much with the population health challenge.

Hospitals’ Progress Towards Value Based Reimbursement

Posted on June 17, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After posting the value based reimbursement research results that were shared by McKesson Health Solutions in anticipation of the AHIP Institute, I came across this infographic from Health Catalyst about hospitals participation in value based reimbursement.

This infographic illustrates a slower adoption of value based reimbursement, but it does illustrate that pretty much every hospital is participating in value based reimbursement. The other thing that stood out to me in this infographic was how small hospitals are going to have a hard time accessing the capital they need to manage this shift. This should be troubling to those of us in healthcare. Those smaller hospitals play an important role in our healthcare system.

Hospitals Progress to Value Based Reimbursement

An Acronym Look at MACRA QPP

Posted on April 28, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The proposed rule for the MACRA program has been announced. Here’s an acronym laden summary of what MACRA did (Worth noting that CHIP is the C in MACRA for those keeping track of acronyms at home).

MACRA creates a QPP.

MACRA ends SGR

MACRA creates two paths: MIPS and APMs.

MIPS and APMs timeline from 2015 through 2021.

MIPS combines PQRS, VM (or VBPM if you prefer), and Medicare EHR (MU and Certified EHR) into 1 program.

APMs include ACOs, PCMH, and bundled payments.

MU is now ACI.

If you’re not sure about some of the acronyms above, you can find their longer names here. Good thing they simplified and streamlined the various programs!

We’ll be becoming friends with the acronyms MIPS and APMs. Here’s a good summary PDF of MACRA as well. More details to come.

UPDATE: In a bit or irony, Andy Slavitt posted this acronym free video about MACRA:

Value-Based Lawn Care – Life Imitating Healthcare

Posted on March 28, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

Ah, spring. Warmer weather, budding trees and the return of that big ball of light in the sky. The clearest sign of spring? The arrival of lawn-care flyers in my neighborhood. It’s only been a week of spring and already I have received over 15 flyers.

Normally I just throw these flyers out – taking care of my lawn is a responsibility I prefer not to outsource – but this year one company’s flyer caught my eye. Instead of the pay-as-you-mow or weekly visit programs offered by their competitors, this particular company was offering a program that guaranteed a green lawn until the start of fall. For a set price they would aerate, weed, spray, fertilize, cut and trim your lawn as needed.

“Have a healthy, weed-free lawn all summer. Let us do all the preventative and maintenance work. You just enjoy your weekends.”

Here was a company that was eschewing the industry’s volume-based standard practice and opting for a value-based offering instead. This company smartly recognized that homeowners do not want someone to come and care for their lawn on a regular basis but rather a healthy green lawn. The process to get that healthy lawn makes no difference, just the outcome. Funny how no government penalty system or legislation was need to pressure lawn-care providers into adopting a value-based model.

I must admit I never thought that the lawn care industry in my neighborhood would be going through the same volume-vs-value challenge as we are in healthcare.

I wouldn’t have made this connection had it not been for the excellent post by Sarah Bennight, Director of Marketing at eMedApps. She wrote about the four key requirements she believes are necessary for transitioning to value-based care:

  1. Strong quality measures
  2. Comprehensive population health
  3. Predictive analytics and trending in the clinical setting
  4. Breaking down silos

The lawn-care industry doesn’t have any comparable challenges (or consequences) like those mentioned by Bennight. I can’t imagine that competing landscaping companies are all that interested in sharing data or breaking down industry silos. However, I do think that healthcare can look to other industries for inspiration and ideas to address our own transition to a value-based world.

Better go seed my lawn now.