Monday, August 26, 2013

3 quality, coordination lessons from the Beacons

Being able to digitally submit clinical quality measures (CQMs) to Medicare is one of the big promises of health IT for physicians and providers — and it’s still coming, along with other administrative simplifications.
But digital CQMs have been put to good use on the ground by some of the 17 Beacon Communities, the Office of the National Coordinator for Health IT argues in an issue brief. As the ONC and the Centers for Medicare & Medicaid Services finalize novel eCQMs for Medicare, in the areas of clinical care, care coordination and outcomes, here are three lessons from the Beacons on using quality measurements.
1. Beyond billing.
One common complaint from some physicians has been that particularly older EHR software systems are mostly designed for documentation and billing, with analysis tools being limited and not very usable.
Nowadays, providers are increasingly able to put their EHRs to use measuring their patients’ trends and their clinical performance, which can help develop a culture of improvement — providers turning to their data to scrutinize their care quality.
Through the Crescent City Beacon Community, in New Orleans, 17 providers worked with payers, vendors and other partners to start standardizing digital clinical data, with the goal of using the local health information exchange as a source of clinical quality measures.
Before they can do that, the health data is being validated. Data accuracy is especially important in a city where thousands of patients’ paper-based medical histories were lost to the floods of Hurricane Katrina.
The community-wide HIE will eventually be put to use reporting quality measures, offering community dashboards, provider performance and Meaningful Use reports.
The HIE is also currently deploying a software offering the ability to track patients and coordinate their care management across settings.
2. Aligning CQMs with value-based payments.
Much as Farzad Mostashari, MD, has heralded the decline of fee-for-service (often Tweeting #FFSdemise), only a minority of the healthcare services rendered in the U.S. are currently reimbursed through some type of accountable care or valued-based contract.
Still, healthcare made accountable or measured for value is happening, such as in Indiana. Through the Central Indiana Beacon Community’s Quality Health First program, the Indiana Health Information Exchange offers analytics and patient summaries for docs — showing them, for instance, all patients due for preventative screenings — to help them develop intervention and management programs for patients with chronic diseases.
The program helps providers submit Meaningful Use compliance attestation reports, and lets payers access clinical data, beyond claims, to track provider performance and tailor reimbursement. As of January, 114 provider groups representing 2,252 primary care physicians and 1.4 million patients have participated in the program.
3. Building consensus among unaffiliated orgs.
Fee-for-service’s “misaligned incentives” resulted in a culture of health organizations often only reluctantly sharing patient data with unaffiliated providers, if not “hoarding” the data by default, and that’s resulted in poorly coordinated care for some patients being served by primary care doctors, specialists, hospitals and other providers. And that’s in addition to patients having to navigate healthcare finances from separate providers.
In Bangor, Maine, the small city where Stephen King lives, the Bangor Beacon Community in large part incentivized collaboration for the care of the region’s most vulnerable, with clinicians and care managers meeting to discuss disease management strategies, and robust HIE services performing the bulk of the data management.
The Beacon launched a care coordination project for patients with diabetes, congestive heart failure, COPD and/or asthma, among 124 primary care doctors from three large healthcare organizations, Eastern Maine Medical Center, St. Joseph Hospital, and Penobscot Community Health Care.
For those patients, hospital admissions decreased 42 percent, emergency room visits by 43 percent, and walk-in care visits decreased by 75 percent over the course of 2011 and 2012.
With the goal of tracking the quality of care particularly for diabetes, heart disease, COPD and asthma, the collaborative approved data definitions, revised operational terms, identified regional target goals, and created common EHR patient encounter forms and workflow processes. Powered by Maine HealthInfoNet, the statewide HIE, the providers use a data registry that’s automated with their EHRs and sends them patient summaries.
The Bangor Beacon was successful with multi-organization quality metrics, the ONC concluded, in part because the “third-party centralized disease registry fostered a simplified, less competitive environment for negotiating data sharing agreements.” It also meant independent checks of data integrity.

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