As a buyer of healthcare information platform vendor Arcadia, Ochsner Well being Community has performed an vital position within the growth of a brand new device known as ContractIQ that the corporate says simplifies the design, negotiation, and forecasting of value-based care contracts. Julie Grantz, M.B.A., Ochsner’s vp of value-based insights, spoke with Healthcare Innovation about a few of the keys to the New Orleans-based well being system’s success in value-based care and why they wanted a device like ContractIQ.
Healthcare Innovation: We’ve written just a few instances concerning the success Ochsner appears to have in value-based care, particularly within the Medicare Shared Financial savings Program. As an illustration, the Ochsner Accountable Care Community achieved its eighth consecutive 12 months of top-ranking ends in each scientific efficiency and healthcare financial savings for the Medicare inhabitants in its care. Are there sure stuff you attribute that success to?
Grantz: All of our governing boards, all of our committees are physician-led. I believe when physicians have so-called pores and skin within the recreation, they’re extra inclined to pay attention to the price of care and pay attention to duplicative providers, as a result of they know that in the event that they’re managing the overall price of care, then they’re ready to herald a distribution that helps them rent one other nurse practitioner or helps them broaden their apply in several methods. Having a background in danger administration for independently owned IPAs, I grew to become shut with these physicians and realized how they see it. I believe the physicians who’re a part of our clinically built-in community really feel possession of MSSP. They use Ochsner Well being Community providers, reminiscent of outpatient case administration and the digital ED, to handle the price of care in order that, in the long run, they’ll present higher care to the sufferers, and so they really feel management over it.
HCI: I reached out out to talk to you as a result of I noticed you quoted as a buyer in a press launch from the analytics vendor Arcadia a few new device known as ContractIQ. Right here is the quote:
“We handle greater than a dozen contracts with half a dozen payers, which locations a burden on our staff to reconcile these contracts and ensure we’re getting credit score the place credit score is due. Arcadia’s ContractIQ helps us forecast efficiency in the course of the 12 months so we are able to course right effectively upfront of receiving remaining outcomes.”
May you speak in a bit extra depth about your position at Ochsner and the way this device helps you and your staff?
Grantz: I lead the finance a part of our analytics staff. That’s the staff that makes use of information to search out patterns and interprets and communicates these patterns to our operations staff, which then goes and works with our community of physicians. Once I got here to Ochsner we had been utilizing a earlier device for our analytics platform, and it didn’t deliver numerous EMRs collectively and permit us to take a look at all of our strains of enterprise — Medicare, Medicaid, and business — collectively. So we could not get a full image of what all of our admits per 1,000 or per member/monthly prices had been. We went via a really prolonged RFP course of, and ended up selecting Arcadia to fulfill each of these wants, and it’s a device that my staff on the associated fee and utilization aspect for medical and pharmacy makes use of each single day.
However we nonetheless did not have a monetary device that might deliver within the benchmark parts of our value-based contracts, the premium parts. So I might usually be requested: if price and utilization retains happening, why aren’t we creating wealth in these contracts? Each enterprise has premium or income or a goal, and then you definitely take out the bills, and no matter’s left is what you get in financial savings — and I did not have a approach to do this. Internally we had been utilizing spreadsheets and constructing our personal fashions. After we started to work with Arcadia, I expressed that this was a necessity, and a few of Arcadia’s different prospects had been asking for one thing comparable. And since we had such an important relationship with Arcadia, and we have achieved plenty of beta testing, we agreed that if Arcadia would decide to hiring the fitting actuarial people and monetary groups, that we might decide to constructing the device with them. ContractIQ permits me to herald all the income and premium parts and subtract all of that expense info and really present a monetary image for us.
HCI: So your staff was fairly central to the event of this, not only a buyer off on the aspect ready for it….
Grantz: Sure, it has been a lot enjoyable, actually.
HCI: Is it nonetheless comparatively new?
Grantz: Sure, it is a new device, and we’re implementing it for all of our populations. We went via a means of prioritizing our populations and likewise excited about how Arcadia can use this device for different prospects. We began with Medicare Benefit. That is an area the place value-based care and % of premium contracts and shared financial savings contracts are widespread. So we began there with a payer that has a really commonplace information set. Most suppliers who’re of their value-based contracts get the identical information set, in order that we might replicate it. And it is taken plenty of detailed work, however in the course of the subsequent 12 months I am going to be capable of inform my community of suppliers that they’ll anticipate to earn X quantity of {dollars} on the finish of the 12 months primarily based on their present efficiency. And I’ve by no means been ready to take action prior to now. We had been simply counting on what the payers informed us.
HCI: One factor I hear from different well being programs is that payers need to ship info to shut care gaps, however that the info usually lags, so the suppliers don’t need to use it. Do you utilize these notifications from payers or do you develop your personal from scientific information?
Grantz: It is a mixture. We do get the payer info, and we went via the method the place we had been sharing that with our physicians, and they’d say that is previous. So now my staff consumes the payer info and likewise pulls all the info that’s occurring within the practices that the payers do not even find out about but, and combines the 2. And that is really the place Arcadia comes into play, as a result of we’ve got perception into not simply Ochsner’s occasion of Epic, however different EMRs that our community of independently practising suppliers are utilizing, so it permits us to herald that extra present info. So if a payer says we have 1,000 gaps, we’d be capable of shut 200 of them straight away and solely ship out 800.
HCI: In order that functionality that you simply’re speaking about with Arcadia to share information along with your clinically built-in community, is that comparatively new, or is that one thing you have had for fairly some time?
Grantz: We’re in our third 12 months with Arcadia, and over these years, we have added practices that aren’t on Ochsner’s occasion of Epic. We’ve had some bumps and bruises, however total, the facility of having the ability to have perception into a number of EMRs inside our practices is invaluable.
HCI: I used to be watching a value-based care summit just a few weeks in the past, and several other of the individuals who had been in jobs like yours had been saying that getting information from the business payers was rather a lot more durable than getting it from Medicare or state Medicaid applications. Has that been your expertise with the business payers?
Grantz: I am fully biased as a result of my background is with a Medicare Benefit payer, so it is rather more acquainted to me. However sure, our business contracts have parts to them that we do not have visibility into, like issues that construct our benchmark that we do not get information on. A few of it is so simple as affected person danger scores being delayed by six or eight months. And a few of it’s extra advanced in that the payers, rightfully so, do not need to give us an accounting of their allowed versus their paid, as a result of that is proprietary info, and that is fully comprehensible, however for me to have the ability to redevelop the benchmark and create an precise monetary outlook, it’s tough. It is tougher on the business aspect so in our roadmap for ContractIQ, we do have business contracts and business information that we’ll begin to develop.
