Government and commercial payers are transitioning from encounter-based reimbursement to new payment models that reward coordination of care and population health management. One of the keys to this transition is ensuring the clinical information about their patients and overall populations is current and complete.
Orlando Health recognized the trend early and realized it must act to stay ahead of the upcoming changes. Included in its plans was adopting a population health management (PHM) solution and ensuring all of its primary care providers (PCPs) were recognized as NCQA Level 3 Patient-Centered Medical Homes (PCMHs). Yet in reviewing the availability of patient data to use in making the transition to value-based billing, the health system realized it had two options. One was to manually aggregate the records for its large patient population across the various electronic health record (EHR) systems being used by its physicians – which would be impractical from a resource standpoint. The other was to rely on claims data that could be months old, which would be insufficient because much can change in a patient’s health over that time.
To overcome these obstacles, Orlando Health implemented Phytel’s PHM platform. Phytel offered a comprehensive set of solutions to help Orlando Health establish a Clinically Integrated Network (CIN), including acting as a pseudo-health information exchange (HIE) to aggregate data from all the different EHRs, and then automate functions such as building registries, identifying care gaps, engaging patients to close the gaps in care, and running quality performance reports. In one year, and touching more than 270,000 patient lives, Orlando Health was able to increase the number of diabetic patients with current HbA1c tests by 7%; increase preventive mammogram screening by 10% and colorectal cancer screening by 9%; increase the number of patients overall who closed care gaps by 22% and achieve many additional gains.
These successes also allowed the organization to generate $6.6 million in shared savings from two accountable care organization (ACO) contracts in the first year.