How Simple Data Analytics is Driving Physician Incentives

Easy-to-digest reports and data dashboards may be an easier pill for physicians to swallow than trying to get clinical data into their EHR workflows. Especially if their pay depends upon population management performance.

My latest HealthLeaders magazine cover story on big data started on its journey to publication with the notion that big data is only a sideshow in the healthcare analytics space. During the course of my reporting however, it turned out to be the main event of 2014.

But don't let the industry's fascination with the data analysts' newest shiny object deceive you. Garden-variety data analytics is the immediate tool at hand to realign physician incentives away from fee-for-service and toward population health.

One organization that exemplifies this is Billings Clinic, a community-governed healthcare organization serving patients in Montana, Wyoming, and the western Dakotas. Its multi-specialty physician group practices are dispersed across this geographic area and employ 320 physicians. The anchor of the organization is a 285-bed hospital in Billings, MT, which has received national recognition.

Population Health Challenges HIT, Quality Leaders

Billings serves about 400,000 patients and participates in the Medicare Shared Savings Program with 13,000 covered lives in its Medicare ACO. In addition, Billings is the sole owner of a Medicare Advantage program with an additional 22,000 covered lives, for a total of nearly 50,000 covered lives for full or partial risk. So it has plenty of incentive to find ways to get its physicians to practice population health.

Data Dashboard

What those physicians need, and what all physicians need to achieve success, is relevant data served up in a straightforward way. Starting this year, Billings provided a dashboard to its physicians powered by Caradigm technology, displaying data on readmissions and patient satisfaction data.

The readmissions data can follow a patient following hospitalization to make sure physicians are doing everything they need to do to keep patients from getting readmitted, says Karen Cabell, DO, associate chief of quality and patient safety at Billings Clinic.

Caradigm gets its information from Billings' system-wide Cerner EHR, and is in the process of further developing a drill-down capability on its ACO report card/dashboard.

At last week's HealthLeaders Health IT and Quality Exchange, I heard various CIOs debate how many quality measures to throw at a physician to provide a rich enough set of metrics while not overwhelming them. At Billings, the magic number is 33 – the number of ACO metrics described by CMS. (Of course, the 2015 CMS guidelines will delete some of the 33 and add new ones, but that's a topic for another column.)

Find the Gaps
For now, using the original 2011 list of 33 measures, Billings can slice and dice its populations based on payer status, primary care provider, location, age, and other measures. "You can really delve down into the tool to find out where your gaps in care are, and where you're missing on your clinical quality metrics," Cabell says.

The drill-down features under development will not only let physicians see how they are performing month-to-month, but will also drill down to patient-level data, and let nurse navigators see how they are doing taking care of a panel of patients, she says.

The monthly results for each physician yield a score for each physician, and at the end of the year, that score comprises part of their compensation as well, Cabell says.

"They've got skin in the game," Cabell says. "Most provider organizations that are doing risk-based contracts, whether it be Medicare Advantage or Medicare Shared Savings or private payer ACO, you are incentivizing your physicians to perform well in the clinical quality metrics."

At Billings, the incentives have an up and a down side. Half (50%) of physician compensation is based upon traditional fee-for-service production, and the rest is based upon either clinical quality performance, or performance on access or other operational metrics, Cabell says.

An intense six-month period coincided with the kickoff of the Caradigm-generated reports, a period in which physicians had to get comfortable capturing the proper quality measures on several thousand patients electronically in Billings' EHR.

"It's difficult for physicians to start getting this volume of information back on a regular basis and have them believe it," she says. "They definitely need to have the ability to drill down into their data if they don't believe something. There's a lot of validation that has to be done, so that you can get buy-in, and as part of the whole process… we attend the monthly department meetings for each of the departments that are in this process."

Managing Chronically Ill Patients
"If you have one group of physicians that's performing much better than another group, then we kind of share information about best practice and how they got there and how they have the conversations with the patients," Cabell says.

Chronic-condition patients are benefitting as well. For patient with high blood pressure, high cholesterol, heart disease, or diabetes, who were out of control at their last visit, "we produce a report… to help you kind of chart prep better for the patient on the encounter that's scheduled for the coming week," Cabell says.

Caradigm has a long history. Originally developed as Azyxxi at Washington Hospital Center, it was acquired by Microsoft, enhanced and rebranded as Amalga, then spun out and rebranded again as Caradigm (company name and technology). Before the Caradigm rebranding, Amalga garnered few customers and a Wikipedia page that reads like an obituary.

But for the blocking and tackling of population health, the 2014 iteration of Caradigm might just clear my bar of just-enough technology, and have an advantage that other, heavier-weight analytics technologies and data warehouses lack. For example, it can serve up the latest stats in near-real time. Some other analytics packages or warehouses require more time-consuming weekly or monthly report runs and a small squad of quants to modify reports.

A Simple Data Strategy
The Caradigm approach certainly seems to be working for Billings. True, the data it produces does not flow back into the EHR, and must be digested instead in report format, but for the day-to-day workflow of a clinic, that is probably good enough.

The pain of getting analytical data back into the EHR, coupled with the pain of then having the most important analytics bubble up to the surface of an EHR already bubbling with alerts, may mean that providers such as Billings are able to focus on the immediate business of managing a population and aligning physician incentives with less fuss.

Producing simple-to-digest reports may be an easier pill to swallow for clinicians than fiddling even more with their EHR workflows, provided physicians can be persuaded to read the reports. Tying their compensation to reading and dealing with those reports is a pretty straightforward way to do it.

For now, getting physicians in the mindset that their pay depends upon population management performance, and giving them simple tools to see it for themselves, seems to be plenty of work for healthcare as an industry to get under control.