How data is driving value-based care and population health
Philip M. Oravetz, MD, MPH, head of population health at Ochsner Health in Louisiana, has crucial advice for other health systems considering value-based contracts. Before signing, ask your payers to commit to providing claims data.
This has been a sticking point for the shift to value-based care for many years, said Dr. Oravetz, who provides physician leadership for Ochsner’s value-based contract systems portfolio. These include shared commercial savings and full-risk capitation within Medicare Advantage.
Payers often take a critical view of what is happening with patients relative to physicians and healthcare organizations, “because claims data contains critical practice-level insights,” he said. he declares.
Dr. Oravetz discussed the path to success with Ochsner’s value-based initiatives with Suja Mathew, MD, executive vice president and clinical director of Atlantic Health System, during an AMA Insight Network virtual meeting.
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Ochsner Health is the largest integrated delivery system in the Southern Gulf, providing care throughout Louisiana, parts of Mississippi and Alabama. The system enjoyed a 17-year period of growth and expansion, operating two medical schools while overseeing clinical trials and other research, Dr. Oravetz said.
“And now we’ve added this value-based care portfolio,” he said. Value-based contracts operate on four key elements: improving population health to improve quality; enhance the patient care experience; transform fee-for-service into pay-for-value; and ensure the well-being and care of caregivers.
“We have full capitation contracts where we are responsible for all gains and losses, including post-acute pharmacy and hospital care. We take responsibility for the total patient expense, in addition to patient experience and quality,” summarized Dr. Oravetz.
To achieve good quality results, Ochsner implemented a system to “marry” claims to clinical data in new ways and integrate them into point-of-care practices.
Each practice has a quality coordinator and all data comes from a shared electronic health record. Over the past eight years or so, the health system has integrated data from disease-based registries on diabetes, hypertension, cancer, and other conditions into the workflow of its provider offices.
As soon as a doctor opens a case, they can see where the gaps in care are and begin to fill those gaps. This allows them to have a better view of care as they see patients day in and day out, Dr. Oravetz said.
Using EHRs to examine one patient at a time “is one of the most wasteful things we do in healthcare,” Dr. Oravetz noted. “You really need a platform outside of your EHR…that can organize these claims in a meaningful way.”
Ochsner’s external software platform uses a claims aggregator to estimate total care expenditures for specific patient populations. With this method, “you can start offering interventions one at a time, across the continuum, to start understanding how to reduce variation and make care more effective,” he explained.
Once a health system understands where its high-level savings opportunities lie, it can focus its resources on those programs and take more risk, he continued.
Such changes do not happen overnight. Ochsner’s Medicare Lead Care Organizations, for example, took five years to generate savings and complete enough interventions to impact the total cost of care. Now, these ACOs are successfully generating shared savings.
Ochsner has also integrated behavioral health resources, social workers, and psychologists into her primary care practices. Under the traditional referral process, patients often have to wait several months before seeing a behavioral health specialist.
Under Ochsner’s system, “I can literally walk you down the hall so we can start your therapy,” Dr. Oravetz said.
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