Building An IT Foundation For Patient-Centered Medical Homes

By Health IT Outcomes staff

Population health management technology opens new doors to patient-centered medical homes at Covenant Health Partners.

Healthcare terminology has evolved into a set of phrases and acronyms that tend to leave the average patient confused about how these medical concepts relate to their care. Some are brave enough to raise a hand and ask for clarification, but many do what patients have always done — let the industry jargon flow over their heads, safe in the knowledge their care providers know what they’re talking about. One acronym in particular now seems to be more easily understood than others due to the immediate benefits patients see when they and their care team participate in this model. That acronym is PCMH (patient-centered medical home), a concept recently dubbed the “fastest-growing innovation in medical care” by Consumer Reports. In fact, National Committee for Quality Assurance (NCQA) studies show that the PCMH increases patient and provider satisfaction and reduces emergency room visits and hospital stays.

The NCQA defines a PCMH as a healthcare setting that “facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange, and other means to ensure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.”

Blue Cross Blue Shield of Michigan (BCBSM) has the largest PCMH program in the nation, with more than 3,000 primary care physicians in 994 practices following this model, which incorporates EMRs to better coordinate patient information. Covenant HealthCare Partners (CHP), a nonprofit healthcare system in Saginaw, MI, is looking not only to grow its EMR utilization, but also to grow its participation in the BCBSM PCMH program. Population health management technology is helping the physician hospital organization (PHO) accomplish both at the same time.

Keeping Up With Many Moving Parts
As a PHO, CHP has faced a unique set of challenges in preparing for the initial stages of Meaningful Use and participation in the PCMH program. The PHO includes the 623-bed Covenant Medical Center, which includes 20 inpatient and outpatient facilities; 66 primary care physicians, the majority of whom are independent; 190 specialists; and an additional 256 physicians. All together, CHP takes care of 170,000 patients from 14 local counties annually.

These numbers did not deter Covenant Medical Center from implementing an Epic EMR system at its hospital in 2007. “We don’t mandate that all of our doctors use Epic at their facilities,” explains Dr. Michael Slavin, Medical Director at CHP. “Forty-three of our physicians are on Epic, while the others use systems from NextGen, Allscripts, and Quest Diagnostics. Twelve of our physicians don’t use an EMR at all.”

With so many moving parts, Slavin says it was easier for CHP to let its physicians practice on an EMR of their choosing, rather than adopt Epic across the organization. “As a PHO, we want to allow our independent physicians to run their own businesses and make their own decisions,” he says. “Where we have influence is more on the managed care, contracting, and pay-for-performance sides of things. As long as we have systems that can manage our quality, pay-for-performance, and costs, we don’t care whether they are on an EMR or what kind of EMR it is.”

Forty-one physicians attested for Stage 1 of Meaningful Use, and are now preparing for Stage 2. CHP as a whole, however, has preferred to focus its IT strategy on preparing for and participating in the PCMH program.

Technology Drives Change In The Business Model
The PCMH program has been a huge driver for CHP and its physician practices during the last four years. “We’ve been working hard to transform all of our practices into PCMH practices,” Slavin explains. “When we started on this journey, however, we did not have the IT in place to give us claims data from multiple payers across all of our practices. We were cobbling together data from various sources to give us a holistic look at our entire organization, and even that method wasn’t giving us a good look into clinical quality. We knew that to prepare for and successfully participate in a PCMH, we needed technology that would give us easy access to our full patient population so that we could identify patient care, trends in disease processes, labs, and quality.”

CHP attempted in 2006 to fulfill these needs with Webbased care management services from a different vendor in an attempt to begin the transition into the pay-forperformance business model so many of its payer partners were moving to. “Our previous vendor mainly offered clinical data dumps from health plans, and so we thought we could get together some of the wellness and immunization data we knew we needed to be successful at pay-for-performance,” explains Slavin.

That same year, Slavin and his team became more and more interested in pursuing the PCMH model. As their interest grew, so did the realization that the claims data CHP had been gathering on its own and getting from its previous vendor was not sufficient to successfully participate in a PCMH. “We realized we needed another type of technology that we could implement across all of our offices, one that would be effective in a hospital setting or a physician’s office, and that could bring in data from all of our patient’s health plans,” Slavin says.

Population health management tools and disease registry data were especially important to CHP’s PCMH plans because they would enable reporting on an allpayer basis for a variety of conditions at every level of the organization, from patient to physician to hospital. “You just can’t be successful in the PCMH world without that kind of technology. We had to have something over and above what our EMRs alone could provide — something that would enable us to track and report on populations of patients at the chronic disease level.”

Meeting The Unique Needs Of A PHO
Slavin thought finding a vendor capable of fulfilling the unique needs of CHP was going to be challenging. Multiple EMRs meant Slavin needed to find a vendor that could offer multiple EMR interfaces to its system. After speaking with several PHOs and physician organizations (POs) in the region, he realized fairly quickly that Wellcentive was likely the vendor capable of best meeting CHP’s needs.

“Wellcentive’s ability to provide interfaces to Epic, Allscripts, and NextGen, among other healthcare IT systems we use, was a big draw for us,” says Slavin, “as was the fact that many of its customers were PHOs involved in the BCBS of Michigan’s Physician Group Incentive Program, a stepping stone to its PCMH program.” He adds that Wellcentive’s experience in working with BCBSM’s programs, especially its knowledge of registry requirements for attaining PCMH status, was a big draw for CHP.

Slavin did look at other vendors before signing on the dotted line with Wellcentive in January 2009 but didn’t find a product that compared. “The problem we had with one of the larger vendors we looked at, whose product is now offered by The Advisory Board, was that it didn’t work well with POs and PHOs in that it focused more on the individual office than on reporting at the PO or PHO level,” he explains.

One Challenge At A Time
Once CHP signed on with Wellcentive, it took just three months to implement the company’s Outcomes Manager technology. Slavin notes that while the implementation and go-live went fairly smoothly, the first year of utilization was certainly challenging. Working with separate interfaces for each EMR was one of the biggest challenges, according to Slavin, followed closely by working with registries, which were a newer concept to many of CHP’s physicians. He adds that, as with any new IT, there were barriers to adoption. “Our initial goals that first year were to help our physicians use Wellcentive technology for e-prescribing and to move our practices in the direction of a PCMH model. That push toward e-prescribing helped us build relationships with our physicians that better enabled us to educate them on the benefits of the new system and e-prescribing as a whole. By starting with just one or two main goals, we were able to better support our end users, get them comfortable with the system, and educate them on its benefits.” Collecting data from CHP’s offices was also challenging because Wellcentive had not yet interfaced with the Epic EMR. “We had to work with both the Wellcentive team and the team from e-Covenant, which ran Epic on-site, to develop the best way to link the data from the EMR to the registry. It went more easily than I thought it would, but there was some increased workload that occurred,” Slavin says. “Our entire organization had to be trained by Wellcentive on its technology, so that took some time. We certainly learned in that first year that implementing and using EMRs, interfaces, and registries takes work, dedication, and, if you’re doing your job right, a physician champion.”

Population Health Management Improves Outcomes
The benefits to CHP’s physicians and patients have extended beyond better PCMH preparation. CHP now interfaces with data directly to Blue Care Network, Priority Health, and HealthPlus to aid in pay-for-performance compliance on the PHO side as well as HEDIS (healthcare effectiveness data and information set) compliance on the health plan side.

“I did not have an EMR that first year we used Wellcentive, so I did a lot of data input,” says Slavin. “As I learned after switching to an EMR, it saves me from having to do a lot of that input. We now have interfaces that pull data from Wellcentive and send them directly to our health plans.”

Moving to an EMR has enabled Slavin and his colleagues to gain a better understanding of population health management and the benefits it brings to CHP’s patients. “I thought I took good care of my patients before adopting an EMR,” Slavin says. “And that’s true for the patients that came into my office. The EMR and Wellcentive technologies have helped me to identify the number of patients that weren’t making it in. I came across diabetics who hadn’t been in for six or seven years. You think you’re doing well until you start running these population health management programs and see that some of your patients aren’t being treated at all. As a practicing physician, I would never go back to a nonregistry world, or a nonEMR world, for that matter.”

The reporting benefits seem to resonate the most with Slavin, who now regularly runs care summary reports and patient report cards, which he and his staff are able to share with patients at the end of the appointment. Alerts to gaps in care, such as needed immunizations or mammograms, are another benefit to CHP’s care teams. “My staff gets these alerts before the appointment begins,” he says, “and so they are able to address these potential gaps in care with the patient before I even walk in the room. That’s a real time-saver for me.” Alerts also have contributed to a substantial improvement in clinical outcomes.

Slavin notes he was pleasantly surprised by the positive impact the Outcomes Manager system had on his staff. “My staff now feels more empowered,” he says, “because they feel more involved in the patient’s care, more so than the limited role they had in the past. That has certainly helped with staff retention.”

A dedicated staff coupled with effective technology has helped more CHP offices than ever before achieve PCMH designation. Fifty-two offices have been nominated since implementing Wellcentive technology, and 50 offices have achieved formal designation from the BCBSM program.

Connecting With Specialists
Slavin hopes to see these numbers increase in the next few years as CHP continues its relationship with Wellcentive. Reaching out to the health system’s specialists seems to be priority number one. “This year and next, we’re focused on engaging the specialists for optimum clinical integration so that we can truly embrace the PCMH concept. The idea of getting specialists involved in the PCMH process is relatively new. While there may not have been a lot of collaboration between primary care physicians and specialists in the past, this concept will require it.

“Once you start using these population health management tools,” Slavin adds, “you find out pretty quickly that the benefit to your patients and your practice is huge. We’re looking at this technology as the vehicle for us to be successful, to help with those gaps in care. It’s not the be all, end all, but it’s definitely the right thing to do. I just don’t see how I could be a better doctor without it.”