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Volume to Value : A Path Towards Data-Driven Health Outcomes
Dorothy CucinelliCEO - CBHN
September 26 2019
• Capital Behavioral Health Network IPA, LLC• Parent: Capital Behavioral Health Collaborative
• Started as two IPAs -- 2015• Hudson River United Services (HRUS)- Mental Health• Polaris- Substance Abuse
• Website
www.cbhnetwork.com
• Office location • 255 Washington Ave Extension, Albany
Who we are
CBHN Members1. 820 River St
2. Albany County Dept of Mental Health
3. Catholic Charities- Diocese of Albany
4. Children’s Health Home of Upstate NY (CHHUNY)
5. Columbia County Community Healthcare Consortium
6. Columbia County Dept of Human Services
7. Conifer Park
8. Equinox
9. Hope House
10. Joseph’s House & Shelter, Inc. Troy
11. LaSalle School
12. McPike Addiction Treatment
13. Mental Health Assoc- Columbia-Greene Counties
14. Mohawk Opportunities
15. New Choices Recovery Center
16. Northeast Career Planning
17. Pinnacle Behavioral Health
18. Rehabilitation Support Services (RSS)
19. Rensselaer County Dept of Mental Health
20. Senior Hope Counseling
21. The Addictions Care Center of Albany
22. Transitional Services Association In. (TSA)
23. Trinity Alliance
24. Twin County Recovery Services
25. Unity House
26. Upper Hudson Planned Parenthood
27. Vanderheyden
Service Area
Counties• Albany• Schenectady• Rensselaer• Saratoga• Columbia • Greene• Fulton• Montgomery• Schoharie
CBHN/Healthy Alliance IPA Partnership
• Agreement signed May 2019 • Collaborate on VBP contracting
• Continued support of technology
• Exploring UniteUs partnership for MH/SA referrals
Healthy Alliance
IPA
(Social care services)
CBHN
(MHSA/SA services)
Volume to Value:The Role of Data in Improving Outcomes
James Button, Interim Executive Director, Northwinds Integrated Health NetworkKaren Ashline, Associate Vice President, Adirondacks ACO
Renew MSSP Agreement
Continued Value Based Payment Opportunities
North Country Innovations Pilot (NCIP)
2020- FUTURE
Value Based Payment
Multi-payer ACO
Upside and Downside Risk
Shared Services Agreement with AHI
NYS Approved Request
for State Action Immunity
Northwinds Integrated Health Network IPA
Partnership
2017-2019
2 Year extension for Medical Home Program
Payer Negotiation for future of the Medical Home
Apply to NYS DOH for Certificate of Authority
NYS DOH
Certificate of Authority
2015-2016
Adirondack Medical Home
5 year - Multi-Payer Pilot
2013 - Adirondacks Accountable Care
Organization Formed as Legal Entity
2014 - Adirondacks ACO Approved for 3 year MSSP
contract with CMS
2010-2014
Adirondacks ACORegional Initiatives – Past and Future
ADK ACO Population Health Landscape
ADK ACO
County Footprint
Clinton
Essex
Franklin
Hamilton
Warren
Washington
Northern Saratoga
FFS Medicare
27,000 Patients
500 Providers
Commercial
80,000 Patients
800 Providers
AHI PPS
144,000
Patients
Medicaid: 94,000Uninsured: 50,000
1400 Providers
ADK ACO
Medicare
(MSSP)
NY Medicaid
BSNENY
CDPHP
Empire BCBS
Empire UHC
Excellus
Fidelis
MVP
Population and Providers
Payers
Region
Health Home
3,200 Patients
120 Providers
“To align and integrate services from behavioral health, social care and
physical health providers across the North
Country to assure the highest quality, cost-
effective care.”
Northwinds IPA – Membership & Vision
Northwinds Regional Network & Services• Outpatient MH & SUD Services• MH & SUD Community Housing• MH & SUD Residential Services• Ambulatory & Inpatient Detox• Care Coordination• Transportation• Substance Abuse Prevention• School Based Clinics • Supported Employment • Pharmacy Services
ACO & IPA Collaboration:Building Stronger Community Supports
• Trusted relationships• Peer supports and team based care
• Focus on the whole person • Physical Health• Mental Health• Social Determinants of Health
• Open lines of communication• Real time ability to coordinate team based care
Connecting people to the right supports at the right time in the right settingDecrease in preventable visits – ER and Inpatient
ACO & IPA Collaboration:Data Challenges & Wins
• Payer Participation• Which Measures Matter?• Data Accuracy and Reliability• Limitations of Current Data Platforms• 42 CFR Part 2 Data Sharing• Attribution/Capitation Models• VBP Readiness
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Analytics at CDPHP
Pennie Cuevas, MD, MPH
Medical Director, Clinical Analytics Integration and Quality
CDPHP
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Who We Are – CDPHP
26 365,000+ 825,000+COUNTIES
in Upstate NY
MEMBERSacross all lines of business
PROVIDERSthroughout the country
Physician-founded, not-for-profit, mission-driven
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CDPHP Products
Capital District Physicians’
Health Plan, Inc.
CDPHP Universal
Benefits,® Inc.
Capital District Physicians’
Healthcare Network, Inc.
• HMO
• HDHMO
• Healthy NY
• Medicare Choices (HMO)
• Medicaid
• HARP
• Child Health Plus
• Essential Plan
• PPO
• HDPPO
• EPO
• HDEPO
• CDPHP Shared Health
• Medicare Choices (PPO
and Med Supp)
• CDPHP Student Plans
• ASO
• HRA, FSA, HSA
• Practice Support Services
✓ Acuitas Health
✓ Strategic Solutions
• Healthy Direction
17
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Awards and Recognition
NCQA's Health Insurance Plan Ratings 2018 - 2019Capital District Physicians’ Health Plan, Inc. – Medicaid (HMO) – 4.5 out of 5
Capital District Physicians’ Health Plan, Inc. – Medicare (HMO) – 4.5 out of 5
Capital District Physicians’ Health Plan, Inc. – Commercial (HMO) – 4.5 out of 5
CDPHP Universal Benefits, Inc. – Commercial (PPO) – 4.5 out of 5
Capital District Physicians’ Healthcare Network – Self-Funded (PPO) – 4.5 out of 5
Capital District Physicians’ Healthcare Network Commercial (HMO/POS) – 4.5 out of 5
CMS Star Ratings*CDPHP Medicare Choices HMO: 4.5 out of 5 stars
American Heart Association 2018 Workplace Health Achievement – Gold Level
* Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the
next. The HMO plan is offered to individuals and employer groups; while the PPO plan is offered through employer groups.
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Awards and Recognition – U.S. News & World Report
• Award based on CMS STAR ratings• Reflects the CDPHP commitment to
o Qualityo Serviceo Health and wellbeing of our
members and the community
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Measuring Quality
Care received
Claim submitted
Quality metric
evaluated
Metrics benchmarked and reported
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Data Limitations
• Limited to diagnosis, procedure
• Heterogeneous
– Provider variation
– Member/product variation
• Lack patient centered outcomes
– Lab/test results
– Pain/function/quality of life
The Role of Data in Improving Outcomes
Volume To Value PCP/BH Breakout SessionSeptember 26, 2019
Brian D. Litz, MBAH Maria Gutin, MPHSr. Consultant | Practice Intelligence Analyst | Practice Intelligence
Agenda1. Who Is Acuitas Health?
2. The Reality of Big Data
3. Use Cases
4. Solution Deep Dive - Using Data To Improve Patient Care
Who Is Acuitas Health?
•Acuitas Health is an independent value based health care services organization that was founded through a unique partnership between two of the leading health care organizations in the Capital Region of New York: CapitalCare Medical Group, LLC (CCMG) and Capital District Physicians' Health Plan, Inc (CDPHP).
•People, process and technology.
•Support evolution and success in value based health care.
•Support customers by preparing them to engage in value based payment arrangements.
Who is Acuitas Health?
To empower physicians to make the transition to a value-based delivery
system and catalyze and support the evolution of primary care.
What Is Our Mission?
Our Team • Population Health• Provider Engagement• Practice consulting &
education• Clinical and Financial
metric monitoring• Analytics/Workflow
Integration
• Chronic Disease Management
• Prevention• Outcomes that Matter
to Patients
• Data Discovery & Analysis
• Advanced Analytics• Risk Modeling• Machine Learning
Practice
Intelligence
Data Science
Outcomes
Products• Product Development• Product Management• Project Management
Our Clients
Payers
Independent
Primary Care
Practices
Health
Networks
MultiSpecialty
Group
Practice
Our value-based care solutions are focused on supporting our community with population health management initiatives for clients throughout the larger Capital Region.
Payer #2, #3,
etc…
(planned)
Our Data Sources...
The Reality of Big Data
The Evolution of Data in Primary Care ● Technological integration in Primary Care
○ Meaningful Use ○ MACRA/MIPS Reporting- ePrescribing, HIE, Patient Portal ○ NYS PCMH ○ Comprehensive Primary Care Plus (CPC+) ○ DSRIP
● What Is The Reality Today?
○ We are using technology, but not to its full potential!
Challenges of Big Data ● Complexity in healthcare results in challenges of focus.
○ Financing continues to shift towards cost savings outcomes for providers/payers. ○ As providers continue to assume risk, there is a need to understand patient population,
predict/monitor both clinical and financial health outcomes.
● Data can come from anywhere and go anywhere!
● Alignment of quality and cost-of-care measures across VBP contracts.
● Big Data continues to broaden the range of data that is important for care delivery. ○ How do we manage large volumes of data?○ How do we reconcile inconsistent data from disparate sources?○ How do we protect patient privacy?○ How do we analyze data to create value?
Data Challenges
Data ChallengesSeptember 2019 HBR article
“An accepted best practice is tying performance metrics to strategy”…
● Metrics are important, but they can drive behaviors.
● Are we focused on the wrong ones?
● What are we really measuring?
● What matters to providers and to their practices?
The Grand Canyon of Data ObstaclesClinicians/Site
Managers/Others:
● What is my cost of care?
● How well am I controlling
Diabetes?
● What is the ROI on this
program?
Obstacles:
● Access
● Interpretation
● Education
● Data Integrity
● Others
Data Sources:
● EHR Data
● Practice Management
System (Financial)
● HIXNY
● Claims
● Other
The Role of Acuitas Health Success in value-based care requires providers of care (clinicians, clerical staff,
executive leadership, etc.) to become as informed as payers.
● Work with a client to help them across that ‘Grand Canyon’ of obstacles to deploy both payer and program agnostic solutions, and more importantly, provide clients with the people, processes and technology that will position them for success.
● It is NOT easy to do○ understand practice’s needs, current operations○ formulate a goal together○ identify potential issues○ formulate a process (what’s our plan to get across)
How Do We Use Data?
1.Solving The Problem of Utilization
Timely
Notification of
Discharge
Hospital Activity
Monitor (HAM)
Application
Real Time Visibility To
Hospital Activity
Hospital
Discharge
Information
Readmission
Risk
Financial
Information Tied
to Hospital
Activity
Integration of
EHR Data
Daily Email
Feed
Aggregate multiple data sources to raise awareness of utilization activity for appropriate follow-up, TOC, medication reconciliation and CM/BH interventions.
1.The Solution
Data Source: HIXNY Feed + Client EHRFor Demo Purposes Only
2. Maximizing HCC Coding Opportunities
HCC Insights
Application
Solutions to Maximize
Coding Precision Based
On Persistent Claims
History
Weekly Tailored
HCC Opportunity
Reports
Inclusion of
Opportunities on
Pre-Visit
Planning Alert
Virtual Monthly
Webinars
HCC Single
Patient
Document
Non-Persistent
Opportunities
Coding specificity is critical to ensure health plans recognize the health status of patients and is a critical feature in measuring financial performance in VBP contracts.
2. The Solution
Data Source: Payer Claims + Client PMFor Demo Purposes Only
3. Measuring Success in Primary Care
Empanelment
Trending
Leading Wisely
Dashboard
Dashboard with metrics
that are important to
primary care.
HCC Persistent
Coding
Hospital
Utilization and
Follow-Up
Revenue Cycle
Metrics
Speciality
Referrals and
Utilization
Practice
Operation
Metrics
HCC Coding Performance
3. The Solution - Dashboard Examples
HCC Coding
Dashboard(one view of the data)
Empanelment
Dashboard(one view of the data)
For Demo Purposes Only
3. The Solution - Dashboard Examples
Hospital Utilization
Dashboard(one view of the data)
For Demo Purposes Only
The Process of Using Data To Improve Patient Care
Solution Deep Dive
PreVisit Planning - The Overview● Important to having effective, well informed visits● Very resource- heavy (multiple people organizing/searching for information)● Information is not always timely● Information could be missing● Information source is varied
○ labs, imaging, notes, etc.
● Need: “I need all of this information at the time of the appointment in an organized, consistent way”.○ Not something Acuitas began working on in isolation; came from clinicians/site
managers
The Need for Meaningful Information
● Huge-scale data dumps. ● Not enough meaningful information. ● Leads to inefficiencies in care process.
Previous Workflow: manual paper, illegible and not integrated into the clinician workflow.
For Demo Purposes OnlyFor Demo Purposes Only
Pre-Visit Planning
Determine the need, outline
requirements
PVP EHR Alert Integrated
Work with DDS- begin work to
understand data sources and
validate internally.
Selection of common metrics
Mock up V1; begin
work with pilot
practices.
Output not as
anticipated; debug
Request to include
immunizations;
developed/validated
Issue with how
measures are
populating; debug
Final PVP Doc complete,
fully validated and vetted
Developed release plan,
educational materials
and resources
Pre-Visit Planner (PVP) “EHR Alert”
● Facilitates pre-visit planning.● Enhanced patient-centered care. ● Identification of health
maintenance opportunities.
For Demo Purposes Only
Lessons Learned ● Process took a total of almost a year of intensive design/development.
● Continuous communication with client/pilots.○ what is important to you?
● It is still not perfect.○ Hixny consent = quality of alerts○ How an order is “closed out” = whether a measure is captured
● Deployed; there is still work to do.○ Education/Training
● Improved operational efficiency: 36-42 hours/week for a practice of 6 providers.
● Transparency to metrics that matter to clinicians.
Let’s Recap
Key Takeaways
● There is a critical need for providers to manage data and become as informed as payers, as payment begins to transition to fee-for-value and providers begin to assume risk.
● Managing/leveraging Big Data in healthcare is not easy.
● Successful design and deployment of solutions requires continuous input from all users.
Questions?
Brian D. Litz, MBAH
Sr. Consultant | Practice Intelligence
518.286.5131
Maria Gutin, MPH
Analyst | Practice Intelligence
Thank You!