Driving Efficiency in Community Health
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Transcript of Driving Efficiency in Community Health
Jeb Burrows, Director, Market Strategy
The information presented in this Webinar is current as of date of live airing – June 25, 2014
Driving Efficiency in Community
Health
Community health to athenahealth
Challenges unique to Community Health Centers
The Solution
Question & Answer
Agenda
We are listening and learning
athenahealth Leadership InstituteConnecting health care leaders to innovative ideas
SPECIAL TOPIC:
Federally Qualified Health Centers
Athenahealth Growing FQHC Footprint
6
2009 2010 2011 2012 2013 20140
20
40
60
80
100
120
1 1 2 716 25
32 37 43
57
72
88
FQHC RHC
Data required for reporting is arduous – PCMH, MU, UDS
Maintaining financial viability and having access to cash is paramount
Techonology partners must enable clinical and financial success
.. And here is what we’ve heard
What is a Patient-Centered Medical Home (PCMH)?
PCMH is a model of primary care.
Personal physician:• Each patient has an ongoing relationship with a personal physician
trained to provide first contact, continuous and comprehensive care.
Physician directed medical practice:• The personal physician leads a team of individuals at the practice level
who collectively take responsibility for the ongoing care of patient.
Enhanced access:• Care is available through systems such as open scheduling, expanded
hours and new options for communication between patients, their personal physician, and practice staff
Payment:• The added value provided to patients who have a patient-centered
medical home is appropriately recognized
PCMH Recognition is Growing Rapidly
NCQA Annual Report 2012. http://www.ncqa.org/LinkClick.aspx?fileticket=svcb8LsMDpI%3d&tabid=675
PCMH Recognition is Becoming Part of the Reimbursement
Landscape
More than 25 health plans incorporate PCMH recognition into their own programs, and many will offer financial incentives.
Stage 2 has more core measures, fewer menu measures, and
higher thresholds
STAGE 1 STAGE 2
Higher thresholds
3 of 6 Menu
17 Core
5 of 10 Menu
15 Core
Known challenges of UDS reporting
3. Resource requirements are significant Managing the data, details, “running” the reports
1. UDS is not a canned report HRSA guidelines can (and will) be interpreted differently
Year over year consistency is highly valued during audit process
Switching practice management/EHR systems is difficult
Generate reports anticipating audit questions
2. Process and knowledge retention UDS report specification will change every year
Audit questions may be extraordinarily detailed
Submit, forget details, remember details, resubmit, repeat?
FQHC billing is complex
Identification of and creation of “wrap around
claims”
Flexible reporting system to
support UDS
Claim splitting “rules” reduce work for billing
staff
Poverty-based sliding scales
support indigent care
Greek chorus DOMINATES exam room
72% of physicians say that EHRs distract from face time
Source: athenahealth’s 2012 Physician Sentiment IndexTM (http://www. athenahealth.com/PSI/meaningful-use-incentives.php).
• 52,000+ providers on athenaNet®
• Clients ranging from 1 to 5,000+
• 50 states and 92 medical specialties
• $13+ billion in client collections per year
• 30% annual growth since 1997
• Epocrates serving 330,000+ U.S. MD’s weekly; 1 million+ healthcare providers
“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
#1 Overall
Software Vendor
#1 Overall
Physician Practice Vendor
#1 PatientPortal
#1 Practice
Management
System(1-10, 11-75 physicians)
#2 EHR
(1-10, 11-75 physicians)
2013 Best in KLAS
We are building the health care internet
Perf
orm
an
ce &
V
isib
ilit
y
High
High
Connection to Outcomes
Software
ASP
SaaS
Cloud-Based Service
Cloud-based Service provides high performance, visibility and
connection to outcomes
The Cloud
Monthly billing as percent of collections
No up front
capital investment
UDS reporting,
PCMH accelerator
program are
available at no
additional cost
Paid as percent of collections
$ %
In 2013, KLAS rated athenaClinicals as the most
usable EHR at go live and today
24
“Ambulatory EMR Usability 2013: More Nurture than Nature,” May, 2013. © 2013 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
Athenahealth was first to undergo NCQA PCMH
Corporate Review
0
20
40
60
80
100
85
18.5
31.5
35
Minimum for NCQA Level 3
Practice Responsibility
athenahealth tools
athenahealth pre-validation
athenahealth covers about 60% of the points required for NCQA’s highest level of PCMH recognition
PCMH Accelerator Program
PCMH as one of the many models of care in our evolving healthcare
landscape
Meaningful Use as an HIT adoption,
utilization, and standards foundation
ACO as a
managemen
t and cost
savings
structure
PCMH focusing on Primary
Care
Population Health
as goal for improved quality, cost, and patient
outcomes
Each health initiative builds on a foundation that
supports subsequent programs,
eventually leading to outcomes and a
transformed health care
system
Our approach to Stage 2 Meaningful Use
athenaClinicals received 2014 Edition MU certification on 6/21/13
All athenahealth clients using a 2014 Edition MU certified EHR today
Any software changes to support MU will be pushed to all clients immediately
Centrally monitor the performance of every provider within your practice to tell them if they are ahead or behind in meeting MU criteria
Identify insights based on high and low performers nationwide and roll out to network
Coach on Meaningful Use program performance with intervention for poor performance
Take on the technical work required to satisfy health information exchange measures
Management of registration and attestation with CMS
Incentive payment tracking and processing
95.6% of our participating physicians attested to Medicare MU in 2013
athena’s approach to UDS
• Identify contents of the report• Build data structures to create report• Run and deliver large reports
Software
• Interpret all UDS report specifications• Provide single source documentation for
assumptions• Improve reports based on audit questions• Allow for additional data to combine EMR
systems
Knowledge
• Attend annual training, interpret new specifications
• Provide answers for detailed audit questions• Generate additional one-time reports for audits
Service
And their performance is proof of our combined success
31
On average, 38 days in account
receivable
96% first pass resolved rate
$200,000 in average daily charges
Performance is measured for 2012:Q4-2013:Q1
A Success StoryHudson Healthwaters
“The data is at our fingertips. We can
pull UDS information. We can get gaps
in care reports related to quality
measures. We are now being seen by
the federal government as a very
efficient provider. - Cindy Reynolds
Vice President of Transformation and Clinical Quality
”
Prior to athenahealth: FQHC demands and needy
population nearly cause bankruptcy
Bills sitting in DAR for 85 days
Required federal data and business planning data painful to collect
With athenahealth: Reduced billing staff and still
reduced DAR to 39 days
Collections increased 79.32%
Patient visits increased 5.72%
No-show rate decreased 13.73%
Business and regulatory data instantly accessible
“We know that we will always be
taken seriously
and responded to
– by everyone we interact with
at athenahealt
h.”
– Joel Feinman, MD Valley Medical Group