ACO & The CIO A Complimentary Webinar From healthsystemCIO.com - - PowerPoint PPT Presentation

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ACO & The CIO A Complimentary Webinar From healthsystemCIO.com - - PowerPoint PPT Presentation

Oct 03, 2022 581 likes •1.19k views

ACO & The CIO A Complimentary Webinar From healthsystemCIO.com Sponsored by Tribridge Your Line Will Be Silent Until Our Event Begins Thank You! Slide Deck: http://goo.gl/e7OiPZ Webex Support 1-866-223-3239 Event #664 627 633

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Slide Deck: http://goo.gl/e7OiPZ Webex 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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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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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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ACO & The CIO

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Background

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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

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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.

Values

Integrity 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

Quality

Achieve 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 Health

Improve 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 2012 2008 2009 2007 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 Back ackdrop to an any y Healt althcare Tal alk: H Healt althcare Reform

. . . Ar Are we e on

  • n div

diverging or

  • r converging pa

paths?

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The Challenge We All Face Today……

Cost Quality Access

. . .

. Ba Balancing cost, quality ty and acc ccess

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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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  • 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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Tran ansformin ing Car are - A Coordin inated 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

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Vir irtuaCare Today – Contracts wit ith payers

Self-Funded Health Plan for Employees & Dependents Medicare Advantage Care Coordination Services Third-Party Claims Administrator

13,700 lives 1,600 lives 17,000 lives 12,500 lives

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Vir irtuaCare: In Infrastructu ture

  • 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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Co Communit ity-Based Healt lth Manager (C (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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Reportin ing - 3-Year Perio iod

  • 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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Information Technology

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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 Data Dentist Office EMRs Commercial Pharmacy Data Diagnostic Imaging Centers

Health Information Exchange

State Registries Other HIEs

Sample of Virtua information systems

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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

CCD

Analytics Clinical, Financial & Claims data Foreign Risk

  • Strat. Claims

data * Framework for stratified data, CRM, and Rules/Guidelines across system

MPI matching MPI matching Opt in/out Mngt. Cohort Mngt. CRM Portal for POC personnel

Outside CCDs Care Coordination Protocols/Templates

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Care Coordination Platform

Amalga (clinical data) Data Marts & Cubes – Refreshed regularly

Soarian EDIS Picis OR Invision Docu Mgt Next Gen Misys Compu- data Pharmacy Lab GE IDX Other Other Other

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 Other SQL Tables

Access-Nav System Claims Data Telemed Data

Other

Telemed Data

SQM (Soarian Quality

Measures)

Quality Dashboards

Community Physician Data

Patient Portal

Home Device Data Third-Party Data (Lab, Rx, LTC, etc.)

Virtua’s New IT Landscape

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Acc ccountable le Car are Organizatio ion

ACO – Overall Workflow & System Diagram

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ACO Workflow Version 1 – circa November 2012

The Virtua ACO

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The Virtua ACO

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The Virtua ACO

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  • 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Slide Deck: http://goo.gl/e7OiPZ Webex 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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Acc ccountable le Care Organizatio ion

Information 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

1 1 2 2 2 3 3 4 4 6 6 9 10 11 11 11 14 15 17 19 22 24 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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CRM Data Flow

Acute Ambulatory Amalga

  • Registration
  • Appointments/Schedules
  • Admission
  • Discharges

HIE

  • Admission
  • Discharges
  • Registration
  • Lab
  • Rad
  • ED

CRM

Claims

13,000 +

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CBHM’s Dashboard

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Alert Module

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Patient List

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Contract Management

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Sample of

  • f Par

articipants in in th the Vir irtua HIE IE

  • 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,

  • ver 700,000

unique patients are represented in the HIE’s dataset

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47

  • 1. ADT (Patient Demographics)
  • 2. Problems
  • 3. Allergies
  • 4. Medication Orders
  • 5. Family History
  • 6. Social History
  • 7. Immunizations
  • 8. Procedures
  • 9. Vital Signs
  • 10. Encounter Documentation (Practice EMR)
  • 11. Lab Orders & Results
  • 12. Radiology Orders & Results
  • 13. Discharge Summaries & Transcribed Reports
  • 14. 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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  • 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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ACO & The CIO

Damon Auer, VP of Healthcare, Tribridge

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the Personalization of Care

ACOs and the CIO

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Who’s Tribridge?

team members customers years in business Microsoft Partner of the Year customer satisfaction

650 3700

+15

98% 4X

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What if

healthcare services

were

patient-centered

and

personalized?

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Enabling proactive patient engagement and care coordination for your ACO …

… and a personalization platform for your healthcare enterprise

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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

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“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

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www.tribridge.com/CareCoordination

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Q&A

Click 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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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 aguerra@healthsystemCIO.com

Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see the last 12 months of archived events.