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Transition to value-based care requires planning, communication

Transitioning to value-based care can be a tough road for healthcare organizations, but creating a plan and focusing on communication with stakeholders can help drive the change.

Value-based care is a model that rewards the quality rather than the quantity of care given to patients. The model is a significant shift from how healthcare organizations have functioned, placing value on the results of care delivery rather than the number of tests and procedures performed. As such, it demands that healthcare CIOs be thoughtful and deliberate about how they approach the change, experts said during a recent webinar hosted by Definitive Healthcare.

Andrew Cousin, senior director of strategy at Mayo Clinic Laboratories, and Aaron Miri, CIO at the University of Texas at Austin Dell Medical School and UT Health Austin, talked about their strategies for transitioning to value-based care and focusing on patient outcomes.

Cousin said preparedness is crucial, as organizations can jump into a value-based care model, which relies heavily on analytics, without the institutional readiness needed to succeed.  

“Having that process in place and over-communicating with those who are going to be impacted by changes to workflow are some of the parts that are absolutely necessary to succeed in this space,” he said.

Mayo Clinic Labs’ steps to value-based care

Cousin said his primary focus as a director of strategy has been on delivering better care at a lower cost through the lens of laboratory medicine at Mayo Clinic Laboratories, which provides laboratory testing services to clinicians.

Andrew Cousin, senior director of strategy, Mayo Clinic LaboratoriesAndrew Cousin

That lens includes thinking in terms of a mathematical equation: price per test multiplied by the number of tests ordered equals total spend for that activity. Today, much of a laboratory’s relationship with healthcare insurers is measured by the price per test ordered. Yet data shows that 20% to 30% of laboratory testing is ordered incorrectly, which inflates the number of tests ordered as well as the cost to the organization, and little is being done to address the issue, according to Cousin.

That was one of the reasons Mayo Clinic Laboratories decided to focus its value-based care efforts on reducing incorrect test ordering.

To mitigate the errors, Cousin said the lab created 2,000 evidence-based ordering rules, which will be integrated into a clinician’s workflow. There are more than 8,000 orderable tests, and the rules provide clinicians guidance at the start of the ordering process, Cousin said. The laboratory has also developed new datasets that “benchmark and quantify” the organization’s efforts.  

To date, Cousins said the lab has implemented about 250 of the 2,000 rules across the health system, and has identified about $5 million in potential savings.

Cousin said the lab crafted a five-point plan to begin the transition. The plan was based on its experience in adopting a value-based care model in other areas of the lab. The first three steps center on what Cousin called institutional readiness, or ensuring staff and clinicians have the training needed to execute the new model.

The plan’s first step is to assess the “competencies and gaps” of care delivery within the organization, benchmarking where the organization is today and where gaps in care could be closed, he said.

The second step is to communicate with stakeholders to explain what’s going to happen and why, what criteria they’ll be measured on and how, and how the disruption to their workflow will result in improving practice and financial reimbursement.

The third step is to provide education and guidance. “That’s us laying out the plans, training the team for the changes that are going to come about through the infusion of new algorithms and rules into their workflow, into the technology and into the way we’re going to measure that activity,” he said.

Cousin said it’s critical to accomplish the first three steps before moving on to the fourth step: launching a value-based care analytics program. For Mayo Clinic Laboratories, analytics are used to measure changes in laboratory test ordering and assess changes in the elimination of wasteful and unnecessary testing.

The fifth and final step focuses on alternative payments and collaboration with healthcare insurers, which Cousin described as one of the biggest challenges in value-based care. The new model requires a new kind of language that the payers may not yet speak.

Mayo Clinic Laboratories has attempted to address this challenge by taking its data and making it as understandable to payers as possible, essentially translating clinical data into claims data.     

Cousin gave the example of showing payers how much money was saved by intervening in over-ordering of tests. Presenting data as cost savings can be more valuable than documenting how many units of laboratory tests ordered it eliminated, he said.

How a healthcare CIO approaches value-based care

UT Health Austin’s Miri approaches value-based care from both the academic and the clinical side. UT Health Austin functions as the clinical side of Dell Medical School.

Aaron Miri, CIO at the University of Texas at Austin Dell Medical School and UT Health Austin Aaron Miri

The transition to value-based care in the clinical setting started with a couple of elements. Miri said, first and foremost, healthcare CIOs will need buy-in at the top. They also will need to start simple. At UT Health Austin, simple meant introducing a new patient-reported outcomes program, which aims to collect data from patients about their personal health views.

UT Health Austin has partnered with Austin-based Ascension Healthcare to collect patient reported outcomes as well as social determinants of health, or a patient’s lifestyle data. Both patient reported outcomes and social determinants of health “make up the pillars of value-based care,” Miri said.  

The effort is already showing results, such as a 21% improvement in the hip disability and osteoarthritis outcome score and a 29% improvement in the knee injury and osteoarthritis outcome score. Miri said the organization is seeing improvement because the organization is being more proactive about patient outcomes both before and after discharge.  

For the program to work, Miri and his team needs to make the right data available for seamless care coordination. That means making sure proper data use agreements are established between all UT campuses, as well as with other health systems in Austin.   

Value-based care data enables UT Health Austin to “produce those outcomes in a ready way and demonstrate that back to the payers and the patients that they’re actually getting better,” he said.

In the academic setting at Dell Medical School, Miri said the next generations of providers are being prepared for a value-based care world.

“We offer a dual master’s track academically … to teach and integrate value-based care principles into the medical school curriculum,” Miri said. “So we are graduating students — future physicians, future surgeons, future clinicians — with value-based at the core of their basic medical school preparatory work.”

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With the onset of value-based care, machine learning is making its mark

In a value-based care world, population health takes center stage.

The healthcare industry is slowly moving away from traditional fee-for-service models, where healthcare providers are reimbursed for the quantity of services rendered, and toward value-based care, which focuses on the quality of care provided. The shift in focus on quality versus quantity also shifts a healthcare organization’s focus to more effectively manage high-risk patients.

Making the shift to value-based care and better care management means looking at new data sources — the kind healthcare organizations won’t get just from the lab.

In this Q&A, David Nace, chief medical officer for San Francisco-based healthcare technology and data analytics company Innovaccer Inc., talks about how the company is applying AI and machine learning to patient data — clinical and nonclinical — to predict a patient’s future cost of care.

Doing so enables healthcare organizations to better allocate their resources by focusing their efforts on smaller groups of high-risk patients instead of the patient population as a whole. Indeed, Nace said the company is able to predict the likelihood of an individual experiencing a high-cost episode of care in the upcoming year with 52% accuracy.

What role does data play in Innovaccer’s individual future cost of care prediction model?

David Nace, chief medical officer, Innovaccer David Nace

David Nace: You can’t do anything at all around understanding a population or an individual without being able to understand the data. We all talk about data being the lifeblood of everything we want to accomplish in healthcare.

What’s most important, you’ve got to take data in from multiple sources — claims, clinical data, EHRs, pharmacy data, lab data and data that’s available through health information exchanges. Then, also [look at] nontraditional, nonclinical forms of data, like social media; or local, geographic data, such as transportation, environment, food, crime, safety. Then, look at things like availability of different community resources. Things like parks, restaurants, what we call food deserts, and bring all that data into one place. But none of that data is standardized.

How does Innovaccer implement and use machine learning algorithms in its prediction model?

Nace: Most of that information I just described — all the data sources — there are no standards around. So, you have to bring that data in and then harmonize it. You have to be able to bring it in from all these different sources, in which it’s stored in different ways, get it together in one place by transforming it, and then you have to harmonize the data into a common data model.

We’ve done a lot of work around that area. We used machine learning to recognize patterns as to whether we’ve seen this sort of data before from this kind of source, what do we know about how to transform it, what do we know about bringing it into a common data model.

Lastly, you have to be able to uniquely identify a cohort or an individual within that massive population data. You bring all that data together. You have to have a unique master patient index, and that’s been very difficult, because, in this country, we don’t have a national patient identifier.

We use machine learning to bring all that data in, transform it, get it into a common data model, and we use some very complex algorithms to identify a unique patient within that core population.

How did you develop a risk model to predict an individual’s future cost of care? 

You can’t do anything at all around understanding a population or an individual without being able to understand the data.
David NaceChief medical officer, Innovaccer

Nace: There are a couple of different sources of risk. There’s clinical risk, [and] there’s social, environmental and financial risk. And then there’s risk related to behavior. Historically, people have looked at claims data to look at the financial risk in kind of a rearview-mirror approach, and that’s been the history of risk detection and risk management.

There are models that the government uses and relies on, like CMS’ Hierarchical Condition Category [HCC] scoring, relying heavily on claims data and taking a look at what’s happened in the past and some of the information that’s available in claims, like diagnosis, eligibility and gender.

One of the things we wanted to do is, with all that data together, how do you identify risk proactively, not rearview mirror. How do you then use all of this new mass of data to predict the likelihood that someone’s going to have a future event, mostly cost? When you look at healthcare, everybody is concerned about what is the cost of care going to be. If they go back into the hospital, that’s a cost. If they need an operation, that’s a cost.

Why is predicting individual risk beneficial to a healthcare organization moving toward value-based care?

Nace: Usually, risk models are used for rearview mirror for large population risk. When the government goes to an accountable care organization or a Medicare Advantage plan and wants to say how much risk is in here, it uses the HCC model, because it’s good at saying what’s the risk of populations, but it’s terrible when you go down to the level of an individual. We wanted to get it down to the level of an individual, because that’s what humans work with.

How do social determinants of health play a role in Innovaccer’s future cost of care model?

Nace: We’ve learned in healthcare that the demographics of where you live, and the socioeconomic environment around you, really impact your outcome of care much more than the actual clinical condition itself.

As a health system, you’re starting to understand this, and you don’t want people to come back to the hospital. You want people to have good care plans that are highly tailored for them so they’re adherent, and you want to have effective strategies for managing care coordinators or managers.

Now, we have this social vulnerability index that we have a similar way of using AI to test against a population, reiterate multiple forms of regression analysis and come up with a highly specific approach to detecting the social vulnerability of that patient down to the level of a ZIP code around their economic and environmental risk. You can pull data off an API from Google Maps that shows food sources, crime rates, down to the level of a ZIP code. All that information, transportation methods, etc., we can integrate that with all that other clinical data in that data model.

We can now take a vaster amount of data that will not only get us that clinical risk, but also the social, environmental and economic risk. Then, as a health system, you can deploy your resources carefully.

Editor’s note: Responses have been edited for brevity and clarity.

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Can value-based care models cut costs? Yes, they can

Nearly 25 years after value-based care models began, Change Healthcare’s just-released survey showed 100% of respondents are saving money using those principles.

The survey of 120 insurance company payers is Change Healthcare’s third effort since 2012 to understand what works — and what doesn’t — when it comes to value-based care models.

The universality of savings was a surprise to Andrei Gonzales, M.D., director of value-based reimbursement initiatives at Change Healthcare, a provider of payment, data analytics and a variety of other healthcare platforms based in Nashville, Tenn. “We expected medical cost savings,” Gonzales said, “but to have 100% say they achieved savings and with almost 25% having cost savings of over 7.5% was surprising. We’ve seen savings in our own work, but we wanted a more objective and quantifiable view of the impact of these programs.”

But Gonzalez wasn’t surprised payers were struggling to innovate and to move quickly. Just 21% said they could roll out a new value-based care model in three to six months, while 13% said they needed a full two years.

“Agility in healthcare is difficult, but it is possible,” he said. “With more experience, this should get easier.”

Agility in healthcare is difficult, but it is possible.
Andrei GonzalesM.D., director of value-based reimbursement initiatives at Change Healthcare

Payers were also frustrated with the technology underpinnings of their value-based care models, Gonzales said. More than half of those surveyed said their analytics, automation and reporting capabilities just weren’t doing the job. In many cases, these tools were custom-built specifically for the value-based care models, Gonzales explained. But as more and more initiatives roll out, the services can struggle to keep up.

The other struggle is to get hospitals and physicians on board with value-based care models, he said. “It’s not surprising to us how difficult it can be to engage providers in a value-based care model,” he said.

Busy doctors and staff can do a good job with patient care in their particular silo, but have a hard time looking across the spectrum of care, he said.

“But once they understand the problem and can see the data that they’re not doing as well as a competitor is doing and that they have to compete for patients, then they start to understand. That’s really where the work is right now.”

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Hi, The motherboard on my HP N54L NAS has died.

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Anyone have one you want to sell?

Thanks
Chris

Location: High Wycombe, Bucks, UK

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Cooler Master Masterkeys Pro M – Cherry MX Brown

HP N54L for DSM

Hi, The motherboard on my HP N54L NAS has died.

I do not need drives or memory and do not care about the state of the box. It just needs to be in good working order.

Anyone have one you want to sell?

Thanks
Chris

Location: High Wycombe, Bucks, UK

______________________________________________________
This message is automatically inserted in all classifieds forum threads.
By replying to this thread you agree to abide by the trading rules detailed…

HP N54L for DSM

HP N54L for DSM

Hi, The motherboard on my HP N54L NAS has died.

I do not need drives or memory and do not care about the state of the box. It just needs to be in good working order.

Anyone have one you want to sell?

Thanks
Chris

Location: High Wycombe, Bucks, UK

______________________________________________________
This message is automatically inserted in all classifieds forum threads.
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HP N54L for DSM

Wanted – HP N54L for DSM

Hi, The motherboard on my HP N54L NAS has died.

I do not need drives or memory and do not care about the state of the box. It just needs to be in good working order.

Anyone have one you want to sell?

Thanks
Chris

Location: High Wycombe, Bucks, UK

______________________________________________________
This message is automatically inserted in all classifieds forum threads.
By replying to this thread you agree to abide by the trading rules detailed here.
Please be advised, all buyers and sellers should satisfy themselves that the other party is genuine by providing the following via private conversation to each other after negotiations are complete and prior to dispatching goods and making payment:

  • Landline telephone number. Make a call to check out the area code and number are correct, too
  • Name and address including postcode
  • Valid e-mail address

DO NOT proceed with a deal until you are completely satisfied with all details being correct. It’s in your best interest to check out these details yourself.