Closing care gaps, improving quality and driving down costs across a seven-hospital, 2,500-physician network is no easy feat — especially when you can only see performance data through a rear-view mirror.
That's why Bill Gillis, the CIO of Westwood, Mass.-based Beth Israel Deaconess Care Organization, wanted to move the physician-hospital network to a more nimble analytics platform that supported value-based decision-making. Through a partnership with Arcadia Healthcare Solutions, BIDCO, which cut its teeth in the Pioneer ACO program and now operates as a Medicare Shared Savings Program Track 3 ACO, went live this summer on a cloud-based analytics platform.
We caught up with Mr. Gillis to discuss the rollout of the population health management platform, which pulls in data from more than 45 EHRs across BIDCO's network of hospitals and physician practices and combines it with claims data in real time. In the following interview with Becker's, Mr. Gillis shares the challenges and benefits of the rollout and what's on the docket for BIDCO next year.
Note: This interview has been lightly edited for length and style.
Question: BIDCO launched a new system with Arcadia Healthcare Solutions in August to enable real-time, cloud-based analytics. Can you tell me a little more about that rollout?
Bill Gillis: We broke our go-live into two components: back-end access, or access to the sequel layer of the database for the analysts at BIDCO to go in and run reports, which went live in July. Then in August we opened the front end, which is basically for all the end users. Our goal for those go-lives was to replicate what we had in our previous environment, so we could maintain business continuity, plus any updates we could bring along the way. The good news is Arcadia brought a lot of improvements, particularly on the care management side.
Since August, we've been refining the platform and resolving some issues. For example, when we're looking at that front-end view, we displayed patient attribution at the provider-functional level, which basically casts a wider net for quality. It looked like [providers] had a lot more people they needed to solve care gaps for. That is where we want the platform to go — we really want to cast that wider net for quality — but because of the time of the year, when you're in the last quarter, we decided to roll that back and distribute information based on what they had previously seen in our old platform. Last week we went live with a new version of Arcadia that allows an end-user to toggle between the plan view or functional view, so they can see quality and whether it's attributed to the physician or to the plan itself. That's been a big gain for us and brought us a lot of excitement from the network on use of the platform.
Care management continues to improve. We are moving closer to hoping folks can self-service a lot of their reporting needs from the front-end. We still have a lot of education to do.
While there have been challenges, as with any huge implementation, the data we're seeing and able to deliver is far more usable and accurate than we ever had in our previous platform. People see the value of this implementation.
Q: So it's real-time data?
BG: It's real time. About 87 percent of our EHR data comes in on a nightly basis — we do have a couple EMRs that don't have the technical capability to deliver nightly, but deliver weekly. [That data] is merged or married to the claims data we get and shows people how they're performing in quality, utilization and medical expense. And that gives them a trajectory.
We've actually uncovered a couple places where…some of our members had large amounts of unbilled claims that never went out the door. The EHR data was showing they were closing the care gaps, but the claims data was coming back and not showing the same numbers. When we dug into it and followed some of the bread crumbs back, we were able to find out, 'OK, you billed for this and it went into your billing queue, but it never went out the door. So from the payer's perspective, it didn't happen.' That was a great artifact of having this system being so accurate.
Q: What has been the most rewarding part of the rollout so far?
BG: The most rewarding part so far has been having the data readily available.
It's not only having the front end available to folks — I'll be honest, folks are still learning how to use it — but I'd say [the most rewarding part so far is] on the back end with our own analysts. It doesn't require us to pull data from five different systems, aggregate it ourselves, normalize it and try to put things in spreadsheets. Now it's all in one place, and we're able to go in and pull this information really quickly and readily and produce much more refined reporting, not only for ourselves, but for our leadership and our members.
Q: Based on your rollout experience, what advice would you offer other healthcare organizations looking to implement similar technology?
BG: Make sure you're going into a partnership, not just a client-vendor relationship. We have a real partnership with Arcadia, and they are very invested in our success. I've certainly been in client-vendor relationships where an engineering team will say, 'The lights are green on my end; the problem is with you.' Instead, [Arcadia is] working with us hand-in-hand, trying to help us solve problems and open to hearing why something is important.
And don't underestimate the time it really takes to make this kind of a change. If you are moving your network to really rely on this data to support your performance in a risk-based contract, you've got to be 100 percent confident in that data and able to go back when you're challenged with it. Follow those crumbs back and prove yourself correct. It took us about a year to get to this place.
Q: What are you most looking forward to in 2018 in terms of health IT?
BG: We are really looking forward to what we are calling "Phase Two" of Arcadia. We are going to start pulling in all of these other data elements from our member systems and external systems.
For example, we will be getting all of the [admit, discharge and transfer] data from our member hospitals. We're also going in with a lot of other Medicaid ACOs in the Massachusetts region to exchange Medicaid ADT data between each other for those Medicaid ACO populations. That's going to be a huge win. We're going to pull the schedule data from all 46 EHRs we've got in the community. That will really help practices have more confidence in our data because they won't look at and say, 'Well I'm being dinged for five people here, but by the time I get this report, [those patients have] already had their mammograms.' It really helps with buy-in and real-time accuracy. We're also going to start trying to pull in encounter and billing information, so we have an understanding of what's going out the door at practices versus what's being recorded in the EMRs, and ultimately, what's coming back from the payers.
And of course, the bigger thing is we won't really see the 'aha moments' until probably Q2 sometime, when we get to a place where [providers] see the power of self-serving, big data analytics at their fingertips.
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