Steward Healthcare: ACO success hinges on IT strength, integrated claims, EHR data
Accountable care organization Steward Healthcare recognizes that a robust IT infrastructure is crucial to the success of integrated care delivery.
With 3,000 physicians, 10 hospitals, 24 affiliated urgent care providers and six ambulatory surgery centers, in fact, the system has “a complex network of electronic health records,” according to Heather Trafton, Steward's executive director of performance management, population health and quality.
"Our hospitals are on one EHR, however, while employees and affiliate providers are on several different types of EHRs operating in hundreds of databases,” Trafton said. “The greatest challenge has been the aggregation of the EHR data into a centralized data warehouse where it can be combined and matched with claims data."
In a HIMSS16 session, "Integrated EHR Data and Its Impact on Pioneer ACO Quality Programs," Trafton will discuss the challenges and the benefits of that integration, so critical to success in keeping populations healthy and doing well, financially speaking, under shared risk reimbursement models.
Although the current title of Trafton's talk refers to the Pioneer ACO model, Steward actually left that accountable care program this past November and earlier this month, it was announced as a participant in CMS' Next Generation ACO model.
Trafton is expected to talk about data integration, EHR standardization and more, offering her perspective and experience-derived best practices for integrating EHR and claims data to succeed in the new era of value-based care.
"The obvious issue with using claims data is that it is three to six months lagged," Trafton said. "Your patient could have already been discharged from the emergency room twice and had a subsequent admission before you even know about the first emergency room visit. The ability to positively impact that patient has been missed."
Integrating clinical information from the EHR, on the other hand, enables the approximation of a real-time data feed about what is happening with the patient on any given day.
"It allows for intervention,” Trafton said, “whether that is most appropriately done by care management, a pharmacist, a health coach or PCP."
Steward has seen success by integrating both data types, having developed "a robust, payer-agnostic, quality program with the ability to identify gaps in care for a patient across multiple quality metrics," said Trafton.
"With this information we have been able to create a successful patient outreach program with a single point of contact and tracking system on projected compliance. Without the integrated data, a patient could receive duplicate screening studies and have multiple outreaches by different members of the care team."
Exchanging inpatient and outpatient data is another key step, she said: Steward’s ambulatory care managers use real-time hospital EHR data to spot high-risk patients in the ER and inpatient units, allowing for better discharge planning.
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Trafton said strong vendor partnerships "are necessary to be successful in achieving integration in an organization with a complex IT infrastructure." The ability to identify and articulate infrastructure gaps, for instance, is essential in deciding who to partner with.
However, Trafton said that "community-based organizations can participate in alternative payment models even if they are not integrated by a single EHR; integrating data is just one step in the journey to achieving success under value-based care."
The session, "Integrated EHR Data and Its Impact on Pioneer ACO Quality Programs," is slated for March 2, 2016, from 2:30 to 3:30 p.m. in Palazzo I at Sands Expo Convention Center.
Also, here's a map of where the Pioneer and Next Generation ACO participants are located.