Dayton Children’s Health has a clinically integrated network with an accountable care contract with Anthem for 20,000 lives.

THE PROBLEM

The health system previously had been using one vendor’s system as its population health platform. But that platform reached its end of life, and the vendor was not offering an upgrade path. The vendor was exiting the business and Dayton needed another platform.

"This was an opportunity to look at the state of the market and take a leap forward with our pop health platform," said J.D. Whitlock, CIO at Dayton Children’s Health. "We evaluated several options from the leading population health management HIT vendors and got a good sense of how they stacked up, how they worked, what they offered, and where they were differentiated.

"In the end," he added, "we narrowed it down to two vendors, and ultimately went with Innovaccer."

PROPOSAL

Innovaccer is a healthcare cloud company that offers a data platform for value-based care.

"Both vendors were able to give us the big-picture view on our analytics and performance for executives and management," Whitlock explained. "But I remember, as I was watching the demos, how both vendors were able to provide patient-centered insights at the point of care within the actual ambulatory EHR that the PCP was using.

"The data and analytics make it to the last mile that matters. The PCPs actually use it, because it literally becomes a part of their EHR clinical workflow."

J.D. Whitlock, Dayton Children’s Health

"That’s important, because provider engagement at the point of care – in other words, influencing provider decision-making and behavior while the patient is sitting with them – is the most effective way to identify and close care gaps that improve care quality," he added.

Previous generations of pop health platforms require the PCP to log-on to a separate portal to access the population health pool, he noted.

"That’s a problem, because historically, as anyone who has worked with pop health platforms can tell you, PCPs never use them," he contended. "No PCP is going to leave their EHR’s clinical workflow and go log on to the pop health pool. That just doesn't happen.

"Pop health portals were of limited usefulness for exactly that reason," he continued. "We went to a lot of effort collecting all this data from all these different practices, and performing fancy analytics on all of it."

And then, when Dayton put the previous-generation system in place, the only people that ever looked at it were the care coordinator nurses. That’s better than nothing, but it’s not the people Dayton wanted looking at it, which are the PCPs at the point of care.

"With Innovaccer’s platform, PCPs can see that patient’s data in the population health pool, within whatever ambulatory EHR they are using, and as an integral part of their clinical workflow," Whitlock explained. "It doesn’t care what EHR they’re using.

"Whatever EHR the PCP is using, the holistic patient record and analytics are there, at the PCP’s fingertips, just as if it’s part of the EHR the PCP is logged on to – even though it’s really a separate application," he added.

MEETING THE CHALLENGE

Dayton Children’s Health has a nurse practitioner/care coordinator/CIN quality leader that is leveraging the platform at the management level to drill down into the data and do the risk scores and care gaps. She collaborates with the CIN practices, shares the data with the respective stakeholders and works to drive improvements using one-to-one engagement with the CINs and providers.

"That could be through regular meetings where she’s sharing and discussing insights, or she could be emailing the reports to the network providers and letting them see where they’re at," Whitlock explained. "The information is being collected, analyzed, visualized and disseminated. And you're going to get some improvements out of that, of course.

"But in addition to that, to really influence the performance, you have to be driving those insights to the point of care in real time," he continued. "That’s where you start to scale it up. And the point is that now our providers can get the prompts – the clinical decision support – that we’re going to be giving them through the Innovaccer platform."

Dayton has deployed the platform and has done the initial EHR integration with athenahealth. From there, it will be integrated with other EHRs in use throughout the CIN.

"Ultimately, all of the EHRs will be interconnected, and we’ll be able to get a big picture view of population health across the CIN, as well as drive better decision-making at the point of care with each individual physician and their patients in real time," Whitlock noted.

RESULTS

Whitlock said the success metric in any accountable care contract is: Did you meet your Shared Savings? Were you able to engage providers to reduce healthcare spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts?

"So, we’ll have to wait and see what the impact is, because, again, until now, we have not been able to technologically activate one of the most important aspects of Shared Savings success overall: real-time physician engagement at the point of care," he noted.

"The analytics can only tell you what’s happening, where it’s happening, make predictions, suggest interventions and so on," he said. "It gives the providers the information and insights. But you have to be able to influence behaviors by having providers act on those insights in order to achieve results."

It’s not like just deploying a population health management platform, one suddenly has better results, he observed.

"If people can’t see the data where it matters most, or if people don’t act on the data when it matters most, nothing’s going to change," he said.

"The industry has health systems that literally spend millions on data integration and pop health analytics capabilities, and then nobody does anything with it," he continued. "With Innovaccer’s system, the data and analytics make it to the last mile that matters. The PCPs actually use it, because it literally becomes a part of their EHR clinical workflow."

ADVICE FOR OTHERS

This type of technology is essential when you are pursuing a population health management strategy with a federated CIN, where you have all these practices and all these different ambulatory EHRs that you, by definition, normally cannot get insight into. You need a solution that can do deep integrations into all of these EHRs, centralize and normalize the data, and create longitudinal patient records that enable decision support within the PCP’s clinical workflow.

The goal is to actually achieve the Shared Savings.

"These tools are a necessary enabler of that," he noted. "But there are many other things that have to happen, such as the incentives you set up in your health system, in your CIN. As I said before, health systems may invest in these tools, but if they don’t actually change how they pay their PCPs, if they don’t provide the point-of-care insights that support those incentives, nothing’s really changed.

"Success is all about people, process and technology, not just the technology alone," he concluded. "You need to align the technology to the operational and behavioral aspects, if you will, of how the organization works in order to achieve those Shared Savings."

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