Center is using data to bend the medical-cost curve

DATA BANK: Blackstone Valley Community Health Center has curbed patient costs by integrating data at the point of care. Above, from left: Blackstone Valley physician assistants Dian Cullion and Robert Bowden and medical assistants Kelly Medeiros and Crisolita Evora. / PBN PHOTO/DAVID LEVESQUE
DATA BANK: Blackstone Valley Community Health Center has curbed patient costs by integrating data at the point of care. Above, from left: Blackstone Valley physician assistants Dian Cullion and Robert Bowden and medical assistants Kelly Medeiros and Crisolita Evora. / PBN PHOTO/DAVID LEVESQUE

In 2011, Neighborhood Health Plan of Rhode Island generated net income of about $11 million, after all medical and administration expenses were met. More than 40 percent – $5.1 million – of that profit came directly from savings as a result of patient medical-expense avoidance achieved by Blackstone Valley Community Health Center, according to Blackstone Valley’s calculations.
The key to their ability to curb costs while delivering high-quality care, according to Heather Budd, chief operating officer of the Pawtucket health center, is its integration of patient data at the point of care.
“We are using the integration of data to build the kind of relationships our staff needs to have with patients to make the difference where they can motivate a patient to change behavior,” Budd said. “That’s not something that happens in the electrons of the product, it happens in the relationship between people on the ground.”
While Medicaid premiums in Rhode Island were about $300 per member, per month in the fourth quarter of 2011, Blackstone Valley’s patient expenses were under $190 per member per month for that quarter.
“What Blackstone Valley is doing is incredibly remarkable,” said Brenda Whittle, director of external affairs and marketing at Neighborhood Health Plan. “It’s amazing.”
The health insurer serves more than 92,000 members through its network of primary-care providers, including all nine of Rhode Island’s community health centers. Neighborhood’s membership represents about 66 percent of all Medicaid managed-care participants in Rhode Island.
At the same time Blackstone Valley achieved such significant cost avoidance in patient medical expenses, the community health center also maintained and improved its outcomes in quality measures, such as for diabetic patients.
More than just an investment in technology, Blackstone Valley has also made an investment in its human capital, too, redesigning the delivery of health care services around a team “huddle” approach within its patient-centered medical home model.
“We figured out that we needed to add support staff in key roles in order to enable this to happen and to preserve that artfulness of diagnostics and relationship-building,” Budd said.
Blackstone Valley created a new role, the “administrative medical assistant,” or AMA, to quarterback the new delivery service model and be responsible for running the health IT tools and the flow of communications between patients and providers. Each morning the team, which consists of the AMA, two clinicians, a nurse, a nurse-care manager and two other medical assistants, review the pre-visit planning and population-management data, determining the highest-need, highest-risk patients.
When the patient arrives, each member of the team is fully informed about that person’s medications, recent hospitalizations, visits with specialists and preventative-care record.
Under the leadership of Executive Director Raymond J. Lavoie, Blackstone Valley has developed one of Rhode Island’s most sophisticated health IT systems, using NextGen hardware and software.
It includes the center’s own health-information exchange, an ambulatory electronic exchange that includes itself, the WellOne and Tritown community health centers, as well as a portal for other Rhode Island primary-care and specialty practices, certified by the state’s regional extension center.
The system has its own quality reporting and analytics suite, with the ability to analyze its own data as well as claims data from Neighborhood Health Plan, enabling it to produce population-management analytics for use at the point of care.
In addition, the Blackstone Valley health IT system has its own patient portal, enabling interactions between patients and its staff. “Our nurses receive secure information from the patient portal, and facilitate getting the messages out to the right member of the care team for timely and appropriate answers,” Budd explained. For instance, she continued, it might be a medication question answered by the nurse. If it’s something more complex, she said, “we’ll make sure it gets to the provider.”
The nurse’s role is one of being an educator, according to Budd. In addition, Blackstone Valley works with patients to train them in how to effectively use the patient portal.
Soon to be added to the system is a provider portal, the first of its kind to be developed in Rhode Island, according to Budd. Expected to be operational in January, the provider portal will enable the community health center to make electronic referrals to its specialty providers. “When we’re talking about Medicaid patients, who typically have a harder time being seen by specialists, the more we can grease the wheel to make that appointment easier to book [makes a difference],” Budd said.
And, in addition to its current connections to radiology and laboratory services, Blackstone Valley wants to partner with hospital systems, including Lifespan, to create an admission discharge and transfer, or ADT, portal, to better track patients. On Oct. 22, Blackstone Valley moved into its new $6.7 million facility at 39 East St. in Pawtucket, a three-story health center with 32,000 sq. ft. and 33 exam rooms as well as an integrated behavioral health unit.
At the ceremony, Rhode Island’s congressional delegation joined Gov. Lincoln D. Chafee and Lt. Gov. Elizabeth H. Roberts in praising Blackstone Valley as the innovative leader for the future of health care delivery in Rhode Island – and the nation.
The facility includes an upgraded electronic monitoring system that can record a patient’s vital signs and transmit it directly into the health IT system, without a nurse having to enter the data.
“We are the greatest consumer of our own data,” Budd said. “If we’re not consuming our data and making it usable and actionable, what’s the point?”
Budd drew a distinction between Blackstone Valley’s health-information exchange and the one being created by the Rhode Island Quality Institute, known as Currentcare. “Currentcare is about the breadth of information,” she said. “Our health-information exchange is about the depth of information for our patients. They both have value, but they are different.”
By integrating data at the point of care, Blackstone Valley is harnessing the information at the intersection of medical costs and quality outcomes. In the past, the only feedback that the community health center used to get was when claims data would arrive – some 18 months after the fact.
The change to evidence-based medicine through use of data at the point of care and measuring outcomes on a monthly basis has resulted in a sea change for providers, according to Lavoie and Budd.
“It’s a powerful tool to measure outcomes – for depression screening, for smoking cessation, if a patient is taking his or her meds properly,” said Budd. “A provider never had this kind of oversight in the past; they were seen as the gods, the gurus.” Now, the data is timely and transparent, and the providers share best practices among themselves.
“I would love a chance to talk with a hospital CEO,” Budd said. “Ambulatory care is where the action is. In the past, we’ve relied on hospitals to do the clean up. What we’ve figured out is that it’s extremely costly, and it doesn’t work, because it is not taking advantage of the opportunity for prevention. The more we can keep patients out of the hospital, the better it is.” •

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