Hudson Valley shows how primary care can be the foundation of ACOs

In an interview with Managed Care Magazine, David Nace, MD, medical director at McKesson Corp. and incoming chairman of the Patient-Centered Primary Care Collaborative, discussed the value of the patient-centered medical home and its potential role as the foundation of ACOs. "Blue Shield of California announced an agreement to form an ACO, and as part of that, they are revitalizing their primary care infrastructure. Hospitals that are buying practices to position themselves for accountable care are also investing in them to transform them into medical homes." He noted that, in collaboration with THINC, practices in the Hudson Valley have been working for about five years to develop a medical home network relationship amongst themselves. "They invested in themselves and are now reaching out to contract with payers as an ACO. It is occurring differently in every region of the country." (Managed Care Magazine)  

PCMH funds help Open Door meet Medicaid demand 

In the last year, the Open Door Family Medical Centers in Ossining, N.Y., added 1,867 new Medicaid patients, a 14 percent increase. According to Lindsay Farrell, CEO and president, that helps meet the goal of connecting more individuals with primary care physicians to prevent and manage conditions such as diabetes, obesity and high blood pressure. Through the Patient-Centered Medical Home Incentive Program, the state is providing funds to help Open Door and similar centers meet that goal. Open Door received $14.8 million in Medicaid revenue in 2010, a 14 percent increase from 2009.  (The Journal News)  

Collaboration and teamwork are key to HIT success, says TIPA's Kaye

HIMSS News recently interviewed Dr. Paul Kaye about the integration of health care technology. Kaye, executive vice president of practice transformation with Hudson River HealthCare and medical director of TIPA, emphasized respectful collaboration. "The most important tools IT professionals need to develop are the same ones that physicians need to cultivate--the ability to listen carefully and respond respectfully," he said. "We are a tremendous team. I believe that I might be responsible for about two percent of our success, while the team can take credit for 98 percent of it. The most important thing you can do is empower a team of your colleagues to take charge and work together." (HIMSS News)

NYeC Digital Health Conference slated for December

The New York eHealth Collaborative (NYeC) will hold its Digital Health Conference in New York City at Pier Sixty Dec 1-2. The two-day conference will include numerous educational sessions and exhibits. Among the speakers is Lisa Kern, MD, MPH, associate professor, Weill Cornell Medical College. (For information, go to www.digitalhealthconference.com.)

Stuard talks about HIE

Susan Stuard, executive director of THINC, was recently featured in an Inside Healthcare IT article, "HIE Takes a Multifaceted Approach." She discussed THINC's experience with health information exchange and provides a preview of THINC eXchange, the Hudson Valley's new HIE. Sponsored by THINC and operated by MedAllies, it is a software platform available to the Hudson Valley health care provider community. It aggregates clinical patient information from providers across the region, where it is available to authorized medical staff. (Inside Healthcare IT--subscription required for access)

Connector: Obviously, the Davies Award recognizes your commitment to health IT. Can you tell us how and when Hudson River HealthCare decided to make this commitment?

Nolon: Our work around quality improvement in the federal Health Disparities Collaboratives over the past 13 years taught us about the need for clinical information systems to manage the health of our patients and our communities. We used patient registries to track individual patients and report on quality measures at the same time, but that required an army of data entry personnel and redundant workflows. It became clear an EHR with care management tools was the way to go; clinical data could be recorded once and then used for all sorts of work. We worked with a small startup company to implement and beta test a system in 2000, learning lots of things along the way, including about a thousand things not to do when implementing an EHR. By the middle of the decade it was clear we had to retool, so we joined with other health centers and our colleagues at MedAllies to implement eClinicalWorks. We were especially interested in the population and preventive health tools that New York City helped to develop with ECW.

Connector: Tell us a little about how you use health IT to manage 65,000 patients over 16 primary care sites. Why are you successful at it? What are you doing right? Where are you seeing the greatest impact on patients?    

Nolon: Using our electronic records, we are able to monitor all aspects of a patient's care. Medications, medical diagnoses, previous medical treatments are all recorded. The use of health IT ensures patient safety. There are alerts for allergies and for medications incorrectly prescribed, there are alerts for medical providers to perform preventative services, and there are alerts for potential medication interactions. When consultation is needed, a review of the medical record can be done remotely by another HRHCare provider. The greatest impact on patients regarding health IT is connected to chronic disease management. Our patients are able to receive planned care--staff, using patient registry reports, are called into the health center proactively--getting tests or care which is vital to managing chronic diseases/conditions, such as diabetes and hypertension. In the area of prevention, pediatricians are able to have their patients/parents come in for immunizations as they are needed.

I need to add that, although we didn't go into this looking at ROI--and start up is costly--our integrated approach to health IT has created value and added to the financial stability of our organization.

Nolon: 1. Understand what you want to accomplish before you implement an EHR, and design new workflows so there are people to get the new tasks done--if you're going to call up patients in need of care, who's going to do it, and how?

2. Have a regular leadership team that is cross sectional, involving clinicians, operations, IT, financial and policy staff, and keep that team going forever. We meet every Monday. You need a group of people who can listen to each other and make the necessary changes. I cannot overemphasize the importance of a committed team: We could not have accomplished this without the hard work of many people, including Paul Kaye, MD, former CMO, chief of practice transformation; James Sinkoff, CFO; and Kathy Brieger, COO.

3. Once you start to use information systems to improve care there is no end to the need for internal development, training, retraining and retraining again, in various formats. Plan for that in your budget.

4. Support your clinicians throughout the process. Initially, the EHR  makes their work harder. The payoffs only come later, so be there to support them every step of the way.

5. Workflows and procedures have to be well defined; involve your people in developing them. You have to get the basics right.

 6. Be nimble and be able to keep up with a changing environment. Leadership has to embrace technology not as a one-time investment, but in terms how it improves care. You can't sit back; you have to keep going forward.

News to Know:   

ACO rule now with OMB; next stop, Federal Register 

The Centers for Medicare and Medicaid Services has sent a Shared Savings/ACO final rule to the Office of Management and Budget for review, Health Data Management reports. OMB review is one of the last steps before a rule is published in the Federal Register. Without a final rule soon, it will be difficult for CMS to meet its Jan. 1 deadline for launching ACOs. (Health Data Management)