How one ACO saved $55 million in 3 years with care coordination tech
Dallas-based Catalyst Health Network is a clinically integrated network of 650 independent primary care providers and 85 care team members spread across 220 office locations. Its goal has always been to ensure high-quality, affordable care is provided to the near one million patients it cares for.
In 2015, Catalyst realized there was a big opportunity, or rather, a need, to more efficiently coordinate care and do better by its patients.
“Essentially, like so many large healthcare organizations, we lacked the visibility to close the loop on patient referrals and had tons of outdated, retrospective claims data that we just couldn’t catch up with,” said Dr. Christopher Crow, president of Catalyst Health Network, a top ACO.
“We didn’t know if patients were getting the care they needed because referrals are still being sent through fax-based communication processes, and by the time we got the claims data and information we needed, it was too late to make it meaningful and actionable.”
Catalyst had no way of holding care teams, physicians or patients accountable when referrals didn’t result in appointments. And when an organization is handling one million patients and hundreds of thousands of referrals across the network, one can only imagine the number of patients that unknowingly fall through the cracks, or don’t get the care they were prescribed, and the impact that lack of insight has on an organization’s bottom line.
"It exceeded our expectations. After implementing this tool, we were able to ubiquitously communicate with people internally and externally."
Dr. Christopher Crow, Catalyst Health Network
“Every reputable EHR has a referral function, and where those referrals end up and how they are processed is different in every practice,” Crow explained. “We believed patients deserve consistency in the handoff from PCP to physician or specialist then back to PCP. If it is important enough to send, it should be important enough to make certain it is received.”
Catalyst knew this would be a challenge, given its in-network specialty providers and healthcare organizations used different EHR systems, hindering their ability to communicate and manage care transitions across the continuum.
“We knew we needed full visibility and communication across our network of providers, which required us to find a solution that could seamlessly connect the highly fragmented and expensive Texas healthcare system, something many have tried and failed in doing by trying to form-fit one of the major EHR players,” Crow stated.
LeadingReach is a vendor of provider communication and care coordination technology. When Catalyst met with the vendor to discuss its challenges, it was obvious to Catalyst that the vendor’s team looked at healthcare differently. The vendor’s team had a simple yet smart system to enable coordinated care throughout Catalyst’s integrated network, Crow contended.
“To them, the answer was clear – the key to overcoming interoperability challenges wasn’t to rely on multimillion-dollar system implementations or integrations, it was to make care coordination and communication as easy and seamless as possible for providers – from small specialty practices in Austin to major health systems in Dallas,” he said.
“Furthermore, having the ability to do it was one thing, but that would mean nothing if we couldn’t get providers to join the network and engage with one another.”
Catalyst said the vendor was committed to solving this, and to growing the network to the critical mass required to enable Catalyst to achieve its care coordination and management goals and connect all providers.
“The vendor welcomed the Catalyst team to work closely on the development of the network and solutions we needed, to ensure they would best serve the people using it day in and day out – the care teams, PCPs and front-desk staff,” Crow said.
“They also customized – and continue to customize – the technology to best meet our needs as an ACO so we ensure we have visibility on where our patients are throughout each phase of their care and control costs accordingly.”
For referrals, LeadingReach solved Catalyst’s goal of establishing transition consistency and closing the loop on received referrals. The vendor’s technology is that communication function that creates a singular way of transmitting not only patient information but the intentionality of the referral to a different care provider.
There is a variety of care coordination health IT vendors on the market today, including Ensocare, eQHealth, Greenway Health, GSI Health, Imprivata, Optum, pMD and VitalHealth Software.
MEETING THE CHALLENGE
Implementing the LeadingReach Network and other systems, Catalyst was able to digitally manage care transitions, referrals and coordinate care so patients were choosing the best option, in the most appropriate setting, with more affordable options.
“It exceeded our expectations,” Crow reported. “After implementing this tool, we were able to ubiquitously communicate with people internally and externally.”
The ease of use and intuitive nature of the product struck Crow immediately. The office support of the physician practices having to learn a new system needed a new system without complexity to slow down their workflows.
“Today, we are fully mapping the patient,” Crow said. “We manage in and out of network referrals, we know when and where our patients receive care, we know who is responsible for closing the loop on a patient and who is dropping the ball. We know everything that has to do with our patient’s experience going through the care continuum, which is the power of a connected network.”
The new technology enabled Catalyst to achieve all of its care management goals and created a fully connected information highway for healthcare – and it is arguably the most valuable technology Catalyst has ever worked with, Crow stated.
“In addition to managing care transitions, we’ve also worked with the team to develop value-added solutions on top of the LeadingReach platform, such as medical management programs, care pathways and narrow network compliance for downstream procedures. A full suite to enable full coordination and management of patient transitions and care.”
The bottom line: With this care coordination and communication technology, Catalyst achieved a savings of $55 million in three years.
“The most significant results we’ve seen are broken into three separate phases to date,” Crow explained. “We started with the stark reality of not knowing exactly where our referrals were going. Even if we did know who they were being faxed to, we certainly didn’t know the outcome of the visit. LeadingReach gave us the ability to map our entire network, which was really eye opening. We quickly realized we had more than 3,000 specialty organizations and nearly 8,000 providers in our network providing care for around one million patients.”
Over time, the vendor provided visibility into Catalyst’s patient population and their care plans, which led to a big “aha” moment.
“We started to develop some incredible layers of care management for our patients, such as medication compliance in the form of reminders, pharmacy services and ensuring compliance of care pathways,” Crow revealed.
“Our evolution with the vendor continued as we started creating throughput metrics and measuring our care coordinators and receiving providers,” he continued. “Our coordinators began monitoring when a referral’s status changed from new to received, and if it didn’t happen within 48 hours, a reminder was sent. We started tracking how long it took each provider to schedule appointments, which referrals were declined, and the reasons why.”
Catalyst also recorded other valuable information, such as how far outpatients were scheduled, did they show up to the appointment, and if so, what were the results of the visit. Being able to close the loop on the referral for Catalyst’s more than 650 PCPs allowed them to better care for their patients and ensure the best possible chance for improved outcomes, Crow explained.
“Armed with all this actionable information from LeadingReach, we are entering the next phase of our care management process,” he said.
“Through all of our different measurements, we’ve been able to identify the highest quality and lowest cost providers in our network,” he explained. “As a result of having this in place and our growing relationship with all of the major health systems in our region starting this month, we will be adding 2nd and 3rd level tracking to ancillary services like imaging and physical therapy to inpatient and outpatient surgical procedures into the facilities.”
This allows Catalyst to streamline its network based on a number of different factors such as patient insurance plans and geographic considerations in efforts to provide the best possible care for the patient at the lowest cost to the payer, Crow said.
“This was a key component in how we saved our employers more than $55 million in three years,” he said. “With the help of the LeadingReach systems, we’ve been able to achieve our referral management goals while adding key components to our value-based strategy.”
ADVICE FOR OTHERS
“The care coordination and communication technology providers choose is one of the most important and impactful decisions that healthcare organizations consider, especially under value-based care models,” Crow advised. “We must accept that massive EHRs aren’t enough to achieve interoperability and coordinate care, and the health system won’t ever switch to the same EHR platform.”
Instead, provider organizations and ACOs must look to a flexible, adaptable technology to connect the million-dollar EHR systems the organizations have chosen, he said. Stackable, EHR-agnostic systems hold the key to solving many of the industry’s technological interoperability issues; getting major players to share their data is another story, of course, he said.
“Healthcare providers must choose technology that makes it easy to do what’s right and what’s best for their patients,” he concluded. “We should all be on board with making the necessary changes to provide sound, thoughtful, coordinated care. It’s possible, we’re doing it at Catalyst in the most expensive U.S. healthcare market.”
This level of communication and information sharing is vital, he said, to bettering the health system, and there is technology out there that chooses a collaboration over competition approach – one all healthcare organizations should be following for the good of all patients.