Software That Does More Than Document Care

Charles Saunders, MD

Recent results for medical practice performance in accountable care organizations (ACOs) don’t give Charles Saunders, MD, great confidence that physicians are making significant strides toward value-based care. Saunders is CEO of IntegraConnect, which has just launched a suite of electronic data management services to help oncology practices meet the requirements of the Merit-based Incentive Payment System (MIPS) and the Oncology Care Model (OCM). His company is one of many that have developed Big Data solutions in response to CMS’ demands for a better-quality experience for patients with cancer and reduced dependence on fee-for-service payment.

Practices that meet the goals for improvement in savings and outcomes will be eligible for performance incentive payments. Some physicians have argued it will be difficult for them to demonstrate improvement because they already are highly efficient, but Saunders contends that they may be mistaken. If average performance is not high to begin with, it shouldn’t take that much effort to distinguish yourself from the pack or even from your own past performance, he said in an interview. “The state of the industry is relatively low right now. Let’s say that you went to school and the average score was 30 out of 100. You’d have to get a 45 to stand out, and a 45 is still not very good,” Saunders noted.

Saunders said he has enough experience to know that his assessment is correct. Before taking the helm of IntegraConnect, he served as CEO of Healthagen, an arm of Aetna that focuses on improving the health of populations of patients. “We managed more than 70 ACOs, 350 medical homes, and several million medical lives,” he said. “It’s not that difficult to generate savings between 10% and 30% for these practices.”

The key is to work hard on bringing a few common cost drivers under control. If you can do that well, your practice will easily improve its performance, he said. The first job is to reduce the number of patients who end up in the hospital and the emergency department. The second task is to improve the timing of end-of-life services so that patients don’t die in the hospital. “These things are surprisingly not that difficult to do. It just requires a patient-focused process, a certain mindset, and a different technology. I don’t think that’s going to be difficult for practices that are motivated and that make the necessary investment to do it, and that actually step up in capabilities,” Saunders said. Along the way, patients enjoy a better healthcare experience, he noted, which is also one of the goals that CMS has established for practices to meet.

A glimmer of how oncology practices may perform with the OCM and MIPS is offered by a CMS report on ACO performance for the year 2015.1 ACOs are the forerunners to the OCM, as they encourage coordinated medical care across different provider specialties and emphasize a higher-quality experience for individual patients. The same study results garnered widely different assessments of practice performance. For its part, CMS has declared ACOs a success, partly because of the savings that have been achieved: $1.29 billion between 2012 and 2015. However, industry observers have noted that of the 392 ACOs included in the 2015 survey, just 29% (n = 115) achieved performance levels high enough to share some of the money they had saved CMS on claims payments.2 In addition, roughly one-third of the $646 million in total shared savings was achieved by only 10 of the practices surveyed, which shows that good performance was not evenly distributed and was, in fact, rare.

The overall performance was lackluster even though “the ACOs that volunteered for the program thought they were great,” Saunders said. Based on outcomes like this and his own observations, Saunders predicted the challenge of excelling in the OCM and MIPS programs is going to be an eye-opener for practices. “They’ll probably be surprised when CMS starts writing the checks that maybe they’re not as prepared as they thought they were.”

Of 195 practices enrolled in the OCM, the majority are in a 1-sided risk model of performance, which means that they do not share financial risk for failure to meet performance targets. Because CMS wants all oncology practices to share upside and downside financial risk, those in the 1-sided risk model OCM must also participate in the MIPS program of performance measurement, which involves financial incentives and penalties that are being phased in through 2026. The OCM has 7 basic requirements: practices must provide around-the-clock patient access to clinical support, use certified electronic health records (EHR) management, use performance measures and set targets, initiate patient management services, document care plans for patients, follow generally approved treatment pathways, and report on performance progress.

This is where IntegraConnect has stepped in with its Big Data, cloud-based package of services that the company says can help practices meet these requirements with greater ease and success than if they were using only standard EHR platforms and the “elbow grease” of physicians and practice administrators. The difference between standard EHR systems and what IntegraConnect is offering is a system that helps practices to interpret data rapidly and to identify ways to focus efforts for greater success, Saunders said. The software is a “bolt-on” to the standard EHR platform, he said. The supplement enables patient data from diverse sources to be integrated with claims information provided by CMS and then analyzed effectively, providing an understanding of the patient population and improved coordination of care. Practices are able to see where the weaknesses are in care management, he said. “About 20% of your patients will drive about 60% of your costs. That’s what our data show,” he said. “You need to find out which 20% of patients they are so that you can really focus your attention on those to hold costs down.” An EHR, he said, would fall short on meeting this need because it’s not designed to manage care. “The EHR is really designed to chart a visit for the purpose of generating a bill.”

Market competitors have developed similar tools for addressing CMS’ requirements. McKesson Specialty Health, for instance, offers a trio of products with much of the functionality that Saunders described: iKnowMed, an advanced EHR for documenting OCM-required information; Clear Value Plus, for keeping patient treatment in accord with nationally recognized guidelines; and Practice Insights, designed to optimize both clinical and financial management.

The market for products like this is expected to grow because CMS has indicated that it wants most practices to become involved in models of care like the OCM. In addition, many oncology providers have been developing versions of the OCM they believe would meet their own specialty-care needs more closely. Saunders said that IntegraConnect can easily be adapted to accommodate these additional models. “The specialty industry in general is going to be increasingly reimbursed on an alternative payment model basis, and this software in our platform is highly flexible,” he said. “We have a number of customers that are large oncology groups, but they are also part of a multispecialty group that might also have urology, primary care, and some other specialties represented.”

However, it won’t be enough to simply plug in the software these companies offer and expect to achieve good results, Saunders said. Many practices will go through a period of transformation during which they learn how to use these new tools and start doing things differently, which Saunders said will be key to successful adaptation to CMS standards of practice. “In my previous role with Healthagen, what I found was that putting the technology tools in people’s hands was not enough,” he emphasized. “At the end of 6 to 9 months, if they still weren’t generating savings, it was because they weren’t doing anything differently. For instance, they hadn’t brought on board any nurse navigators or any care managers. They were still just seeing patients, and they expected somehow that the technology would drive savings.

somehow that the technology would drive savings. “What we do is we combine the technology tools with what we call practice transformation services and support. We actually go in and spend a lot of time up front teaching them what to do differently—what is care management? What is the design of a care management program? If they need it, we’ll help them set up a care management program and teach and train their nurse navigators and care managers,” Saunders said. That support extends to the use of analytics tools, he added.

The point is, it’s not all about more technology and business-as-usual. “It requires a little bit of cultural and practice transformation, which at the end of the day is what CMS is after,” Saunders said. “The OCM program provides a huge carrot but also a significant stick to get them to transfer to value-based care.”

References

1. Physicians and health care providers continue to improve quality of care, lower costs. [news release] Washington, DC: CMS; August 25, 2016. www. cms.gov/newsroom/mediareleasedatabase/press-releases/2016-pressreleases-items/2016-08-25.html. Accessed April 2, 2017.
2. Introcaso D. ACO performance year three: what happened and what does it mean? The Health Care Blog. October 1, 2016. thehealthcareblog.com/ blog/2016/10/01/aco-performance-year-three-what-happened-and-whatdoes-it-mean/. Accessed April 7, 2017.