Colorado Beacon Consortium Newsbrief
Welcome to the The Ascent, an e-resource from the Colorado Beacon Consortium that brings you timely, targeted news once a month--news about transformation, technology and people working to pursue better care, lower costs and a healthier community.
Three questions for CMS' Richard J. Baron
Richard J. Baron, MD, MACP, is Group Director of the Seamless Care Models in the Center for Medicare & Medicaid Innovation, part of the Centers for Medicare and Medicaid Services. Among the Innovation Center's projects is the Comprehensive Primary Care (CPC) initiative, a multi-payer effort fostering collaboration among public and private health plans to strengthen primary care. Colorado was one of only seven markets nationwide selected to participate. (For more on the initiative, visit the Innovation Center's CPC site. Read more from this interview in a forthcoming CBC issue brief.)
Ascent: How does population health management align with the CPC's aims? Why is the public/private element important?
Baron: One of core design principles of CPC is that practices don't transform for just part of their business; they transform for their entire patient population. By focusing on transforming the structure of a practice, we are moving toward encompassing transformation for all the populations they serve. That's why the public/private collaborative aspect is so important. Just as we have a fragmented delivery system, we have a fragmented payment system. Providers do business with multiple different payers. When you try within a practice to innovate in the context of those multiple payers, it's difficult to get everyone on the same page.
It's clear--and wonderful and gratifying--that private payers have a tremendous interest in seeing stronger primary care and a willingness to support that with increased investment. But each would approach it slightly differently. Practices cannot develop new delivery models unless they are confident there is a new payment model to support them. So one of our key strategies is to create a framework that sends consistent payment signals to practices, along with a consistent set of expectations. That's what CPC does.
Ascent: What is the role of health IT in population health management?
Baron: There are several different ways information technology is central to population health management, including measurement, quality improvement, sharing data across teams and across the continuum of care, and construction of a population.
Ascent: Can you elaborate on "construction of a population?"
Baron: One could almost say that the population as a population gets created by information technology. As soon as you talk about population health and population health measurements, you are asking about numerator and denominator data. In a given population, what's the rate of morbidity, what's the rate at which certain procedures are being done? That sort of data does not emerge from a morning of seeing patients in the office. You have to construct a denominator and associate a numerator with that denominator. The process of doing that almost demands information technology. You use health IT to identify a population and understand, in real time, what is happening to them. It ties directly into measurement and, certainly, population health management requires health information technology if you are to know where you stand. This involves a conceptual shift. If you really want to know how you are doing, don't look at the patient you saw this morning, but the ones you saw on the same date in 2011. How many of them are still in treatment? If you ask doctors who should get a mammogram, they will say "every woman between 50 and 65." But the real question is this: How many of your patients got one? That's a very different question.
Affinity Group takes dual approach to health IT
Advancing health information technology demands a dual focus--attention to the technology itself and to how it's deployed in the practice setting. Marc Lassaux, CBC technical director, is one of the leaders in a collaborative national effort to address both: the ONC Beacon-EHR Vendor Affinity Group. The group, sponsored by the Office of the National Coordinator for Health Information Technology (ONC), includes representatives from several Beacon communities and EHR vendors with active workgroups for Engagement and Technology. Pam Foyster and John Lichty of QHN/CBC actively participate in the workgroups.
The Affinity Group was formed to figure out how to engage community physicians to help them better utilize their EHR systems, and to understand and work through barriers to use of those systems for quality improvement and reporting. The work complements efforts to help physician practices achieve Meaningful Use, and helps identify and resolve technology obstacles to achieving clinical transformation.
On the technical side, the goal is to develop toolkits, standards and specifications for effective extraction of data out of EHR systems for basic exchange, as well as for more sophisticated needs such as population health management. Standardization is crucial to capture community data. "Without that data, we don't get an accurate picture of the patient. Comprehensive primary care demands an approach that can utilize data from many disparate systems."That requires collaboration -- as in the Affinity Group model. "Collaboration is difficult, but it is vital so we minimize one-offs," Lassaux says. Individual, disconnected efforts can do more harm than good, he contends. "It is important to realize that, as much as everybody thinks this has already been figured out, it hasn't. Each effort is a little bit different. Collaboration is essential."
The CBC views participation in the Affinity Group and collaboration as critical components of the Beacon program. It's still a work in process, but if the group achieves its goals, it could have implications for practice design and interoperability around the country. But community transformation is incredibly difficult and complex. In particular, reaching providers where they are and teaching them to embrace and use technology can be a challenge. "We deal with a diverse range of providers and stakeholders who use technology with different levels of understanding and knowledge," Lassaux says. "To be successful, we have to make sure all involved understand what needs to occur and why. Health IT is complicated. We have to make it as simple as possible to ensure rapid adoption."
Learning Collaboratives foster transformation
At Colorado Beacon, transformation is a collaborative effort, and the process includes learning how to foster transformation. One way CBC accomplishes this is through quarterly Learning Collaboratives. CBC leaders tailor them to the needs of participating practices. Each practice must attend four Learning Collaboratives a year.
Marsha Thorson, office manager at the Town Clinic of Crested Butte, says the quality of speakers, materials presented and networking opportunities have been important to her husband's newly formed clinic. (Eric Thorson, MD, opened the practice 18 months ago in rural Colorado.) "They've been inspiring and energizing because you learn new approaches and ideas that can be applied to your practice," she says. "The speakers and other leaders provide a rich culmination of very practical information."
Speakers and instructors are recruited locally and nationally; participants often return as faculty. The Collaboratives cover a broad range of topics, from how to use data to improve quality and patient activation, to the integration of technology in more efficient, patient-centered workflows. Each office presents a storyboard depicting best practices to small groups of similar practices. "This gives the practices the opportunity to learn from each other," says Brooke Thomas, a CBC Quality Improvement Advisor. "We also group practices based on the EMR systems they use so they can discuss what works or how to make adjustments."
Learning Collaboratives appear to enhance patient care: The ONC noted in its Health IT Buzz blog that practices participating in Learning Collaboratives are increasing rates of depression screening (for patients with diabetes and ischemic vascular disease), breast cancer screening and tobacco cessation advice.
There's one more aspect: Learning Collaboratives are replicable and can be a model for disseminating best practices nationwide. Gregory Reicks, DO, FAAFP, made this point in a recent HIMSS blog post. "At CBC, we have regular Learning Collaboratives in which practices learn from experts and from each other. I envision that sharing on a national scale. Imagine how much more we could learn by doing that across the country."
Note: The two remaining CBC Learning Collaboratives are on Fri., Sept. 28 (previously scheduled for Aug. 31) and Thurs., Dec. 13. Registration information will be sent to practices three to four weeks prior to the scheduled date.
|News to Know
Colorado Health Foundation funds Western CO behavioral health payment reform evaluation
Rocky Mountain Health Plans will participate in an innovative pilot project with the Collaborative Family Healthcare Association and the University of Colorado Denver department of family medicine. The pilot, supported with funding from the Colorado Health Foundation, will test a global payment model for integrated behavioral health care in five to 10 primary care practices. Among the goals: Evaluate the impact of reformed payment on the sustainability of integrated behavioral health services in primary care setting. (U.S. Politics Today)
An Institute of Medicine report released earlier this month found the continued lack of trained health care providers will make it difficult to meet the growing demand for mental health services from the nation's growing elderly population. The report estimates as many as one in five seniors had at least one incident of mental health or substance abuse in 2010. The problem will grow as Boomers age. (IOM report; Kaiser Health News)
Expect Stage 3 MU recommendations by August
Members of the Health IT Policy Committee's Meaningful Use Work Group are scheduled to develop initial Stage 3 recommendations by Aug. 1; their goal is to issue final recommendations by May 2013. "We think that by Stage 3, we need to begin to transition from a venue-specific orientation to a more patient-centric solution," Siemens Medicals' Charlene Underwood, who led care coordination subgroup, tells Healthcare Informatics. (Healthcare Informatics)
CBC helps Reicks' office better use health IT
In an interview with CMIO, Dr. Gregory Reicks discussed the benefits of working with the Colorado Beacon Consortium. "Prior to Beacon, we weren't really using our population health management tool as effectively as could have." Participating in Beacon--and meeting the reporting requirements--pushed Reicks' practice to use technology in a more proactive manner for the benefit of the patients and the practice staff. (CMIO)
ACA SCOTUS resources
Kaiser Health News has assembled a collection of articles, videos and other resources related to the Supreme Court's ruling on the Affordable Care Act--and what will come next. (Kaiser Health News)
CMS proposes primary care pay hike
CMS has issued a proposed rule that would give family physicians a 7 percent pay boost in 2013. It would increase Medicare payments to other primary care practitioners between 3 and 5 percent, and would reimburse for the coordination of care after patients are released from nursing facilities and hospitals. (Medpage Today)
The absence of an integrated health IT environment causes problems for patients, providers and payers, explains Patrick Gordon, program director for the Colorado Beacon Consortium. "We won't realize the vision of the Triple Aim unless we address the challenge of health IT interoperability across multiple system platforms," Gordon warns. "Beacon communities are leading the effort to test, study and implement systems and standards that support the safe, secure exchange of discrete data, which will improve patient care and support broad population health improvement efforts." (NeHC webinar site)
Colorado Beacon Consortium
Colorado Beacon Consortium
The Colorado Beacon Consortium is a a region-wide, multi-stakeholder initiative in Western Colorado in which health providers and supporting community organizations are working to demonstrate the impact of practice transformation and health information technology on population health. CBC includes executive-level representation from four mission-driven, not-for-profit, Western Colorado-based organizations, all of which have nationally acknowledged track records of coordination to achieve superior outcomes. They are the Mesa County Independent Physicians' Practice Association, Quality Health Network, Rocky Mountain Health Plans and St. Mary's Regional Medical Center. The Colorado Beacon Consortium's mission is to optimize the efficiency, quality and performance of our health care system, and integrate the delivery of care and use of clinical information to improve community health. The geographic focus of the Consortium's activities includes the Colorado counties of Mesa, Delta, Montrose, Garfield, Gunnison, Pitkin and Rio Blanco.
About the Beacon Community Program
The Beacon Community Cooperative Agreement Program is part of a larger movement to modernize health care that demonstrates how health IT investments and Meaningful Use of EHRs advance the vision of patient-centered care, while achieving the three-part aim of better health, better care at lower cost . The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States that have already made inroads in the development of secure, private and accurate systems of EHR adoption and health information exchange. Each of the communities, with its unique population and regional context, is actively pursuing the following areas of focus: building and strengthening the health IT infrastructure and exchange capabilities within communities, positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years; translating investments in health IT in the short run to measurable improvements in cost, quality and population health; and developing innovative approaches to performance measurement, technology and care delivery to accelerate evidence generation for new approaches. These investments are part of a larger movement to modernize health care and will position communities to achieve measurable improvements in population health, in care and cost, and to succeed in a transformed payment environment.
To read more, click here.
Want To Learn More About CBC's Success?
"The Cost Conundrum: What a Texas town can teach us about health care," New Yorker, June 1, 2009 (This is Atul Gawande's article highlighting success in Grand Junction.)
"Improving patient and population health management" -- Advisory Board case study of CBC's use of the Crimson Care Registry
"Low-Cost Lessons from Grand Junction, Colorado" by
Thomas Bodenheimer, MD, MPH, and David West, MD;
New England Journal of Medicine Oct. 7, 2010
"Grand Junction, Colorado: how a community drew on its values to shape a superior health system," by Marsha Thorson, Jane Brock, Jason Mitchell and Joanne Lynn; Health Affairs, Sept. 2010
"The Beacon Communities At One Year: The Colorado Experience," by Lori Stephenson and David Herr; Health Affairs Blog, May 19, 2011