Genesis Health System — a Cerner ITWorks℠ client in Davenport, Iowa — joined the University of Iowa Health Alliance accountable care organization (ACO) in 2015. The goal: improve patient care while limiting unnecessary spending.
In 2018, when the University of Iowa Health Alliance disbanded, leaders had to figure out a new strategy to continue to manage the health and well-being of more than 48,000 contracted lives within its independently managed Genesis ACO.
The Genesis ACO team began to use HealtheIntent®, an EHR-agnostic data and insights platform inclusive of claims data, to better understand the cost and utilization of their managed lives. Genesis ACO implemented several products that leverage the power of the HealtheIntent platform, including: HealtheAnalytics℠, HealtheEDW℠, HealtheCare℠, HealtheRegistries℠ and Cerner Hierarchical Condition Categories (HCC).
A foundational element to managing an ACO is patient attribution — a method of identifying a patient-provider healthcare relationship and the premise of providers accepting accountability for managing the full care continuum for their patients.
Before the organization moved to HealtheIntent, patient attribution was a “big hurdle,” Steven Aguilar, MD, medical director for primary care, Genesis ACO said. The intelligence within the HealtheIntent platform helped enable providers to identify their patients.
“Providers appreciate that they're not being held accountable for patients who they can't manage or should not be managing,” he said. “From our standpoint, they're much more engaged in being able to manage the patients who are indeed theirs.”
Beyond attributing patients to providers, Genesis ACO is utilizing HealtheIntent tools aiming to empower providers to put quality at the forefront of care. “As a provider, having the tools we can easily refer to at the point of care in the office is beneficial,” Dr. Aguilar said. “Through HealtheRegistries, providers use analytic tools to show how well they're performing. Using HealtheRegistries is valuable to see how we're doing, both financially and from a quality standpoint.”
The team transitioned from managing spreadsheet data to providers seeing both clinical and financial data in a single view.
“With a click, providers look at their scorecard performance, which assists in determining which patients they need to bring in, and overall, just how providers are performing,” Dr. Aguilar said. “We would pull spreadsheets from various sources to look at financial performance, and we were very reliant on payers to give us data, which oftentimes took months. With HealtheIntent, we have much more near-real-time data that are often within weeks of performance.”
Genesis providers were able to leverage HealtheRegistries to help improve the percentage of their diabetic population receiving Diabetic Eye Exams from 43.73% to 46.80%. This meant that 681 more patients received their exam compared to the same timeframe in the prior year.1 The Center for Disease Control and Prevention (CDC) says regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.2
Additionally, Genesis providers were also able to better manage their diabetic population by using HealtheRegistries to reduce the percentage of their diabetic population with A1C results greater than 9 from 18.04% to 15.61%. This meant that 235 less patients had A1C results greater than 9 compared to the same timeframe in the prior year.3 The CDC says that effective blood sugar management can reduce the risk of eye disease, kidney disease and nerve disease by 40%.4
While providers used HealtheRegistries to help close diabetes care gaps, they also utilized Cerner Hierarchical Condition Categories (HCC) to code risk appropriately. The Centers for Medicare and Medicaid (CMS) HCC risk adjustment model is used to calculate risk scores that help determine how much a physician should be compensated for caring for chronically ill patients.5
From calendar year 2019 to calendar year 2020, Genesis providers were able to capture the acuity levels more accurately in their Medicare Shared Savings Program (MSSP) population and saw Genesis’ risk adjustment factor (RAF) score go from 1.080 to 1.164.
“The HCC advisor is invaluable; having the problem list flag the HCC codes in a visual way was beneficial for our team,” Dr. Aguilar said. “We would update problem lists, and then the system would flag HCCs needing coded. That’s worked well especially for diabetes.”
“Even a small change in our RAF score can make a significant impact to how we perform in our value-based contracts as the RAF score indicates how sick of population we are caring for,” said Priscilla Stilwell, executive director for population health. “The sicker the patient, the more care required.”
As part of addressing cost and utilization, Genesis is managing social determinants of health, such as transportation. Genesis ACO care team members use HealtheCare as part of a holistic approach. Care plans within HealtheCare include difficulties with transportation, patients living alone and housing conditions that can impact chronic conditions, potentially leading to poor outcomes.
“Genesis ACO care coordinators use [HealtheCare] to contact a patient and ensure smooth transitions in care from the hospitals and the skilled nursing facilities,” Dr. Aguilar said. “They're getting appointments set up in their primary care office and are able to have social determinants of health identified and managed.”
As regulations and requirements through value-based contracts evolve and change, the Genesis ACO staff appreciates Cerner.
“Medicare is more and more of our population; we need these tools to submit data that we’ll no longer be able to submit manually,” Ms. Stilwell said. “Cerner keeps up with regulations, and HealtheIntent tools support that.”
1In August 2020, there were 13,371 Genesis patients who qualified for the Diabetic Registry and needing a diabetic eye exam. Of the 13,371, 5,847 (43.73%) received an exam in the prior 364 days. In August 2021, there were 13,948 Genesis patients who qualified for the Diabetic Registry and needing a diabetic eye exam. Of the 13,948, 6,528 (46.80%) received an exam in the prior 364 days.
2“Cost-Effectiveness of Diabetes Interventions,” Center for Disease Control and Prevention, accessed August 2, 2021, https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm
3In August 2020, there were 13,389 Genesis patients who qualified for the Diabetic Registry and qualified for A1c testing. Of the 13,389, 2,415 (18.04%) had their latest A1c result greater than 9. In August 2021, there were 13,965 Genesis patients who qualified for the Diabetic Registry and qualified for A1c testing. Of the 13,965, 2,180 (15.61%) had their latest A1c result greater than 9.
4“Cost-Effectiveness of Diabetes Interventions,” Center for Disease Control and Prevention, accessed August 2, 2021, https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm
5“Hierarchical Condition Category Coding,” American Academy of Family Physicians, accessed August 19, 2021, https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html