ChenMed, a family owned prmary care practice, has developed a delivery model focused on care for seniors with complicated healthcare issues, including heart disease, diabetes, dementia, and cancer. More than 70 percent of its patients have five or more chronic conditions, according to Bryan Sivak, chief technology officer of the Department of Health and Human Services.

Sivak visited ChenMed, based in southern Florida and now expanding in the Southeast, because it is an example of an innovative care model that improves patient care and makes its delivery more efficient.

Christopher Chen, MD, CEO, demonstrated how ChenMed's uses of data are guiding clinical staff on decision-making from the moment the patient walks through the door, Sivak wrote in a Jan. 28 blog.

Dashboards, clinical decision support tools, automated reminders, in-house pharmacy and drug utilization tracking systems are part of every care encounter. “Overseeing the operations is an ‘air-traffic control’ center that monitors the flow of patient services, measures patient experiences, and guides management decision-making in real-time through each office visit,” he said. 

[See also: New primary care model in the making in New Orleans.]

ChenMed’s performance is tracked at multiple levels, including patient satisfaction and disease quality measure performance, such as hospitalization rates and hemoglobin A1C levels at a practice level for diabetes care effectiveness.

Chen explained that his performance-based care model required ChenMed to build its own IT system to accommodate the types of practice it uses to engage  patients in a non-fee-for-service based model.

As Sivak sees it, ChenMed is an example of how data-driven healthcare is changing outcomes, and innovation is occurring on the front lines in America’s primary healthcare.

“We need to advocate for policies and innovators that test new approaches and gain insights in quantitative ways to improve the outcomes of all patients,” Sivak said.

HHS agencies provide data sets, which are machine-readable and downloadable, from its vaults at Healthdata.gov for researchers and developers to use to create applications, products and services to improve healthcare, HHS also provides examples of how innovators, such as ChenMed,  are using data to boost patient care. The Health Data Initiative is part of the Obama administration’s Open Data Initiative.

[See also:Feds should integrate primary care and public health, IOM report says.]

To further open up its data, the administration has created an online showcase, a first-draft release, which highlights selected Open Data resources and how they are already being used by private sector entrepreneurs to benefit people. Over time, it will grow and evolve to help catalyze future improvements to the design, content, and infrastructure of Data.gov, according to Danny Chapman, Ryan Panchadsaram, and John Paul Farmer, Presidential Innovation Fellows who developed the experimental site.