Crystal Run Healthcare (CRH), a large multispecialty practice with more than 350 physicians practicing in over 40 medical specialties over 15 locations, was one of the first in the country to earn Level 2 ACO status from the National Committee on Quality Assurance (NCQA). To accomplish this, CRH had to shift to value-based care and population health management, show its capabilities with regard to value-based care, and show how it actually manages populations.
CRH’s Chief Clinical Transformation Officer, Medical Director, and Physician Leader for Crystal Run Healthcare’s Pediatrics division, Jonathan Nasser; and Chief Quality Officer, Medical Director, and Physician Leader for Crystal Run Healthcare’s medical specialties division, Scott Hines, acknowledge leadership and clinical structures played a key role in successfully accomplishing these tasks, but the two also singled out technology as an essential element.
Top administrators from Crystal Run Healthcare look back on what it took to make the successful transition to value-based reimbursement and the role that transition played in its population health management initiative.
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Crystal Run Healthcare (CRH), a large multispecialty practice with more than 350 physicians practicing in over 40 medical specialties over 15 locations, was one of the first in the country to earn Level 2 ACO status from the National Committee on Quality Assurance (NCQA). To accomplish this, CRH had to shift to value-based care and population health management, show its capabilities with regard to value-based care, and show how it actually manages populations.
CRH’s Chief Clinical Transformation Officer, Medical Director, and Physician Leader for Crystal Run Healthcare’s Pediatrics division, Jonathan Nasser; and Chief Quality Officer, Medical Director, and Physician Leader for Crystal Run Healthcare’s medical specialties division, Scott Hines, acknowledge leadership and clinical structures played a key role in successfully accomplishing these tasks, but the two also singled out technology as an essential element.
Q: How did CRH get its start, and how does it currently serve the market?
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Nasser: As an organization, about five years ago, we began our transformation towards a value-based model. In doing so we’re now an ACO, leading the charge in terms of healthcare organizations adapting to what the healthcare system is demanding of us. We were one of the first participants in the Medicare Shared Savings program and are also one of only seven NCQA-accredited accountable care organizations in the nation. A lot of that work — led by Dr. Hines, myself, and others working at the practice — was involved with adapting and learning a new model of delivering care for our patients.
Hines: The foundation for the value-based transformation began 16 years ago when the decision was made to put in an EHR, years before they were mandated. We felt it was the right thing to do for patients. Even before any of the mandates came down — and before this really became the accepted standard of care — we were leading the charge.
Nasser: This proactive approach has paid off several times, most recently with the sharing of patient data as a means to demonstrate capacity and ability to deliver high-quality care. We need data to be able to demonstrate that we’re achieving that goal. Take for example anticoagulation evaluation. Our data demonstrated we were able to improve the safety of anticoagulation and have a larger percentage of patients who were at this safe level of blood thinning when they were on that medication.
Q: How is CRH leveraging data mined from EHRs?
Nasser: We’re using the data amongst clinicians, gathering up different validations, and applying it to internal programs. Data is really important for us to be able to leverage improvements. We use the data to show our physicians how they’re doing, and we use that data to drive change. Armed with data, we’re able to talk with our colleagues about how we’re doing, how we’re going to improve, and moving forward, how we can expand upon and deliver higher-quality care than what we’ve been able to do to date.
Hines: These programs, though effective in the long run, didn’t start off without a few bumps. I would say 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 as we were very transparent with data sharing. This transparency was more of a factor than aligning incentives with compensation, although that was important as well.
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CRH felt sharing results of its initiatives at medical home meetings and provider quarterly meetings was effective, as physicians tend to be pretty competitive people and nobody wanted to be in the middle to lower end of the pack. When they 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.
Q: Are you applying that data to your patient population?
Nasser: Early on, one of the first things we were able to do with our data was identify diabetics and patients with heart disease, then shine a light on them to identify gaps in care. We’ve evolved that process now and have a care optimization team which looks at registries of patients and can generate a list of those we need to reach out to. By doing this, we can close those gaps in care and act to achieve better performance.
Hines: There’s just so much we need to do in our patient visits that, if we can get the process-oriented tasks done behind the scenes, physicians can concentrate more on performance measures such as blood pressure control. We built our care optimization team to use the registries we’ve pulled from the EMR to identify patients who have gaps in care that might have been lost to follow-up for those process-based measures. They can actually reach out to those patients and make sure those measures and gaps are closed and then get them in with their primary care doctor who has more time to focus on care.
Q: Where else are you looking to leverage this data?
Nasser: We’ve moved on to take this same data to address home care models as a means to reduce readmissions. As you know, on average, about 20 percent of Medicare patients are readmitted within 30 days of going home. Three years ago we started sending providers to their homes within one to two days of discharge as a way to assess patients in their own environments.
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As a result, 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.” It’s not every patient, but it certainly provides an opportunity for those who can’t get to the office to be seen when they need to be seen. Again, our goal is to intervene so that we can prevent avoidable utilization events, such as hospitalizations.
It’s not always easy, but CRH’s forward-thinking has resulted in better management of the health of its diverse patient population. It has also helped improve the quality of care the practice provides while saving money. It’s ironic we’re getting cost savings while returning to a personalized style of healthcare. I guess it’s back to the old model. What’s old is new again.
Crystal Run Healthcare (CRH), a large multispecialty practice with more than 350 physicians practicing in over 40 medical specialties over 15 locations, was one of the first in the country to earn Level 2 ACO status from the National Committee on Quality Assurance (NCQA). To accomplish this, CRH had to shift to value-based care and population health management, show its capabilities with regard to value-based care, and show how it actually manages populations.
Nasser: As an organization, about five years ago, we began our transformation towards a value-based model. In doing so we’re now an ACO, leading the charge in terms of healthcare organizations adapting to what the healthcare system is demanding of us. We were one of the first participants in the Medicare Shared Savings program and are also one of only seven NCQA-accredited accountable care organizations in the nation. A lot of that work — led by Dr. Hines, myself, and others working at the practice — was involved with adapting and learning a new model of delivering care for our patients.
CRH felt sharing results of its initiatives at medical home meetings and provider quarterly meetings was effective, as physicians tend to be pretty competitive people and nobody wanted to be in the middle to lower end of the pack. When they 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.
As a result, 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.” It’s not every patient, but it certainly provides an opportunity for those who can’t get to the office to be seen when they need to be seen. Again, our goal is to intervene so that we can prevent avoidable utilization events, such as hospitalizations.
