How Eastside Health Network has been smoothing the path to value-based care by normalizing data

Credit: Eastside Health

THE PROBLEM

Eastside Health Network, based in Bellevue and Kirkland, Washington, saw which way the healthcare winds were blowing: Towards value-based care, in which financial performance is tied to clinical quality. But to get there, it knew it had to "normalize" the data, bringing disparate electronic health record systems together in a way that was actionable.

PROPOSAL

EHN formed when two integrated health networks came together, and one of them used population health management company Philips Wellcentive. The new, larger network elected to stay with Wellcentive for its ability to handle a wide variety of data situations.

"It allows providers to be providers wherever they are," said EHN Chief Administrative Officer David LaMarche. "That process has occurred and is ongoing. We pulled in all of the large practices. Some smaller ones are on incompatible systems … and haven't been pulled back in yet."

A committee is currently deciding how this multi-faceted, multi-angle data intake philosophy can translate into actionable change. According to LaMarche, payers have a veritable universe of claims data, and while they might send some of it to the system, they often won't provide the allowed amount because of rate confidentiality

EHN's reaction was to zero in on the data it had, and look, for example, at where its spend was too high so it could focus on opportunities for remedying the situation.

The result was a longitudinal patient record, accessible by a wider network of providers.

"As a whole, what we're really looking for is, 'Are we adding market leverage for these things that are commodities?'" said LaMarche. "You make sure there's no duplicate data, and make sure clients are getting the care they need."

MEETING THE CHALLENGE

The longitudinal patient record allowed the network to develop what's essentially a population health management framework, which focused the system on putting resources and infrastructure in place so that instead of treating people episodically, it was able to view them as a population.

The idea, said LaMarche, was to meet the patients where they are. Using the embedded Johns Hopkins ACG risk tool creates resource utilization bands, which anticipate the potential utilization of a member, EHN could start at the top and create a pyramid of risk, determining the best support opportunities for each patient.

"We're able to hopefully address costs and utilization per patient, and make sure the care they need they get, and the care that don't need they don't get," said LaMarche.

It's been a difficult process, what LaMarche called "pick-and-shovel work." The system has made good progress, but it's still got a ways to go.

"Our biggest significant challenge has really been pulling in all of the different clinics and interfaces from practice management systems," he said. "Getting those in has been really challenging. You have to get buy-in from the practice management system vendor and the EHR vendor, and from the practice itself.

"Sometimes they want to know how the data is going to be used. Sometimes they just want to push a button."

RESULTS

Determining the extent of the financial improvements has been tricky. There are many different ways to assess the financials of a clinically integrated network, but so far, from the data they've seen, the picture looks promising.

The clinical improvements have been easier to gauge. Across 17 different clinical categories, all saw improvement, and some showed a direct link to the data approach EHN adopted.

"It's fantastic," LaMarche said.

Yet the work isn't done -- and given the fluid nature of healthcare, it may never truly be. From a data infrastructure standpoint, the network will continue to partner with Philips Wellcentive on the next steps, which involve getting the rest of the interfaces built.

"The more you do, the more there is," said LaMarche. "It's a never-ending piece of work."

ADVICE FOR OTHERS

To do what EHN did, there needs to be a good vendor partner - one that sees the network's challenges as its own. The payer relationships are important as well; everyone has their own way of viewing data, their own way of doing things. Some of the data elements needed may not be what's being given, especially when it comes to what's allowable on claims.

Look at incremental improvements as a victory, LaMarche advises. There's no terminus, per se. No panacea.

"You've got to make sure your incentives are aligned," he said. "It's really important that the team that does the work related to this kind of thing knows the life of primary care. Primary care is besieged right now with more and more for the same pay and for the same amount of time. They're struggling to see the value of the work they're doing.

"One more click on EHRs, one more piece of information or one more login, that can be the straw that breaks the camel's back. Our job as a network should be to improve costs and improve outcomes, but also provider satisfaction."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com