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Building the Data Governance Strategy for Effective Population Health Alliances

Posted by Matthew Smith on Aug 5, 2015 12:42:52 PM

By Tara Tesch, MHSA, Senior Manager, GE Healthcare Camden Group

This is the third of three articles in the Population Health Alliances series. The first article examined physician engagement strategies and detailed specific strategies that have proven successful for alliances. The second article focused on the value of true care redesign.

High-performing organizations possess robust information technology ("IT") infrastructure and associated tools to deliver, track, and document patient-centered, evidence-based care at the point of service and can disseminate actionable and meaningful data quickly and transparently. IT infrastructure implementation is an iterative process and rarely do organizations have a “fully baked” IT solution at the onset of implementation.

There is no single vendor that can provide a comprehensive data analytics solution to meet all needs (see graphic below) at this time.


 Future State CI Network Platform

Population Health, Data Governance

© The Camden Group 2015


In order to truly impact how care is delivered, end users must have actionable information in real time to support care redesign efforts. Providing patient-relevant decision support at the point of care can improve provider effectiveness in delivering appropriate and necessary interventions, furthering the organization’s goals of improving individual and population health. Too many organizations stall in developing their IT infrastructure by letting “great get in the way of good.” IT should support the care not drive it, therefore, systems and tools must translate and support care redesign. Too much data that is not well organized or analyzed can simply create confusion and cloud the necessary focus required to impact population health.

It is critical for population health alliances to have a well thought-out IT strategy and data management plan that will provide connectivity between members. The strategy should call for a means to collect the data, offer a robust tool to aggregate the data, and support reporting that will translate information into behavioral change and allow providers to more effectively communicate with and engage patients. The key factor for success: build your strategy beginning with the end in mind.


 Data Governance Strategy Build

© The Camden Group 2015


Success begins with the development of an information management and data governance strategy, which includes a data governance structure (who is going to own it, clean it, analyze it), organizational structure (what resources and types are required), and core data needs (reportable, transactional). An objective of the strategy is to take data and create meaningful information that leads to action-oriented knowledge. Out of the strategy, capabilities will be identified that drive interoperability and analytics requirements. These requirements should provide the criteria for selecting health information technology (“HIT”) that support the business and clinical needs of the alliance. Avoid buying the tool then trying to create a strategy around it; this will inevitably fail.

Defining Objectives

Designing the data strategy requires a sophisticated understanding of the alliance’s business and clinical objectives, clinical guidelines and care processes, and requirements of analytics to support these activities. First, define the end goal (outputs) such as care management or value-based contracting, and identify the data sources that will be used (i.e., EHR, claims, ADT, etc.). Next, determine how the data will be used to support the outputs; will it be reportable and retrospective (e.g., risk stratification, predictive modeling, scorecards) or transactional and action-oriented (e.g., point of care, gap closure, alerts, real time analysis to support decision-making).

To be successful, this planning process must include clinical/operational leadership (e.g., chief medical informatics officer, care management leads), in addition to finance and the member organization chief information officers. Staffing should include a data architect and a clinical informaticist able to translate the data into clinically meaningful information.

Once the strategy has been defined, identify the data requirements and associated capabilities. This may include standard processes and reporting templates – tools to automate the current state and optimize care delivery. Next, select a vendor that either has the ability to grow with your organization as it evolves or decide to pursue a “plug and play” vendor approach. Either way, the vendor must support the alliance’s CIN data requirements and capabilities.

In the end, it is critical to maintain strong, positive relationships with clinicians during the design and development of these key technology capabilities. Clinicians drive the clinical care of patients and care models to support the delivery of clinical protocols. Organizational and individual needs will evolve based upon initial successes and challenges, and clinicians will bring forth a multitude of suggested and needed changes after the initial “go live.” Technology is the tool to support the clinical requirements, and developing ongoing processes to solicit clinician feedback for continued improvement is an important contributor to long-term success.

Data Governance, Value-Based Care, Population Health


Ms. Tesch is a senior manager with GE Healthcare Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at tara.tesch@ge.com

Topics: Population Health, HIT, HealthIT, Data Analytics, Population Health Alliance, Tara Tesch, Data Governance

Population Health Alliances: The Value of True Care Redesign

Posted by Matthew Smith on May 6, 2015 4:26:28 PM

By Tara Tesch, MHSA, Senior Manager, The Camden Group

population_health.jpgThis is second of three articles in the Population Health Alliances series. The first article examined physician engagement strategies and detailed specific strategies that have proven successful for alliances.

Healthcare systems are increasingly choosing to partner with other provider organizations to pursue population health initiatives on a more regional and sometimes statewide basis. These “alliances” are often viewed as alternatives to more traditional mergers and acquisitions, and are created through the collaboration of more than one health system, hospital, or physician group. This emerging collaboration model provides opportunities to share common infrastructure, expand geographic reach, and increase access to additional clinical and support resources. These alliances also face additional challenges associated with sponsorship by multiple organizations that in some cases have historically been competitors.

Care Redesign

Value-based care management is a physician-led, patient centered, interdisciplinary approach to integrating healthcare across the care continuum, with the goals of improving patient health status while reducing the cost of care. Many value-based delivery networks have components in place, but to be successful in the movement toward population health, true care redesign is essential. Here are a few interesting facts to consider:

  • It takes 17 years to go from a proven breakthrough to use in every day practice1.
  • Only 55 percent of physicians are using/following evidence-based guidelines2.
  • Most dramatic change in the physician workforce is the movement from independent to employed practice. In 2014, 53 percent of physicians were employed by a hospital or medical group. Ninety percent of newly hired physicians are electing employment over private practice or partnerships3.

So what does this mean then for population health alliances? Physician leadership should drive the clinical transformation and care team development. The healthcare environment is changing at a rapid pace and population health alliances must continually educate their physicians and staff on these changes. Rigorous training programs focused on standards of practice should occur regularly, and care management staffs will need significant training to ensure they are providing adequate support to providers, and are working at the top of their license.

The role of the alliance, then, is in establishing the clinical standards, guidelines, and best practices and providing the information back to members regarding adherence to the clinical standards. Providers will also look for alliance-level resources to assist with tools and process change, including ongoing training and education. In order to educate members of the network on their performance, the network will need to have the capability to conduct analytics and reporting for both patient and population management. Clinical integration relies on transformation of the clinical care model; clinical transformation can only occur with enough data to produce information that will drive this change.

Alligned Incentives

Care is local, so actual redesign should occur at the local level to reflect the specific needs of the populations served. This will require different economic models to align incentives as well as multiple levels of care management resource needs. The growth of accountable communities is creating a burning platform for change. Care redesign must be approached at the continuum level and focus redesign efforts to impact total cost of care at the process/workflow level. While the most dramatic change will occur at the individual physician practice level, there is also increased pressure on networks to integrate in-home care in the continuum of providers. Care transitions and community-based resources become increasingly critical to both network and care model development for the alliance members.

Thus, the member provider networks will look to the alliance to provide actionable and real time information on their clinical outcomes, adherence to protocols, and value-based metrics. Transparency in these reports, including financial results, is critical to physician behavior change.

Coming soon: Watch for the final installment of our Population Health Alliances series examining Data Governance.

Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180.

Elizabeth A. McGlynn, Ph.D., Steven M. Asch, M.D., M.P.H., John Adams, Ph.D., Joan Keesey, B.A., Jennifer Hicks, M.P.H., Ph.D., Alison DeCristofaro, M.P.H., and Eve A. Kerr, M.D., M.P.H. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med 2003; 348:2635-2645. June 26, 2003. DOI: 10.1056/NEJMsa022615.

2014 Survey of America’s Physicians. Survey conducted on behalf of The Physicians Foundation by Merritt Hawkins. Completed September 2014. Copyright 2014, The Physicians Foundation.


tara.pngMs. Tesch is a senior manager with The Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at ttesch@thecamdengroup.com or 312-775-1700.

Topics: Population Health, Population Health Alliance, Tara Tesch, Care Redesign

Population Health Alliances: Rethinking the Business Model

Posted by Matthew Smith on Mar 26, 2015 12:01:00 PM

By Tara Tesch, Senior Manager, MHSA, The Camden Group

PopHealthAlliance3Healthcare systems are increasingly choosing to partner with other provider organizations to pursue population health initiatives on a more regional and sometimes state-wide basis. These “alliances” are often viewed as alternatives to more traditional mergers and acquisitions, and are created through the collaboration of more than one health system, hospital, or physician group. This emerging collaboration model provides opportunities to share common infrastructure, expand geographic reach, and increase access to additional clinical and support resources. These alliances also face additional challenges associated with sponsorship by multiple organizations that in some cases have historically been competitors.

The Next Generation of Physician Engagement Strategies

The healthcare environment is changing at a rapid pace and the path toward population health requires committed physicians, administrators, and clinicians at all levels and across the continuum of care. These leaders must commit to taking accountability for clearly communicating the transformational vision, goals, and objectives of the population health alliance to unite its members around this effort. Success in engaging the providers will be around demonstrating a true desire and understanding of the critical importance of integrating physician and clinicians into all levels of the alliance’s governance and operations.

Key to meeting this strategic imperative is to engage dynamic, knowledgeable physician leaders with creditability among the broader physician network to proactively meet with the front-line physicians and build support and engagement. Do not assume that established structures (e.g., medical staff meetings, etc.) will always be an effective means to distribute information and build engagement.

Additional strategies that have proven successful for alliances include:

  • Ongoing education for community-based providers in clinical integration, innovative care models, and tracking of clinical quality and outcomes aimed at increasing their understanding of the value of participation in the alliance network. Education requirements should be included in all physician agreements, and dedicated staff and resources assigned to support these efforts.
  • Leadership training and support to empower the next generation of physician leaders to jointly problem-solve and collaborate in achieving the tenets of population health. Set the tone that this is a transformational journey that will have successes and mistakes; jointly learning from them will offer new insights and promote future efficiencies in ongoing value-based care delivery planning and implementation.
  • Transparency in communication and evolving metrics are necessary to keep providers informed and engaged, and to elicit critical behavioral change. Adjustments in reimbursement, care models, coding requirements, IT systems and capabilities, and alliance-wide goals should be distributed regularly followed by timely educational sessions. Physicians can no longer focus only on their individual performance; rather, focus must shift to the care of their patients across the network continuum, and feedback on how appropriate interventions and utilization of care can improve the health of the populations served.

Adding Value to Physicians

Another critical concept in understanding best practices in physician engagement and network development is the realization by alliance and member system leadership that physicians only practice one model of care; they do not change that approach based on what payer or “bucket” the patient may be attributed. Where alliances can add true value to physicians and actively engage providers is in support services such as care management and IT platform/analytics – areas to support efficiency and provide actionable information in real time.

  • Create a centralized care management institute at the network level that includes performance improvement and care management resource support that can be accessed by other organizations if they do not have their own resources for local work efforts.
  • Establish an ongoing monitoring process, overseen by the alliance clinical committee to measure and track improvement in a clinical indicators over time. This active monitoring and validation helps to test whether or not the data is accurate, the metric(s) is (are) appropriate, and if the process in place actually impacts performance/outcomes.

A consistent challenge remains around providing meaningful data at the point-of-care to educate and engage providers around their performance on clinical quality and financial outcomes. As value-based care delivery relies on care model transformation, physicians rely more and more on receiving actionable information around their clinical outcomes, adherence to evidence-based guidelines and protocols, and value-based metric performance to impact behavior change and operational tools to support practices in care redesign.

The new care models and payment methodologies associated with population health management will require more tightly aligned financial and clinical incentives between hospitals and physicians. Initiatives in these areas must be physician-led to achieve sustained success clinically and financially.

One final consideration: employment does not guarantee physician alignment or integration. The same principles of engagement hold true whether employed or independent, and incentives that align with targeted behavioral change become increasingly important for longer-term success and transformation. Design incentive plans that not only encourage productivity, but reward physician efforts to achieve shared goals in care, quality, and cost control.

Parts two and three in this series will focus on Care Redesign and Data Governance, respectively.


 

taraMs. Tesch is a senior manager with The Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at ttesch@thecamdengroup.com or 312-775-1700.

Topics: Clinical Integration, Population Health, Clinically Integrated Care, Physician Engagement, Population Health Alliance, Tara Tesch

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