Assuring Value-Based Care with Data Integrity

The following is a guest article by Cliff Frank, Executive Director, Shore Quality Partners

Data infrastructure plays an important role in healthcare networks’ ability to navigate evolving care delivery and payment models. Taking meaningful steps to ensure data integrity while maintaining a thoughtful infrastructure is instrumental in realizing the potential of population health management and other value-based care initiatives.

Increasingly, healthcare organizations must rely on a multitude of stakeholders to collaborate around outcome-oriented care. For clinically integrated networks (CINs) like Shore Quality Partners, proactive, personalized and informed engagement with those stakeholders—supported by a shared data infrastructure—has proven key to their ongoing success.

Formed in 2014, Shore Quality Partners is comprised of more than 240 independent and employed primary care physicians in southeastern New Jersey. The CIN, which is part of the Allegiance accountable care organization, contracts with commercial and federal payers to support the health of approximately 35,000 patients.

Shore credits its ability to improve patient outcomes and achieve shared savings success to the CIN’s data- and analytics-driven strategy. The organization partners with New Jersey-based HealthEC to support its data infrastructure and population health program efforts. Shore has leveraged their population health platform to aggregate data sources, benchmark clinical performance at individual provider and network levels, and drive improvements within the CIN. What follows are real-world examples of a few of the ways Shore is using data to align stakeholders and promote clinical transformation.

Laboratory Referrals

A review of lab utilization data revealed a large cost differential between regional labs. While most providers within Shore were referring patients to one centralized, low-cost lab, two practices routinely were sending patients to a higher cost lab. Clinician rationale ranged from convenience (the lab was right down the street) to apathy (it was what they always had done).

Shore used their population health platform to aggregate and verify the data, and then had their value-based quality team validate before presenting to clinicians. The report showed with confidence that referrals to the high-cost lab were costing clinicians money, indicating exactly how much was at stake. In light of the data, clinicians within the CIN shifted referrals to the lower cost lab, which net a savings of $50,451 for the ACO from 2017 to 2018. The resources saved from this change directly correlate to the contracts with the participating physicians.

Radiology Referrals and Utilization

Another challenge Shore faced related to a popular radiology center in the area that had a reputation for doing repeat procedures. The risks for running repeat radiologic procedures included over-exposure of the patient to radiation as well as duplicate costs, and therefore merited exploration.

Shore leveraged the CIN’s shared analytics platform to calculate a benchmark of other ACO clients to compare radiology orders. To standardize the comparison between practices, the report specifically looked at the likelihood of a repeat radiology study done within eight weeks at each facility. Comparison revealed that the average rate of a repeat procedure for radiology practices within the CIN was 16%. The radiology center in question had a 24% chance of a repeat study; 50% more than at Shore’s in-network facility. As with the lab utilization analysis, data was shared with clinicians to demonstrate the variance, driving physicians to modify referral patterns.

High-Risk Patients Not Recently Seen by a PCP

To address issues related to gaps in patient care, Shore wanted to identify high-risk patients that hadn’t been seen by a clinician within the past 6, 8 and 12 months. Using the population health platform, leadership provided clinicians with a quarterly report listing high-risk patients that hadn’t been seen recently. The report equipped practices with the information needed to proactively contact those patients to stem the tides of a potential health emergency down the road. Reports also identified patients not properly attributed to a clinician and made recommendations on which patients should align with which physicians within the CIN to ensure the greatest cost and quality impact.

Shore used data reports to illustrate the impact to cost, care quality and subsequent bonus performance distributions to network physicians. Armed with the necessary information, Shore clinicians have implemented proactive programs to engage high-risk patient populations and avoid unnecessary emergency visits.

Data’s Impact on Driving Physician Culture and Behavior

The effective use of reliable data can have a dramatic impact on leadership’s ability to drive physician behavior in a positive direction. Shore physicians have overwhelmingly responded favorably to initiatives backed by data. Leadership’s ability to leverage data to quantify the clinical and financial impact of carrying on with business as usual versus implementing recommended changes has helped the CIN cultivate trust and follow-through among clinical staff. Physicians now proactively seek data insights for their practice. Beyond the immediate cost and quality benefits of this increased engagement, the network has been able to reinforce a culture of camaraderie and consistently improve the network’s bonus performance with value-based contracts.

About the Author

Cliff Frank is interim Executive Director at New Jersey-based Shore Quality Partners.