HIStalk Practice Interviews Lerla Joseph, MD Board Chair, Central Virginia Coalition of Healthcare Providers

Lerla Joseph, MD is an internal medicine specialist and board chair of the Central Virginia Coalition of Healthcare Providers, a Medicare ACO created for solo physicians and small practices.

Tell me about yourself and the organization.
I have been a practicing internal medicine specialist for 36 years, and have been in private practice for 33 of those years. My practices are located in a medically underserved community in Richmond, and in the small town of Petersburg. I am very much interested in the availability of quality care for all persons and have advocated for more access to care my entire career. Central Virginia Coalition of Healthcare Providers (CVCHIP) was developed to ensure the triple aim of Medicare and to ensure the sustainability of the private practice of medicine. It is particularly interested in serving the small medical practice. We have 20 medical practices affiliated with CVCHIP, all of which are located in Virginia and North Carolina. We were approved as a Track 1 ACO in the Medicare Shared Savings Program in December 2015. We are primarily primary care practices, but have a few specialty practices as well.

CVCHIP implemented chronic care management technology last month. Why prompted the ACO to consider this type of software?
CVCHIP recognized early on that in order to achieve the quality metrics required by CMS, we need to engage in care coordination. Many of our patients suffer with two or more chronic diseases and are not accustomed to care management with emphasis on prevention and a holistic approach to care. Additionally, participating in the CCM program meets several of the MACRA measures that heretofore were PQRS and Meaningful Use. We believe earlier engagement in CCM rather than later will greatly benefit our patients and the quality and cost of care our providers give.

How do you envision this type of health IT impacting outcomes in the near future?
Our initial expectation is better patient engagement. We believe that having multiple touch points with the patients will give them a better understanding of their disease process, improve their lifestyle choices, and give them confidence in doing self-management. We also expect the providers to be better informed about the total patient including their support network, socioeconomic situation, and the patient’s ability to execute the recommendations for care we give. This should all translate into more collaborative care with decreased emergency department and hospital utilization.

What other types of healthcare IT is CVCHIP looking at right now (or will be looking at in the near future)?
We have in place a population health tool. Going forward, however, we will look at forecasting and data analytics tools.

When it comes to implementing new health IT, what are the biggest obstacles/pain points for CVCHIP physicians?
Cost is always a major concern for our practices when we look at implementing new IT solutions. At the same time, we want to be certain that the solution we select gives us data that is actionable and efficient – one that does not require additional human resources to utilize.

The MACRA final rule is still making headlines. How will MACRA affect CVCHP and its participants? What will 2017 and 2018 look like for the ACO in terms of reporting?
As an ACO, one of the selling features is our ability to do reporting for our participants. Many have not done PQRS or Meaningful Use reporting, and those that had found it confusing and cumbersome. With the ACO reporting GPRO, this removes some of the burden for the practices. What is disappointing is that the practices will still need to report Advancing Care Information because Track 1s are not Advanced APMs. We are gearing up for the 2017 reporting, and our population health tool will help with that.

Is CVCHIP doing anything to help its physicians with their population health management programs? Is the ACO leveraging relationships with local payers in this area?
We have started integrating participant EHRs into our population health tool. We have the ability to share claims data submitted by CMS to our participants. We have targeted quality metrics to keep them abreast of emergency department utilization and annual wellness visit utilization by practice. We have not engaged as yet with any of the local payers.

What do you consider to be the number-one challenge facing practices in ACOs right now? How have you seen your members overcome this?
CVCHIP is a physician-led and governed ACO. The challenge for our participants is time management in finding the balance between caring for their patients and devoting the time necessary to make CVCHIP all it can be. We are dedicated to preserving the private practice of medicine. This requires our input in decision -making and implementation of our strategies for success. It is called physician engagement and workflow management. I prefer to look at it as the time necessary to advocate for our patients and our practices. No one can do that better than we can. We are trying to overcome this by committee assignments for our participants, conference calls for quality reviews, and quarterly in-person governing meetings.

Do you have any final thoughts?
I truly believe physicians are the best advocates for their patients. This new era of health care delivery de-compartmentalizes the care delivery we have created over the last 40 years, placing the patient at the center of care. It is a shift for all of us. However, I believe that ultimately patients and physicians alike will be more satisfied and gratified with the change. Change is always daunting, but the providers of CVCHIP are ready to embrace the change for better care and healthier lives.

Contacts

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

More news: HIStalk, HIStalk Connect.

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News 11/14/16

Top News

Access to retail clinics does not, in fact, reduce trips to nearby ERs, according to a new study published in the Annals of Emergency Medicine. Though retail clinics have increased exponentially over the last decade – jumping from 130 in 2006 to 1,400 in 2012 alone – only a miniscule decrease in ER visits was seen amongst retail clinic patients with private insurance. The primary effect of retail clinic access thus far seems to be increased utilization of services by those newly insured under the ACA – a fact that surely gives area PCPs cause for concern.

Webinars

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

Here’s the video of one of our webinars from last week, “CMIO Perspective on Successful 25-Hospital Rollout of Electronic Physician Documentation.”

Here’s the recording of another webinar from last week, “How to Create Healthcare Apps That Get Used and Maybe Even Loved.”

Announcements and Implementations

HealthAsyst adds payment technology from Worldpay to its patient intake software.

ACO Arizona Connected Care selects The Diary’s CarePro care management app to help it better care for its 300 members with chronic conditions. Designed on Apple’s CareKit framework, the app’s patient-facing features include symptom tracking, messaging, and incentives.

Radiology Associates of Atlanta’s Piedmont division renews its RCM agreement with Zotec Partners.

The North Carolina Dept. of Health and Human Services implements Therap’s developmental disability software, which includes messaging, billing, and HIE capabilities.

People

XG Health Solutions promotes Steven Pierdon, MD to CMO.

Telemedicine

Greater Oregon Behavioral Health partners with fiber optics company LS Networks to launch a telemedicine program for 16 communities across the state, courtesy of a $436,506 Distance Learning and Telemedicine Grant from the USDA Rural Development Program.

Web-enabled hearing solutions company IHear develops EarPing, a collection of direct-to-consumer services including virtual screening and hearing-aid programming.

Government and Politics

STAT taps “early and often anonymously sourced reports” to put together a list of likely HHS appointees in President-elect Trump’s impending administration.

Other

Uber donates 6,000 gift cards to the Fisher House Foundation, a nonprofit that provides housing for veterans undergoing medical treatment at local VA facilities. The foundation will distribute the cards to vets and their family members in Los Angeles, St. Louis, Houston, and Washington DC. The ride-sharing company has also added a feature to its app that informs riders when their selected drivers are veterans (should the driver opt to share that information to Uber). “As we’ve all learned as a country in the last couple of days, it’s important to find things that keep us together,” says Uber Chief Business Officer Emil Michael. “And what keeps us together are our veterans and their service for our country.”

Physician burnout takes center stage: Playwright and actor Michael Milligan will stage “Side Effects” November 17 at Mayo Clinic’s Geffen Auditorium in Rochester, MN. As Dr. William McQueen, Milligan will offer up a look at the side effects of practicing medicine and what it means to be a doctor in America.

Seguin Dermatology (TX) is hit with ransomware that the practice says it was able to remove. It did not disclose the number of patient records affected, though it did maintain that the compromised server did not contain medical records, lab reports, or financial information. Computer security expert Matt Snider believes hackers included the office in a broad sweep that detected vulnerabilities in its server, then unleashed the malware.

Contacts

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

More news: HIStalk, HIStalk Connect.

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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

More news: HIStalk, HIStalk Connect.

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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

More news: HIStalk, HIStalk Connect.

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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.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.