Playbook to CMS' Delivery System Reform Incentive Payment Program: What hospitals need to know

Our current healthcare delivery model is one in which hospitals act on the frontlines of defense — particularly by treating high-risk patients in emergency departments — with less emphasis on primary care and self-management.

CMS created the Delivery System Reform Incentive Payment program to improve quality of care and healthcare access for underserved individuals. State governments use funding from CMS to encourage Performing Provider Systems to participate in this program..

According to a recent Caradigm webinar, Todd Ellis, managing director of KPMG, Technology Enablement, and Vicki Harter, vice president of product management for care coordination and activation at Caradigm, a healthcare analytics and population health company, to successfully participate in DSRIP, healthcare organizations need to inverse the traditional delivery model.

Hospitals should place less emphasis on hospital utilization and more on primary care, self-management, eHealth, prevention and coordination of care. Essentially, both health systems and communities must be proactive and engaged in population health management.

"Delivery system reform isn't just a change in the delivery model, but in the reform of care, relationships and the entire paradigm," Ms. Harter said. "This means no longer hospital-centered care, but person-centered and engaged patient care. It is really about the triple aim — improving quality, efficiency and the care experience."

Four key components of successful population health management under DSRIP programs according to the webinar are shown below.

1. Enterprise-wide IT systems. Population health management under the DSRIP requires having certain tools from an IT perspective.

"From the technology perspective, the use of EHRs and HIEs ensure the caregiver has a thorough history of the patient, but in the new paradigm, the focus is on having the tools in place to get in front of populations to provide care within the community before patients show up at the emergency department," said. Mr. Ellis.

The coordination of these systems among providers and within the community is key. According to Ms. Harter, decisions about HIT in the past were largely business-oriented and offered mostly individual solutions. They did not necessarily look at the broader enterprise and connect data, processes and workflows. HIT systems today must take a new, enterprise-wide approach to ensure data-sharing and the coordination of care.

Additionally, Ms. Harter said while hospitals and health system invest in IT system, it is important to plan for increasing availability of data and interoperability in the future. Even if data isn't available to the organization today, the data system must be able to ingest, normalize and provide data in a way that can improve coordination, analytics and patient engagement.

2. Analytic capabilities. In the past, the extent of data analytics was retrospective reporting. The current science of data analytics in healthcare is blended artificial intelligence, with the highest accuracy, sensitivity and specificity of information to forecast cost and risk of inpatient stays and emergency visits, as well as measure quality compliance.

Accurate and meaningful prediction using analytics will help healthcare systems identify the most "actionable" patients, or those whose health management will have the biggest impact on healthcare utilization rates.

"Healthcare providers must take an analytics-driven approach to assure targets are met by calculating performance, benchmarking performance and analyzing quality gaps and workflow integration," Ms. Harter said.

This means data beyond that which is stored in EMRs is essential to provide a longitudinal view of a population, rather than a patient's encounter-by-encounter medical history.

According to Mr. Ellis, as organizations develop enterprise-wide data analytics strategies, they should seek partners that can help with data control, analytics, care coordination and patient engagement. Caradigm's data systems help achieve this by providing organizations with tools to reduce variations in care with evidence-based content mapping. Among its other capabilities, the Caradigm interface uses intuitive assessments with branching logic — including data such as social determinants, risk factors and obstacles to care — to recommend methods for increasing efficiency, tracking progress and outcomes.

3. Team-based care. Organizations require substantial support to properly manage population health under DSRIP. Various care providers — such as care managers, physicians, behavioral health specialists, medical assistants, social workers and clinical and business analysts — must work together as a team.

As a team, each member must understand his or her role, relationships and responsibilities so all of these can be coordinated, according to Ms. Harter. Additionally, work must be delegated appropriately so each member can operate at the top of his or her license.

4. Patient engagement. Both Ms. Harter and Mr. Ellis agree: One of the most critical factors of a successful population health management program is engagement among the patient population. Patients who play an active role in their own health — by tracking their vitals, communicating with caretakers and preempting the need for hospitalization with early intervention — play a key role in population health management. However, none of this is possible without the proper IT infrastructure on the provider end.

To view the webinar on YouTube, click here.

 

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