HIStalk Practice Interviews Brian Yeaman, MD Chief Administrative Officer, Coordinated Care Oklahoma

Brian Yeaman, MD is chief administrative officer of Coordinated Care Oklahoma, an HIE based in Norman, OK.

Tell me about yourself and the organization.
I am a family physician still actively practicing, and have done work as a hospitalist in the past. I was CMIO for Norman Regional Health System for 10 years and have been doing work with health information exchange for 10 years. I am currently the chief administrative officer for Coordinated Care Oklahoma.

I’m particularly intrigued by CCO’s decision to implement/offer MyDirectives. How will this be marketed to physicians and their patients? How will these directives integrate with the HIE?
This is a project we have been passionate about for over three years. As a family physician, I recognize that when an elderly patient presents to the hospital, they frequently do not come with an advance directive. Usually, their healthcare proxy is not necessarily there at the same time, and at that point, without a current up-to-date copy of the advance directive, we have to fully resuscitate, even if that was not what the patient necessarily wanted. Providers rapidly understand the problem we are trying to solve; hospitalists and emergency room physicians are especially embracing this approach. We have begun outreach to patients with a simple message for encounters on individuals over 45 years of age.

Why did CCO feel the time was right to implement secure messaging technology?
A lot of form factor drove this decision. We started doing a lot of work in the post-acute care space connecting many SNFs, nursing homes, home health and hospice. The HIE is basically doing automated medical record requests, but we still have to talk to one another. With RAC and MACRA/MIPS we have to talk to larger and larger care teams that are outside a health system that is acutely discharging a patient. Secure messaging across regions and universal contact lists was just a no brainer. Providers love Backline. Bringing HIE data into the mobile form factor in Backline makes a lot of sense for providers who are mobile across orgs, facilities, and patient homes.

Is the organization working on any other healthcare IT implementations? 
Oh yes, sitting still is not what we do. We are going live with LightBeam analytics right now, and that should be fully launched by Q1 2017. We are also working with Nuance and their PowerShare application to launch image sharing in parallel with CCO using the power of our master patient index. It is going to knock people’s socks off.

What sort of IT adoption challenges are unique to HIEs?
Interop equals challenges. The biggest one is actually trying to meld federation and centralized data connections in being a hybrid HIE data consumption model and delivering some of the services. The MPI provides a tremendous anchor and the way we stage and time connections is obviously key to add federated connection data to some solutions or add on solutions to the HIE core service.

How is the HIE helping its provider members – particularly independent physician practices – overcome interoperability challenges?
We help providers care for their patients – it is just that simple. We crossed the threshold years ago when providers began to demand the HIE data to expedite and have more complete medical record requests and sharing. We check the boxes on MU and with MACRA/MIPS coming, we add an integral service there. At the end of the day though, if we do our job right and deliver a comprehensive HIE service with the right add-ons, quality and cost organically improve and patients get much more coordinated care. That is our ultimate goal and mission.

How do you see HIEs fitting into the new MACRA landscape? What role will they play in helping the healthcare industry transition to value-based care/payment models?
Obviously, they’ll help with requirements around data sharing, completing quality reports, and helping enhance condition management tasks. We help by bringing data forward and soon-to-be images forward to avoid duplicative tests and improve savings, and we help avoid complications by sharing drug allergy information, etc.

Do you have any final thoughts?
I think HIE is a funny thing in the marketplace right now. Everyone now knows it has to mature into a business and leave the more academic and grant-based foundation we all started on. I see HIEs evolving into two models – one that is service oriented and leverages the MPI and data to enhance additional services that directly impact care and outcomes. This is a bedside-up approach to administrative tasks and analytics, and is focused on treatment and operations.

The second model is one that is more focused on monetizing the clinical data and is heavily focused on payer initiatives. This approach around payment makes a lot of sense on the surface and represents an analytics down-to-the-bedside approach to healthcare reform. This model has additional challenges as you start to drill down into consent models, how the patient consent was administered, and how that holds up as the data is moving to more and more third parties separated from the original patient consent for care under TPO. Throw in to this mix ACOs and health systems that compete …  the politics and logistics start to become extremely complicated. Keeping it simpler and delivering HIE like a service – just like cable and Internet providers with the privacy and security necessary in healthcare.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

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5 Questions with Rick MacCornack, CEO, Northwest Physicians Network

Rick MacCornack is CEO of Northwest Physicians Network, a Washington-based independent practice association and multispecialty provider network that has experienced record growth in the last 12 months.

NPN has seen an 80-percent increase in membership over the last year – a statistic that highlights the fact that independent physicians want to stay that way. What are the biggest obstacles private practices face when it comes to remaining independent?
The largest obstacle facing private practice today is the increasing administrative burden associated with so-called value-based payer contracts. Performing well on quality metrics, which are now required by all public and private payer contracts, is a challenge when the payment methodology is predominantly fee-for-service within PPO products. Patients are permitted to not have a primary provider, which flies in the face of a practice’s attempt to be actively “accountable” for an individual’s health. Technology cannot solve this issue. This is an adaptive, behavioral issue. Payment methods and consumer incentives are currently not in alignment with policy attempts to achieve the goal of population health.

How does NPN help them to overcome these challenges?
In the NPN network of 1,000 providers, there are 49 different EHR platforms in use. NPN staff supports the primary care providers by collecting and handling their clinical data for reporting and management purposes. This is done through remote access as well as in-clinic, manual abstraction of records. NPN supports a cloud-base registry, warehouse, and analytics platform, which serves as the aggregator and processing center for all reporting for each provider. Both clinical care gap reporting at the practice and patient level and managed care analytics (total cost of care and cost and utilization broken out by service category, per member per month) is provided to each clinician on a scheduled basis. Both sets of reports provide the clinic staff with a means of managing defined populations of patients. Reports to the provider are payer agnostic.

What role does healthcare technology play in this predicament?
Healthcare technology used by NPN is all cloud-based. NPN provides a comprehensive referral and care coordination platform to ease the administrative burden of referral processing, patient tracking, and care coordination. NPN also provides secure messaging via smartphone and desktop. And quality, utilization, and cost analytics are provided to all providers. The cost of providing these services is subsidized by NPN for all primary care providers, who are the least able to afford these technical services on their own.

What type of healthcare technology seems poised to best help private practices keep their doors open and patients satisfied?
All cloud-based solutions used by NPN have been developed and are provided by small startups who are experienced working in heterogeneous care delivery environments like IPAs. The private practice environment is a non-standard environment. True collaboration between vendor and the client in developing and delivering the service is required. NPN has even served as both an alpha and beta site for some of the technology services it uses.

How does NPN plan to help its network prepare for and work through MACRA? What resources do you feel practices are most in need of to make it through this transition?
MACRA adoption is a process of education and learning which track is most appropriate for each practice. One size doesn’t fit all. Across all tracks, data reporting by the practice and performance feedback to the practice are essential to participate under MACRA guidelines. NPN’s approach to supporting private practices under MACRA is to relieve the administrative burden of data collection from the EHR, uploading it into an analytics environment in combination with claims data, and returning results to practices on a scheduled basis for assessment and action. NPN staff serve to educate and support work flow changes in a practice to enable them to reach designated performance targets.

That said, until the payment system in the US is fully converted to “value-based” payment that is attached to administrative requirements that support performance- (cost and quality) based payment, it will be difficult for providers in any delivery system structure to consume practice-level data in a way that achieves better management of resources, one patient at a time. Population health is an unreachable goal when patients are not tied to a primary care provider who has the responsibility and the resources to manage each patient’s individual clinical needs over time.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

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News 11/9/16

Top News

Trump’s presidential win sets the nation abuzz and gets healthcare insiders busy predicting his cabinet picks. Several media outlets have tossed out Ben Carson, MD and Louisiana Governor Bobby Jindal as potential HHS Secretary appointees. Trump representatives have already said he’ll have his cabinet nominated and approved within two weeks of inauguration.

In other post-election news, several medical societies weighed in on the president-elect. The AAFP sent Trump a letter highlighting health policies that need immediate attention, including the need to reduce the administrative burden of family physicians. AAFP President John Meigs, MD added that family physicians and the new administration can work together to “ensure continued progress toward healthcare for all, supported by a payment system that rewards value over volume of services, that promotes prevention and wellness, that protects patients from financial barriers to needed services, and that builds a primary care physician workforce that can meet the growing demand for care.”

AMA President Andrew Gurman, MD issued this rather bland statement: “We look forward to working with President-elect Trump and a new Congress to improve the health of the nation. The AMA has a history of working with all sides as we pursue policies that improve care delivery and the outcomes for our patients. We know there are many health policy issues facing our newly elected leaders, and the AMA is ready to lend its expertise and offer guidance on these complex issues.”

HIStalk Practice Musings

The real winner in all of this is Alec Baldwin, who will likely continue his portrayal of Trump on SNL for the next four years.

Webinars

None scheduled soon. Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Athenahealth will convene a neighborhood meeting to address grievances from local residents relating to the company’s new construction at the Arsenal on the Charles property it purchased in 2013. Complaints range from the addition of 1,000 more parking spaces than originally planned, a lack of communication about the project, overnight lighting, and enforcement of an employee parking policy. “Since purchasing the property in 2013,” explains SVP & General Counsel Dan Haley, “we unveiled our plan to open up a formerly-sealed off military base, connect a beautiful historical property to the community, and create more outdoor shared space. We have collaborated with the town, and with our neighbors, at each step, and we are committed to continuing that engagement.” Construction began last week and is expected to last 15 months.

Announcements and Implementations

BCBS of Kansas will offer value-based contracts and relevant patient data (presumably claims) to Aledade Kansas ACO members beginning January 1. The ACO started out with 13 practices – mostly rural – earlier this year, and plans to add three more in the coming months.

Telemedicine

Humana expands its partnership with MDLive, offering telemedicine visits to Medicare members in Georgia and South Carolina beginning next year. The payer announced a similar offering to New Mexico members last month.

People

Jesse Gamez (Kaiser Permanente) joins the Northwest Physicians Network as COO.

Government and Politics

Athenahealth CEO Jonathan Bush (who did quite the Donald Trump impersonation at HIStalkapalooza earlier this year) sits down with Fortune (pre-election results) to address the next administration’s likely healthcare plans. A few snippets:

• “This will be the president with the lowest mandate to do anything – in my whole life – so I think what they will tackle is not getting impeached.”
• “I don’t expect a very activist healthcare agenda for the next four to eight years. Remember, we’ve had a really activist healthcare agenda for the last eight. I expect the next chapter will be a digestion of all that new policy and not a lot of change.”
• “I’m imagining a silencing of the federal role and an explosion of the healthcare system’s role, the local health plan’s role, and the employer’s role. Those things will start to spike up as the roar of Washington dampens down.”

Other

It’s not the five-second rule I’m worried about: Baylor College of Medicine Professor Jeffrey Starke, MD advises those who work in office environments to forego washing their beloved coffee mugs with the communal sponge, pointing out that, “The sponge in the break room probably has the highest bacteria count of anything in the office” given that it’s used to clean all manner of dirty dishes and sits damp for hours at a time. “Most people would call that gross.” Also gross: The notion held by some that never cleaning your mug makes coffee taste better.

Sponsor Updates

• Aprima will exhibit at the Practice Management Institute November 9-11 in Las Vegas.
• Medicomp Systems recaps its annual training event that was held October 3-7 in Bangkok, Thailand.
• EClinicalWorks will exhibit at the Kentucky Primary Care Association 2016 Conference November 9-11 in Lexington.
• Healthwise’s Leslie Hall will present at Partnering for Cures November 13-16 in New York City.

Blog Posts

• The Top 10 Reasons Transformation is the New Normal for Healthcare – Reason 5 (GE Healthcare)

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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News 11/8/16

Top News

ONC submits its HITECH-mandated annual report to Congress, which as those following healthcare IT news already know, focuses on improving interoperability. It also contains several statistics related to the progress physicians and hospitals have made in their use of health IT. The most promising, as far as physician practices are concerned, is the 30-percent jump office-based physicians have seen in their view/download/transmit patient engagement efforts, and a slightly larger increase in their ability to share patient data with outside facilities.

Webinars

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Practice Fusion receives an undisclosed amount of financing from Orix Growth Capital, which CEO Tom Langan says the company will use to help fund interoperability initiatives. As of February 2016, the company had raised $150 million. It has been mum on previously announced plans for an IPO in 2017.

Announcements and Implementations

The Great Lakes Practice Transformation Network extends the deadline to apply for MACRA-related grant funding for practice transformation and quality reporting assistance. Backed by funding from the CMS Transforming Clinical Practice Initiative, the grant is open to physicians who see Medicare and/or Medicaid patients and are not already participating in the Ohio Comprehensive Primary Care Initiative and several other value-based payment programs.

Bizmatics adds medication management technology and adherence insights from Surescripts to its PrognoCIS EHR.

Michigan Health Information Network Shared Services implements custom parser technology from OpenAirware that enables it to pull key data out of large CCD/CDA files so that only the data needed for a particular use case is shared.

Research and Innovation

Harvard researchers build a chain-smoking robot to better understand chronic obstructive pulmonary disease. Programmed to smoke at customizable intensities and frequencies, the robot passes the smoke to a “lung on a chip,” which can accommodate living lung cells. This capability helps researchers compare and contrast the effects of chain-smoking with cells from a patient with pulmonary disease and with cells from a healthy patient.

Other

No tipping allowed: Austrian startup SmaXtec sees big potential in its connected, implantable sensors that help dairy farmers remotely monitor a cow’s health data in real time. Embedded in the first of a cow’s four stomachs, the sensors alert users via corresponding app and texts to any changes in the animal’s temperature, movement, pH levels, and milk production.

Quartz highlights the plethora of contracts Apple users digitally sign on a fairly regular basis, noting that those who own at least five Apple devices have signed at least 30 contracts containing over 100,000 words of legalese (most of which, I’m willing to bet, were never read). That word count is greater than either “The Hobbit” or the “Harry Potter and the Sorcerer’s Stone.”

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

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5 Questions with Pamela Fletcher, Administrative Director, Glendale MRI Institute

Pamela Fletcher is administrative director at the Glendale MRI Institute, a boutique imaging center in Glendale, CA with one part-time radiologist and 16 additional staff members. With the help of locums radiologists and teleradiology, the practice sees close to 35 patients each day. The practice has partnered with Healthpac Computer Systems in Savannah, GA for its radiology information system, and recently implemented ReferralMD referral management software.

What was the impetus for implementing referral management software?
We needed a marketing tool to keep referrers “sticky” to us and to o make it easier for referring docs to communicate with us. Plus, we also wanted to make ourselves know to providers who weren’t aware of us and thus weren’t referring to us.

How do you hope its utilization will benefit your organization and its patients?
See number one! Also, it was a huge and pleasant surprise to discover how much time it saved our scheduling staff to have the faxed referrals go directly into the new software.

What sort of healthcare technology adoption/implementation challenges are unique to outpatient MRI facilities?
The biggest challenge is to convince our referrers to embrace new ways of communicating with us.

Interoperability continues to be a challenge. Has Glendale MRI connected to local HIEs or joined other interoperability-friendly groups to make data sharing easier?
We have a software service that delivers reports to the desktop of our referring providers. They can configure their EMR to retrieve the reports and put them directly into the patient files.

Healthcare cost transparency has also become a hot topic. Have you noticed an uptick in patients asking for upfront pricing? How is Glendale MRI positioning itself to handle these inquiries?
Oh yes! This is a strategy we implemented several years ago when the big imaging chains and hospitals started taking over our HMO contracts. We are too small to compete, so we put together competitive cash pricing and started marketing it through social media, pay-per-click, and brand awareness campaigns. This has been very successful. We also offer interest-free financing, which has been very popular.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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