Much of the burden of success under value-based contracting falls to the PCP, who must deliver high-quality care at low cost for vulnerable populations while ensuring care continuity. Often, medical services that fall outside the provider’s office can provide critical insight at the point of care. When providers are unaware of these encounters, their ability to gain a “whole patient” perspective is compromised – and health outcomes suffer.
However, when the electronic health record (EHR) is complemented with access to a community health information exchange (HIE), providers gain critical line of sight into patients’ care needs and concerns. The data presents a complete narrative of the patient’s health history, supporting a value-based approach that improves health.
Seventy percent of healthcare executives surveyed by HFMA believe the ability to aggregate clinical information internally and across networks is key to value-based contract success. There are four ways access to a community HIE allows providers to improve population health.
1. More informed decision making at the point of care. Community HIEs provide instant decision support with tools that push automatic notifications to providers regarding patients’ recent care interactions – and it’s a game changer for healthcare. Patients often neglect to share information that could be important to determining next steps in care, such as a visit to the emergency department (ED) with complaints of chest pain. When automatic alerts bring providers up-to-speed, they can access data from a patient’s recent trip to urgent care or visit to a specialist in just a couple clicks. The clinical data received and the one-on-one conversations that occur afterward may lead to adjustments in the patient’s chronic care plan.
For example, patients undergoing oncology treatment see specialists outside the primary care practice. Having access to their records is critical to supporting their whole health needs when they come to their PCPs with other ailments. It’s a significant step toward supporting less-fragmented, more patient-centric care for patients and communities.
2. Enhanced partnership for population health. A recent study points to the promise of community HIEs helping cities better understand the health of their communities. In New York, the use of EHR data around chronic conditions such as obesity, diabetes, hypertension and tobacco addiction helps public health officials measure the extent to which these conditions exist locally. It also supports in determining what types of publicly funded interventions to provide for residents in underserved areas of the city. The findings demonstrate the power of the community HIE to drive insight on public health in a more effective, much less expensive way than telephone surveys and in-person examination surveys, which have traditionally been used to gather data for public health surveillance.
3. Prioritizes Risk. An EHR combined with a rich HIE provides otherwise unheard-of risk identification of patients that might otherwise slip through the cracks. This risk identification can be provided back in the form of Hierarchical Condition Category (HCC) coding opportunities that a provider might have previously recorded or another provider in the community might have recorded. In addition, the same information can be used to stratify the patients into groups by their disease burden. This technique allows providers to easily fast track patients into chronic care management programs designed to prevent ED visits and costly admissions. Prompt reminders at the point of care for both risk awareness and stratification are key to the effectiveness and scalability of a population health program. An example of an active program is for the 5 percent of chronically complex patients to visit a PCP every 90 days to reduce the likelihood of an ED visit.
4. Decreased waste. With access to the patient’s complete medical history, providers avoid ordering duplicative tests or services or prescribing medications that may not interact well with medications the patient already is taking. This reduces costs of care, improves efficiency and results in a better experience for the patient, who is not subjected to unnecessary care. Additionally, a collaborative approach to clinical data sharing better enables providers to execute on risk-based contracts, boosting the organization’s financial health.
Holston Medical Group, which serves more than 200,000 patients in northeast Tennessee and southwest Virginia, accesses the community health record data via the provider’s existing EHR workflow and enables providers to discuss cost-effective options for specialists, medications and sites of service with patients face-to-face. Our approach has reduced inpatient admissions to 20 percent below the market rate while increasing ambulatory evaluation-and-management visits by 4.2 percent. Our performance under risk-based contracts is strong, increasing revenue while improving patient satisfaction.
A Tool for Improved Value
In an era of increased regulatory requirements and intense focus on value, investment in a feature-rich community HIE designed for population health is a key differentiator for provider practices and hospitals. It’s an approach that supports enhanced internal and external collaboration – the key to a holistic approach to population health management.
Wesley Combs is chief information officer, Holston Medical Group, a regional health network based in Kingsport, TN
