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Value-based programs and care management boost quality while decreasing cost and utilization

by Roper St. Francis Healthcare

Published on 8/11/2020

While most of the U.S. health care market inches toward value-based care, Roper St. Francis Healthcare in Charleston, South Carolina, has fully adopted the payment model as part of its more than 150-year-old mission: “Healing all people with compassion, faith and excellence.”

The four-hospital, nonprofit community provider currently manages three value-based care populations, including its Medicare Shared Savings Program (MSSP) accountable care organization (ACO), employees and a neighboring aerospace employer population. In total, the organization is accountable for the health and well-being of more than 79,000 lives.

Roper St. Francis Healthcare leaders realized one of the best ways to fulfill their mission was to create an all-encompassing, longitudinal record using HealtheIntent®, a data and insights platform powered by Cerner. This platform enabled the organization to integrate data from its eClinicalWorks outpatient electronic health record (EHR), its Cerner inpatient EHR, more than thirty-five other EHRs across its clinically integrated network (CIN) and multiple payer sources.

“Reviewing data across those applications was a manual spreadsheet exercise,” said Jeanne Ballard, MD, chief medical information officer. “To get a sophisticated engine like HealtheIntent where we can ingest data, match it together and run analytics has been hugely valuable. We've gone from micromanaging the inpatient and the outpatient space to looking at that entire care continuum.”

Using this longitudinal record, the organizations can strategically target and implement innovative outreach strategies to specific populations and geographic areas in need.

“We focused on providing easy access to our primary care physicians, and they focused on providing preventative screenings and wellness,” said Kathy Guatteri, chief operating officer of Roper St. Francis Physician Partners. “In the last two years, we've exceeded our financial targets and basically bent the cost curve for all three of our managed populations.”

One initiative leading to the cost reduction was the introduction of the community care management program. The program targets high-risk, high-spend patients in value-based arrangements and matches them with a care manager who supports care between provider visits.

Prior to HealtheIntent, care managers manually scoured individual records to decipher patient eligibility for community care management services. Using HealtheIntent, Roper St. Francis Healthcare worked with Cerner to aggregate de-identified data to create, test and validate an algorithm that identifies populations based on their care expenses, chronic condition prevalence and participation in value-based programs. The automated process was deployed in its care management workflow to create a manageable, prioritized list of eligible care management candidates, helping care managers spend less time identifying patients and more time supporting them.

“Our care managers help patients navigate the confusing health care system and address any barriers to a healthy life,” said Caroline Pate, manager of operations for primary care. “Whether it’s sorting out transportation and food insecurities or walking them through a new diagnosis and medication plan, the care managers serve as a health coach, and the impact they’re having on our patients’ quality and overall satisfaction is remarkable.”

The outreach strategy plays a critical role in the success of the Roper St. Francis Healthcare MSSP ACO, which in 2018 achieved a quality score of 95.83% from the Centers for Medicare and Medicaid Services (CMS) - nearly three percentage points higher than the 2018 national average.1 Patients who actively participated in the community care management program avoided an average of $787 in care expenses, compared to patients who weren’t actively engaged.2 Furthermore, actively engaged patients recorded 42 fewer emergency department visits per 1,000 members, compared to unengaged members.3

In 2019, CMS awarded two of the Roper St. Francis flagship hospitals (Bon Secours St. Francis Hospital and Roper Hospital) the highest overall quality rating of five stars, a prestigious honor received by only 293 hospitals nationwide.4

“Working with Cerner and leveraging the power of HealtheIntent, we’re able to develop metrics across multiple sources, including EHRs and claims, to show avoidable spend, per member per month costs, ED utilization, and more,” said Robert Oliverio, MD, chief executive officer, Roper St. Francis Physician Partners. “It helps make the business case that operating in a value-based world makes sense.”

1 https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2018-Shared-Savings-Program-SSP-Accountable-Care-O/v47u-yq84/data

2 Comparing the average care expenses for a cohort of 790 managed patients to the average care expenses for 3,120 non-managed patients measured from January 2018 to March 2019.

3 Comparing the average number of ED visits per 1,000 members for a cohort of 790 managed patients to the average number of ED visits per 1,000 members for 3,120 non-managed patients measured from January 2018 to March 2019.

4 CMS Overall Hospital Quality Star Ratings published in February 2019: https://www.medicare.gov/hospitalcompare/search.html?
List of 293 5-star hospitals available via Becker’s Hospital Review: https://www.beckershospitalreview.com/rankings-and-ratings/the-293-hospitals-with-5-stars-from-cms.html

Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.