Future of care tied to analytics

CRUNCHING NUMBERS: R.I. Quality Institute Director of Quality and Analytics Darby Baroker, left, speaks with COO Gary Christenson. The organization is overseeing the CurrentCare database. / PBN PHOTO/RUPERT WHITELEY
CRUNCHING NUMBERS: R.I. Quality Institute Director of Quality and Analytics Darby Baroker, left, speaks with COO Gary Christenson. The organization is overseeing the CurrentCare database. / PBN PHOTO/RUPERT WHITELEY

It is clear to most decision-makers in the health care industry that future services will be determined and guided by analytics that measure outcomes, costs, preventive benefits and patient satisfaction.
In Rhode Island, considered to be one of the leading states in innovation and the adoption of a patient-centric model of health care, according to Dr. Michael Fine, director of the R.I. Department of Health, there are several – six to eight, depending on how you count them – such analytic engines being deployed.
The landscape is a wide-open, technological playing field. Competitors include software companies, hospitals, for-profit health insurance companies, nonprofit health insurers, government agencies, group practices and community health centers.
At one end of the spectrum is Lifespan, the state’s largest hospital network, which is investing more than $100 million over the next four years to build a new model of patient-centric care, at the heart of which is a new health IT platform being built around the Epic software system.
“What we’re doing at Lifespan is creating a system of care to improve patient health,” Dr. Timothy J. Babineau, president and CEO of the health care system, told Providence Business News. Babineau stressed that the effort was not about installing a new IT system but rather redesigning the way in which health care was delivered, centered on the needs of the patient.
“At its fundamental centerpiece, medicine and health care are about the exchange of information at the point of care, so that our providers have the information to make real-time decisions.” The new system of care, Babineau continued, “is how we move from volume to value.”
At the other end, in terms of size and how far along they are in successfully using analytics to generate savings, is Blackstone Valley Community Health Center. The center has achieved a sophisticated deployment of health IT data integrated at the point of care, using NextGen software.
Employing a patient-centered, team approach to health care, Blackstone in 2011 generated savings of more than $5 million for its patient base of about 11,000 individuals. “Providers – doctors, nurses, physician assistants – have lost the artfulness of medicine with the dawn of the electronic age,” said Raymond Lavoie, Blackstone’s executive director, explaining Blackstone’s philosophy in how the center deploys its health IT. “We’ve tried to give them back that artfulness, so that they really can have the relationships they need to have with patients, to make the difference at the level where they can motivate a patient to change [behaviors],” he said.
In between Lifespan and Blackstone on the spectrum is Coastal Medical, the state’s largest physician-owned, primary-care group practice, which is working closely with eClinicalWorks to pilot the development of an analytics engine to help Coastal Medical improve health care delivery for patients, according to Dr. G. Alan Kurose, president and CEO of Coastal.
“We’re never going to understand cost without [being able to measure] quality and outcomes,” said Kurose, who has led his group practice into new shared savings contracts with Blue Cross & Blue Shield of Rhode Island and a designation as a “Shared Savings Accountable Care Organization” with Medicare patients.
The place that Coastal is in with analytics, Kurose continued, “is that we are a beta site with eClinicalWorks. They are making an analytics platform available to a small number of practices around the country. It’s not in its finished form. … The architecture is unique, allowing communications in both directions with an electronic medical record.”
The state of Rhode Island, which is undertaking the largest building of health IT infrastructure in its history, investing $105 million with Deloitte to create a Unified Health Infrastructure Project platform, also has its hands in the analytics pie.
The R.I. Health Benefits Exchange, which is scheduled to begin operation on Jan. 1, 2014, as an online marketplace for individuals and small business to purchase health-insurance products, expects to deploy a comparative outcome and cost database known as the All Payors Claims Database to help consumers make good decisions about health care.
There is also an effort, as yet undefined, to link the exchange with the Rhode Island Quality Institute, a nonprofit organization that has the responsibility of managing the state’s health-information exchange, known as CurrentCare, which creates a database for electronic health records. To date, there are about 283,000 Rhode Islanders who have opted to participate in CurrentCare.
The Quality Institute also has been involved with conducting analytics for the R.I. Chronic Care Sustainability Initiative, under the auspices of the R.I. Office of the Health Insurance Commissioner and funded through the federal Beacon program. There have been preliminary discussions with Amy Zimmerman, the health IT coordinator at the R.I. Executive Office of Health and Human Services, and Tricia Leddy, the deputy director of the R.I. Health Benefits Exchange, to explore what kinds of analytics could be conducted by the Quality Institute, according to Gary Christensen, the institute’s chief operating officer.
“There is a great opportunity in the pooling of payment information,” said R.I. Health Commissioner Christopher F. Koller. “These will provide significant opportunities for state agencies to measure what is happening and the effect of state policies,” Koller said. “With appropriate safeguards for safety and confidentiality, they can also be resources for private-sector partners who are working with us to improve the health of Rhode Island’s citizens.”
UnitedHealthcare of New England, a division of the for-profit national health insurer, is introducing into the Rhode Island market a new health-insurance product, Choice advanced, which deploys an analytical engine to look at cost and quality to make that information transparent to members, according to Stephen J. Farrell, CEO of UnitedHealthcare of New England.
“We’ve got our finger on the pulse of the marketplace, creating a needed solution for customers and brokers who are trying to get their arms around improving health care quality and lowering health care costs,” he told PBN.
“People will have the ability to look at health care costs, to look at providers, to look at services, to look at alternative costs, and how those costs will apply to them,” Farrell said.
The larger question around the use of population-management health analytics, according to Jennifer Wood, chief of staff of Lt. Gov. Elizabeth H. Roberts, is the need to ensure that conclusions drawn from data analysis are valid.
“Defining commonly accepted metrics that are viewed by patients, providers, payers and policymakers as valid is one critically important step,” Wood said. “Using data to isolate cause and effect when payment and delivery-system changes are made, so as not to mask where the real impact lies, is also essential.” •

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