Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

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Dr. Greg Spencer & Dr. Scott Hines

Preparing for the Future: Using Analytics to Drive Clinical & Operational

Excellence



Today’s Hosts

Dr. Gregory A. Spencer is the Chief Medical and Chief Medical Information

Officer at Crystal Run Healthcare and the Vice President of Medical Staff at

Orange Regional Medical Center (ORMC). Dr. Spencer graduated from the

Medical College of Wisconsin (Marquette University) Medical School and

completed his residency in Internal Medicine while in the U.S. Air Force at

Wilford Hall USAF Medical Center in San Antonio, TX. Dr. Spencer joined

Crystal Run as an internist in 1996 and was appointed to Chief Medical Officer

and Chief Clinical Information Officer in 2008. Dr. Spencer is board certified in

Internal Medicine and is a Fellow of the American College of Physicians.

Scott Hines, MD is Crystal Run Healthcare’s Co-Chief Clinical

Transformation Officer, Medical Director and physician leader for Crystal

Run Healthcare’s medical specialties division. Dr. Hines is board certified in

Internal Medicine, Endocrinology, Diabetes and Metabolism. Dr. Hines earned

his Medical Degree from the Wake Forest University in Winston-Salem, NC

and completed his residency in Internal Medicine at the Dartmouth-Hitchcock

Medical Center in Lebanon, NH. Dr. Hines completed his Endocrinology

Fellowship at the University of Maryland Medical Center in Baltimore, MD. Dr.

Hines joined Crystal Run Healthcare in his current capacity in 2006 to help

develop and implement the clinical programs necessary to deliver value based

care.



Topics

ACO progress review – national trends and Crystal Run 1

Review of progress in data-driven decision making2

Review progress with key challenges 3

Early results and wins 4

What’s next? 5



Poll Question

1. What best describes the organization you

belong to? 235 responses

a. Hospital – 21%

b. Health Plan – 11%

c. Physician Group – 13%

d. Provider Organization – 12%

e. Vendor – 43%



Crystal Run Healthcare

Physician owned MSG in NY State, founded 1996

325+ providers, 20+ locations

Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology

Early adopter EMR (NextGen®) 1999

Accredited by Joint Commission 2006

Level 3 NCQA PCMH Recognition 2009, 2012

Approved Health Plan (NY)




Single entity ACO

April 2012: MSSP participant

December 2012: NCQA ACO Accreditation

25,000 commercial lives at risk

MSSP

10,400 attributed beneficiaries

82% primary care services within ACO




The mission of Crystal Run Healthcare is to improve the

quality and availability of, and satisfaction with, health care

services in the communities we serve. To accomplish this

goal, the practice emphasizes both traditional medical

excellence as well as responsiveness to consumer needs

through service excellence and patient empowerment.



ACOs – National Trends

• Explosive growth in the number of Accountable Care Delivery

(ACO) organizations nationally

• In 2014, there were a total of 626 public and private ACOs in the

US1

• ACOs now cover an estimated 20.5 million lives in the US1

• Strong physician involvement

• 51% led by physicians and another 33% jointly led by physicians

and hospitals.2

• This is probably not surprising giving that a focus on value means

a focus on the process of care.

• Strong, effective leadership from physicians is indispensible

• Crystal Run—physician led and physician owned

1. Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from

http://leavittpartners.com/wp-content/uploads/2014/06/Growth-and-Dispersion-of-Accountable-Care-Organizations-June2014.pdf

2. Colla, C., et.al. (2013). First national survey of ACOs finds that physicians are playing strong leadership and ownership roles. Health Affairs, 33(6): 964-971.



Growth of ACO Covered Lives

Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from




ACO Penetration by Hospital Referral Region

Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from




A World in Transition

• Majority of reimbursement still fee

for service (~80%) but beginning

to see a shift toward value-based

reimbursement (now ~20%)

• In anticipation of this new future,

we are implementing a strategy

focused on:

• Rapid growth (to better manage

risk)

• Aligning physician reimbursement

with favorable patient outcomes



Key Challenges

To effectively execute on growth and population

management strategies, need to continuously

improve on:

• Reducing clinical variation, enhancing operational efficiency, and

positioning the organization to better manage risk

• Supporting informed decisions by providing clinical and

operational decision-makers efficient and effective access to all

necessary information

• Using data from a “single source of truth” integrated from several

disparate source systems

• The use of “self service analytics” by decision-makers to avoid

unnecessarily prolonged decision-making processes



Current Areas of Focus

Growth and

practice

expansion

Risk-based

contracting

Physician

compensation

Population

health

management



The Need for Data

Because data is a prerequisite for the data-driven

future, Crystal Run implemented:

• An enterprise data warehouse (EDW)

• Key foundational analytical applications to mine

and view data in order to answer key questions

and identify important trends

Key Process

Analysis

Cohort

Builder

Comorbidity

Analyzer

Population

Explorer



Poll Question

2. If you receive claims data from at least one

payer, how do you currently use this data

for population health management? 191

responses

a. We use an internally developed application –

34%

b. We use a third party application – 25%

c. We do not use the claims data we receive – 13%

d. Other – 28%



Poll Question

3. For those of you who do not receive claims data, how do you determine the cost of care for your patients, particularly for services outside of your network? 106 responses

a. We use summary reports provided by our contracted payer(s) and estimate costs – 22%

b. We attempt to extrapolate costs based on costing information within our organization – 20%

c. We do not have insights into the costs of care outside of our network – 23%

d. Other – 35%



Example – Growth & Practice Expansion

To support growth, Population Explorer helps:

• Identify growth opportunities

• Visualize population characteristics in a certain

geographic area

• Population size, demographics, case counts,

readmission rates, charges, revenue, length of stay,

likely visit types, etc. by zip code

• Assist physician hiring and placement decisions

• Marketing



Population Explorer



Population Explorer

Animate with circled areas



Example – Risk Contracting

To support growth, applications

like Cohort Builder and

Comorbidity Analyzer are used to:

• Ensure the conversations with

payers are more data-driven

and accurate

• Justify a higher PMPM to

support investment in

additional care infrastructure

• e.g., hiring more care managers

to help coordinate better care

for these patients



Comorbidity Analyzer



Example – Physician Compensation

To effectively and fairly address

important physician

compensation issues,

foundational analytics

applications are used to:

• Accurately assessment of the

care physicians actually

deliver (volume, risk profile,

subspecialty work, etc.)

Example: A breast surgeon who also does general surgery can be

more accurately benchmarked based on the volume of breast surgery

compared to the volume of general surgery, and the risk profile of the

patients they serve



Cohort Builder



Example – Population Management

To support population management, the Key Process

Analysis (KPA) tool is used to:

Can quickly visualize variation rates stratified

by physician and adjusted by risk to decide

what the biggest opportunities are so that the

variation reduction initiatives can be prioritized Identify

inappropriate

variation

1

Enhance

physician

engagement

2



KPA Tool



Example –New Revenue Opportunities

The KPA and Cohort Builder tools were used to

identify new revenue opportunities (not previously

available)

• Example: CMS DSRIP incentive program

• Although Crystal Run as a practice did not exceed the

35% threshold for Medicaid and uninsured visits,

using Population Explorer and Cohort Builder, we

were able to show that individual specialties and

individual providers surpassed the threshold

• This allowed Crystal Run to apply for a waiver to be

included in the funding for the grant program.

• Application in process



Example – Improved Budgeting

To improve the budgeting process,

Crystal Run used data and analytics to

manage and predict productivity:

• Example: A seasonally adjusted budget

(“snow days”)

• In 2014, Crystal Run experienced a

profound negative financial effect

from snow days that impeded the

ability of patients to come in for care

• This necessitated a more proactive

and accurate seasonal budgeting

and physician productivity plan



Results –Time Savings

Office expansion

● The analysis would have taken a developer about 3 days to

complete; now completed in about 2 hours

● This informed a $30M go/no-go new office construction

decision ensuring optimal ROI

Physician compensation

● Aligned physician compensation with their actual work effort

● Ensures that personnel costs are properly matched to the

clinical costs, but also ensures the physician feels fairly

compensated improving satisfaction and retention.

● The specialty assessment previously would take half a day

to conduct, and is now completed in just 5 minutes .



Results –Time Savings

Medicaid grant petitioning

● Previously, the BI team would need to have spent approximately

one week to collaborate and design multiple SQL queries to create

a useful report.

● With the foundational applications this analysis was complete in

just one hour.

● This identified a multi-million dollar Medicaid grant revenue

opportunity.

Annual budgeting and productivity planning improvements

● Created a more accurate seasonally adjusted budget and

productivity plan

‒ Avoid having thousands of patients who need care to not be seen

during the months of severe weather, and

‒ Allow physicians to better balance their professional and personal lives.



Results – Improved Contracting

More effective negotiations on risk-based

contracts

● Crystal Run is now able to bring new

information to the table to drive more

data-focused and accurate

conversations

● Crystal Run needs to capitalize on

each shared savings and risk

contract they have

‒ Comorbidities and risk profiles will ensure

transparency around the financial risk

associated with those patients and more

appropriate per member per month rates can

be negotiated



Results – Best Practice

Facilitates reduction in inappropriate clinical variation while

ensuring utilization of evidence best practice

● Clinical variation initiatives are more easily prioritized

● Priority areas are identified within the KPA tool and

discussed with providers serving a specific domain (e.g.,

diabetes care)

● Physicians have ownership in the development of best

practices and are accountable for making changes in their

individual practice to better align with evidence-based

medicine

● Ultimately, aligning on best practices will result in less

variation in care and ultimately lower costs



What’s Next?

Goal – move quickly to value-based care

● Applying for HMO license to enable Crystal Run to become a health plan ( “Crystal Run Health Plan”)

‒ Health plan will overcome some of the MSSP limitations (providers still receive fee-for-service payments; patients free to be seen wherever they want)

‒ The health plan will be a narrow network product to better ensure that patient’s do not migrate inappropriately allowing accountability for their care over long periods of time

‒ For patients on the new health plan, the majority of the care would be performed by Crystal Run

‒ It is anticipated that this health plan will launch in January, 2015

● In order to manage the plan population effectively, maximize quality and lower costs, will continue to leverage the EDW to conduct robust analytics

‒ Requires multiple levels of drill-down capability



Placeholder, enter yourown text hereQuestions,

discussion,

comments…


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Thank You

Greg Spencer, MD, CMO

Crystal Run Healthcarewww.crystalrunhealthcare.com

Contact Information

Scott Hines, MD

Crystal Run Healthcarewww.crystalrunhealthcare.com

Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

Healthcare

Transcript of Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence