As an organization, we began our transformation to value-based model about five years ago. In doing so, we’re now one of seven accountable care organizations accredited by the NCUA in the country. We were also one of the first participants in the Medicare Shared Savings program, a direct result of the work we put in adapting and learning a new model of delivering care for our patients.
At Health IT Outcomes, we’ve made it our mission to provide the healthcare industry with expert guidance on technology system selection, integration, project management, and change management. To help achieve this goal, we speak with industry leaders on everything from EHRs to HIEs to HIM, and then share these conversations with you. We recently traveled to Chicago to attend HIMSS15 where we had the privilege to speak with Jonathan Nasser, Chief Clinical Transformation Officer and Scott Hines, Chief Quality Officer, both at Crystal Run Healthcare. They spoke with us about EHR adoption, data transparency, and population health management — and how they’re using these tools to make the shift to value-based care.
Health IT Voices: How does Crystal Run Healthcare do serve the market?
Nasser: We’re an independent physician, multispecialty practice in New York State, specifically in the lower Hudson Valley. We’re a full service practice offering over 50 specialties and have almost 30 locations in four counties. We pride on ourselves is being able to provide the full spectrum of care for our patients to meet their needs, whatever those may be.
As an organization, we began our transformation to value-based model about five years ago. In doing so, we’re now one of seven accountable care organizations accredited by the NCUA in the country. We were also one of the first participants in the Medicare Shared Savings program, a direct result of the work we put in adapting and learning a new model of delivering care for our patients.
Health IT Voices: What was your approach when the EHR mandates were discussed?
Hines: Even before any EHR mandates came down, and before this really became the accepted “standard of care” in the country, we were leading the charge. We made a decision early on having and EHR was the right thing to do for patient care and partnered with NextGen. They’ve been able to adapt and meet the needs that we’ve had as our practice has grown and we couldn’t be happier.
Health IT Voices: What do you do with your patient data, and how do you share it within your practice?
Nasser: We use patient data in our systems in order to demonstrate that we have the capacity and ability, as an organization, to deliver high quality care. Moving forward, as we gather up different validations and taken on new programs, that data will be used to leverage improvements. We use the data to show our physicians how they’re doing, and we use that data to drive change. We’re really “armed” with data and with it we’re able to talk with our colleagues about how we’re doing and how we’re going to improve. Then, moving forward, how we can expand upon and deliver higher quality care than what we’ve even been able to do to date.
Health IT Voices: How is that adoption process going? Are you getting resistance, or is there enthusiasm for it?
Hines: Initially there was some resistance. Interestingly, the resistance we met early on was more with patient satisfaction scores and patient satisfaction reports. When it came to the clinical quality data, our physicians were less resistant. We found that the most powerful motivator to get physicians engaged and aligned to the work we’re doing is transparent data sharing, even more so than aligning incentives with compensation.
Transparently sharing data at our provider quarterly meetings was a huge factor. When physicians see their data up there, compared to their colleagues, it really motivates them to want to do better, to want to change, and ultimately, to want to serve our patients better.
Health IT Voices: How are you leveraging EHR data to manage chronic disease and involve the entire care team?
Nasser: Early on, when managing chronic diseases, we used our data to create patient registries. One of the first things we were able to do with our data was to identify diabetics and those with heart disease, and then shine the light on them and to identify gaps in care for those groups of patients. Now we have a whole care optimization team that uses that same data and looks at registries of patients and can generate a list of patients that need to be reached out to.
Hines: Our care optimization team consists of nurses and non-clinical staff that use registries we’ve pulled from the EMR to identify patients who have gaps in care who may have been lost to follow-up for those process-based measures. Then they can actually reach out to those patients and make sure that those measures and those gaps are closed, get them in with their primary care doctor, then at the visit, it leaves the physician more time and more focus on things.
I think that one of the most important advances or mind shifts we’ve had over the course of the last year or so are primary care doctors telling us, “You need to start taking some stuff off of our plate.” There’s just so much we do in our patient visits that, if we can get more process-oriented things done behind the scenes like making sure patients have age appropriate cancer screens and are up to date on their vaccines, we can concentrate more of the performance measures such as blood pressure control and A1C control during the visit.
Health IT Voices: What led you to the arena of home care models?
Nasser: We started that program with our transitions and were looking to reduce readmissions for patients from the hospital. Twenty percent of Medicare patients, on average, are readmitted to the hospital within 30 days of going home. What we did was send a provider to their home within one to two days of discharge. It was an opportunity to see patients in their own environment. At those visits, we look at all of the medications — and all of the family members’ medications — so that way we know what the patients are taking.
Since then, we’ve reduced readmissions by almost 15 percent. Patients have actually said, “You know what? This is really cool, that you can come out to our home within a few days of discharge. I have a really hard time coming to the office. Can I have my primary care visits in the home?”
Health IT Voices: Not only do you get the benefits of cost savings and cost reductions, but you’re returning to very personalized healthcare.
Nasser: It’s the old model, but what’s old is now new.
