In an interview with Healthcare Informatics, David Higginson, senior vice president and CIO, and Bob Campbell, senior vice president of business development and chief strategy officer, discussed the hospital’s journey to clinical integration, challenges faced and what they hope for the future.
Mr. Higginson on the types of data involved in integrated networks and accountable care: Rather than using canned sets of reports or measures, the leaders of the [Phoenix Children’s Care Network] ACO had to agree what their quality measures would be and tightly align those with nationally accepted measures — so, we had to define pediatrically relevant measures. So there was a whole cross-team group — where they agreed on those quality measures.
That was our first-prong, short-term approach, to get up and get going. It’s critical for ACOs to gain credibility by bringing some things live. And now we’re focusing on care coordination and population health management, so we’re beginning to work with…vendors to support that. So we’re now building on those tools, to manage that population.
Mr. Higginson on challenges in pediatric-focused accountable care: The care coordination aspect [is one of the biggest challenges] — and that we’re just beginning to solve. But sometimes simple things like getting the patient to the appointment, can prove to be challenging to overcome. If the parents have to take the bus or something, what can we do to make the scheduling work for them?
Mr. Campbell on challenges in accountable care: Most of our challenges at the ACO or integrated network level have been in aggregating and integrating data to establish baselines, and then using the data to affect the care model. Our overall challenge is the implementation of a more effective care model to improve quality and reduce costs; that remains the biggest challenges.
Mr. Campbell on the process of achieving clinical consensus: When we set up our clinical integrated organization, we set up a quality committee through the board of the ACO. And the task of that committee is to define the merits that will be used. The committee consisted of 12 participating physicians. A number of them were general pediatricians, and then a cross-section of specialists as well. So we got input from payers in terms of what they were interested in; we had interest from our state Medicaid program around integrating metrics that as of this year are now mandated to track. And it was very challenging in terms of where to start and it wasn’t clear, in terms of pediatrics. In the adult world, you have the MSSP ACO metrics; we didn’t have that, so we looked at our greatest opportunities and priorities, and developed our metrics and dashboards out of that. The other challenge we’ve had is that there is the tendency of payers to focus on measures of individual interest to them. But we wanted to standardize across multiple payers.
Mr. Campbell on biggest lessons learned: One of the biggest lessons learned was to make sure we have a well-developed plan for the start-up of the organization. In many cases, there’s a tendency to try to develop too much too quickly. So having a well-designed process — developing consensus among the physicians — and investing time and effort in developing a shared understanding and a plan that can be incrementally implemented, have proven to be very important.
Mr. Higginson in biggest lessons learned: Don’t start with a grand design and spend three years on it. Start with a fairly attainable goal, get boots on the ground, and move forward. We continue with our approach of continually adding to the solution. And from a data perspective, what worked for Phoenix Children’s Hospital in terms of data collection didn’t necessarily work well for the ACO. For years and years, we’ve been thinking somewhat narrowly only about Phoenix Children’s in terms of data and IT, so there’s had to be a mind shift from a narrow corporate perspective, to a mindset of thinking about the ACO going forward.
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