During the annual College of Healthcare Information Management Executives (CHIME) Fall Forum, CIOs and senior healthcare IT executives from around the world come together to help advance healthcare IT.
At this year’s event, Cerner’s John Glaser led a roundtable on the topic of engaging in at-risk contracts. Following the roundtable, Glaser sat down with Pamela McNutt, senior vice president and CIO of Dallas-based Methodist Health System. McNutt is a previous CHIME and HIMSS John E. Gall CIO of the Year award-winner. In a Q&A with Glaser, she discussed Methodist’s population health journey and shared her advice for other health systems preparing their organizations for population health.
Glaser: Methodist’s clinical and quality outcomes rank in the top quartile, and the health system is considered a leader among the largest health systems in the U.S. Can you share some background on Methodist’s population health journey to date?
McNutt: We started 10 years ago, looking at creating a patient-centered medical home (PCMH) for our own employees, and then going in full-force with a wellness program for those employees. We were already self-insured, so we decided to see how well we could do. It turns out we did very well.
We use a Cerner program to help with our employee wellness. We sell our Wellness Program to other employers in town.
When we started to hear the rumblings that health systems needed to be prepared for a total risk-based market, we decided to go ahead and enter into the Medicare Shared Savings Program (MSSP). That was about 5 years ago.
What results have you seen from the MSSP?
Years one through four, we achieved great savings. Now, in year five, it’s getting harder and harder to generate big savings – because we’re compared against how well we’ve done in the past. While we achieve top savings and quality in regards to benchmarked data the physicians in the ACO are getting smaller shared savings payments each year.
How would you describe where you’re at today with your population health plans?
We’re in a bit of an evaluation period. We know what we’ve done over the past five to ten years with our employees and our highest-risk patients is good and that it needs to be applied across a broader population, and we’re anxious to do that. It would be nice to have some partners that wanted to come and share some of the risk with us. We feel like we’ve done a good job of bending the cost and quality curve and we would like to expand that progress.
Looking at bending the curve, what have you done to manage the health of those who are really sick or the disadvantaged?
We have a large indigent population, and we have programs like Delivery System Reform Incentive Payment (DSRIP) in which the Texas Health and Human Services Commission received a federal waiver to expand Medicaid. DSRIP pays for health care improvements and directs more funding to hospitals that serve large numbers of uninsured patients through projects that improve access, quality, cost-effectiveness and coordination. Current projects at Methodist include emergency department (ED) navigation and diabetes management.
The ED navigation project provides services in the ED to targeted patients who are at high risk of disconnecting from health care services or who are identified as not having a primary care physician or medical home to address their needs. Through this program, we’ve increased access to social workers and connected patients to primary and preventative care and chronic care management.
The diabetes management project applies evidence-based care management models for ED patients identified as having high-risk health care needs associated with diabetes. Through the program, we’ve developed chronic disease management education, protocols and self-management criteria for patients through a multi-disciplinary process. These protocols are being implemented in our hospitals through new education services and our network of primary care physicians supporting diabetic patients.
If you were to give advice to health care IT colleagues about what they can do to prepare their organizations for population health, what is the most important thing you’d tell them?
We’ve been through a couple of different toolsets for population health data. The reason why we’ve changed a couple of times is because we’re striving to get affiliated ACO doctor’s EHR data interfaced in a timely fashion, rather than waiting on claims data. This has proven to be challenge that no toolset has been able to deliver for us.
When it comes to population health management, my number one piece of advice for other health care organizations is: don’t let looking for a utopic solution stop you from starting somewhere and dipping your toe in the population health journey. You can start simply and work your way up: first with care management/navigators, analytics and risk identification, and then move into care variation management.
I think organizations have to learn how to do those things. Whatever the risk based payment model flavor of the day is – a health maintenance organization (HMO), an accountable care organization (ACO0 – it seems clear that those skillsets are required no matter where you are going We don’t know what the government program de jour is going to be in a few years, but it’s hard to imagine that care management will be an irrelevant idea. If nothing else, so many of us are self-insured – organizations that are can practice on themselves.
We’re focused on connecting traditional venues, the health continuum and advanced information about a person’s lifestyle to empower individuals in their health and care. Learn more about Cerner’s population health management solutions.