1. AMGA IQL Conference
Advanced HIE Technologies Improve Medical Adherence and Quality Management
Tom Deas, Jr., MD
September 22, 2011

2. Agenda Preparing for accountable care Effective physician engagement
HIE as the cornerstone for ACO
North Texas Specialty Physicians (NTSP)
NTSP physician engagement
Essential HIT elements for ACO
Questions 2

3. Learning Objectives Describe how NTSP engages physicians
Understand the tools physicians need to effectively and efficiently improve patient outcomes
Outline NTSP’s ACO care model 3

4. Accountable Care Transforming the Model of Care
Patient centeredness and engagement
Physician-supported governance and leadership
Integrated technology
Community-wide HIE
Clinical decision support tools
Quality measurement and reporting capabilities
Financial risk management of patient population
Integrated care management for chronic conditions
Case managers
Nurse reviewers
Advanced medical management processes 4

5. Our Patient’s Current Predicament
Patient is here 5

6. Putting Accountability into Accountable Care
Patient-centered care requires that physicians, hospitals, and payers do what is best for the patient
Aligning with other community partners
Engaging across the community to improve outcomes
Breaking down the competitive barriers
Sharing clinical data
Physicians make better clinical decisions with more information at the point of care 6

7. Current Care Model One physician One information silo One problem
The Enemy is “One”
One physician
One information silo
One problem
One point in time
Reward service volume irrespective of quality or medical necessity 7

8. Physician Engagement Integrated care team required to manage:
Needed for Accountable Care
Integrated care team required to manage:
Patient populations
With complex medical problems
Over a continuum of time
Reward higher quality outcomes that eliminate waste and reduce errors/adverse events 8

9. Essentials for Physician Engagement
Strong physician leadership
Champions for HIT adoption and utilization
Voices for other care providers
Clear vision of future integrated care models
Trusted physician governance 9

10. Community-wide EMR and HIE Infrastructure
Essential for Accountable Care
Community-wide clinical and business intelligence
Access to care guidelines and clinical data at all points of care
Effective communication tools
Real time access to clinical decision support and quality measurement tools
Predictive modeling for high risk patients
Population registry and reporting tools 10

11. Importance of HIE in ACO Formation
High Physician Adoption and Utilization 11

12. North Texas Specialty Physicians (NTSP)
About Us
600+ physician-driven IPA in Fort Worth, TX
Capitation management since 1997
Physicians make better clinical decisions with more information at the point of care
Real-time patient information
Information from multiple sources
Enhanced physician communication
Knowledge-based decision support tools 12

13. Geographic Footprint NTSP serves these counties: 13 Pop Hosp Phys
Tarrant 1,809, ,471
Johnson 146,
Parker 116,
Erath 36,
Dallas 2,368, ,389
Tarrant
Johnson
Erath
Parker
Dallas 13

14. NTSP and Accountable Care
NTSP’s IPA provides clinically integrated accountable care supported by a community-wide HIE with point of care decision making tools and guidelines within a virtual structure.
30,000 Traditional Medicare patient base
Build on current core business (i.e. risk model)
Shared governance with hospital partners
Expandable footprint: Medicare, Medicaid, commercial payer
Deliver point of care clinical integration tools
Utilize current HIE infrastructure 14

15. NTSP Methods to Engage and Align Physicians
Develop effective, physician-led governance
Adopt pay for performance incentive programs
Create oversight committees
Medical Management
Medical Executive
Quality Council
Finance Committee
Primary and Specialty Care Divisions 15

16. NTSP Methods to Engage and Align Physicians
Adopt national and internal quality standards
PQRS
HEDIS
Medicare Five-Star
Embed case managers within the patient’s care
Apply predictive models across the risk population
Administer annual patient satisfaction surveys 16

17. NTSP Methods to Engage and Align Physicians
Incent HIT adoption
Subsidize EMR licenses
Hosting and training
Help desk and support
Eliminate information silos with HIE connectivity
Incorporate evidence-based guidelines at the point of care
Implement clinical decision support and other business intelligence tools 17

18. NTSP’s Clinically Integrated ACO Model
Patient
Hospital
Case Manager
Payer
NTSP Division
P4P
Patient Education
NTSP Quality Council
Ancillary Provider
Physician 18

19. Impact of HIE on Patient Care and Cost Efficiency
Office visit: 64 year old woman with chronic liver disease
HIE documented 2 ER visits in the past 2 months, chemistry panels, diagnoses, abdominal US, Head CT, medications, and allergies
Alerted the use of Doxepin
HIE data that was presented prevented the ordering of duplicate diagnostic imaging & laboratory studies
Potential savings attributed to HIE technology:
2010 Medicare reimbursement: $15,191.45
Insurance reimbursement: $24,086.48 19

20. NTSP’s Health Information Exchange
High Physician Adoption and Utilization
1.85 million patients
1,700+ physicians and staff trained
375+ physicians feeding EMR data
65,000 clinical transactions per day 20

21. Essential Technology Elements for Quality Improvement and Accountable Care
Continuity of Care Documents (CCDs)
Secure HIE web portal for non-EMR users
Quality measurement and reporting 21

22. Continuity of Care Document
CCD
CCD: provides a longitudinal healthcare record for each patient in an existing EMR by combining disparate health information – irrespective of the source.
NTSP current vendor footprint:
- NextGen - Allscripts
- eClinicalWorks - Epic
- LabCorp - Quest 22

23. Continuity of Care Document
CCD 23

24. Secure HIE Web Portal Community Impact
Improved decision-making with access to a robust medical history
Enhanced communication among care providers
Better management of chronic conditions
Expedited care delivery 24

25. Secure HIE Web Portal
Connecting the Physician Community 25

26. Quality Measurement and Reporting
Move the Needle on Improving Patient Outcomes
Point-of-care decision support
- Dashboard with quality measures- PQRS, HEDIS, Meaningful Use, Medicare Five-Star, and Ad Hoc measures
Population reporting
Multiple levels of aggregation and periodic reports
Patient registry
- Mining of patient data to assure compliance
Utilization reports
Promote quality focus
Point-of-Care availability
One place to go within current workflow processes 26

27. Clinical and Business Intelligence
Move the Needle on Improving Patient Outcomes
Patient Registries
Track patients falling outside of care guidelines
Quality Scorecard – score a physician’s patient panel on a particular measure
Recommended actions using patient preferences (e.g. secure message reminders)
Clinical Decision Support
Evidence-based care recommendations delivered real-time at the point of care
Based on multiple disease-related parameters and the patient’s medical history across care providers
Population Reporting
Through the lens of HEDIS, PQRI , EHR Meaningful Use, and custom measures
Multiple levels of aggregation (physician, specialty, care delivery organization, payer, etc.)
Prospective
Point-of-Care
Retrospective 27

28. Quality Measurement and Reporting28

29. Quality Measurement and Reporting29

30. Quality Measurement and Reporting30

31. Clinical and Business Intelligence Tools
The Cornerstone of ACO Performance
Sourced by the HIE with information from:
Clinical systems
Claims/payer systems
Financial systems
Case management systems
Designed for use by clinicians before, during and after patients’ visits
Comprehensive clinical data repository enhances accuracy and usability of care recommendations
Assists the ACO’s care providers in achieving measurable improvement in quality 31

32. Clinical Case Study
Effective Use of HIT across the Physician Community
Scenario
Patient visits specialist for autoimmune hepatitis after hospital admission
Valuable HIE data included,
Blood transfusion
Upper endoscopy results
Hospital discharge summary with problems and medications
PCP and specialists
Results
Better clinical management decisions made at the time of care
Patient reassurance
Eliminated need for additional tests
Office report with assessment and care plan was sent real time to her PCP, cardiologist and rheumatologist 32

33. Engaged Physicians The Key to Accountable Care Patient centered
Engaged patients
Strong physician governance and alignment
Population risk management
Care management teams
HIT adoption and utilization
Performance and quality measurement at the point of care
Pay for performance mechanisms 33

34. Questions
Tom Deas, Jr., MD NTSP Board Member