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Quality Update - Health care quality issues for Minnesota's health care leaders

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Health IT's Role in a Changing Reimbursement Landscape

Health information technology (HIT) has become an essential tool in the new care reimbursement models which reward value over volume. Value Based Purchasing, Total Cost of Care, Health Care Homes, and Accountable Care Organizations (ACO) all require new uses of data for health care organizations to succeed in the value driven world.

New models of care have expanded the use of population data beyond external reporting for performance ranking. The payment structure of the Health Care Home model now incents providers to use disease registries to target improvement opportunities for patients with specific conditions, such as asthma, diabetes, and heart failure.

For the 89 Medicare ACOs across the country, HIT plays a critical role in supporting their goals to improve care quality and reduce costs through:

  • Quality reporting
  • Clinical information exchange
  • Medical management across the continuum of care
  • Member engagement
  • Predictive modeling
  • Managing financial risk1

“Health IT is a platform and a tool to help us begin to innovate models of care,” said Raymond Gensinger, chief medical information officer, Fairview Health Services, one of Minnesota’s three Pioneer ACOs, among 32 across the country.

Medicare provides ACOs with all claims data for their assigned fee-forservice patients. They can now see care these patients receive outside their own walls. By amassing all forms of patient information through a data warehouse, ACOs are analyzing data in new, more complex ways, including risk stratification and predictive analytics.

“Risk stratification, predictive analytics, population disease registries, proactive treatment, chronic disease management— this is exiting, cutting edge stuff,” commented Gregg Teeter, lead analytics advisor at Park Nicollet Health Services, another Minnesota Pioneer ACO.

ACOs are starting to learn more about their populations and leverage that information to identify the most promising interventions.

“The role of HIT is to turn data into actionable lists of high risk patients and reach out to them to engage before they peak and encounter an acute situation,” said Teeter.

Predictive modeling in action

Teeter and his colleagues in health sciences research at the Park Nicollet Institute partnered to develop a model to predict which patients currently in the hospital are likely to be readmitted within 30 days.

For each hospitalized patient, a probability score for readmission is generated based on a regression model that looks at comorbidity, prior utilization, and demographic variables. Patients are determined to be at high, medium, or low-risk for readmission. High risk patients are flagged in the EHR and care coordinators provide them with more intensive follow up.

Looking ahead

Health reform and the Affordable Care Act are incenting leaders to innovate and are pulling all health care organizations toward value-based care.

If ACOs can successfully move away from the fee-for-service model, they can use the value driven approach with commercial payors and talk about contracting in a new way that incents health and wellness.

Federal meaningful use requirements are propelling the use of electronic health record (EHR) systems at all clinics and hospitals. Providers must meet objectives for quality reporting, lists of patients by specific conditions to use for quality improvement, and information exchange across settings. Effectively using this EHR functionality for care management will begin to prepare health care organizations to participate in value based care models.

1. Health Information Requirements for Accountable Care. Computer Sciences Corporation, 2010.

REACH client progress toward meaningful use