{"id":2978,"date":"2018-01-31T06:00:44","date_gmt":"2018-01-31T14:00:44","guid":{"rendered":""},"modified":"2023-05-31T16:40:01","modified_gmt":"2023-05-31T23:40:01","slug":"holston-medical-group-transforms-teamwork-with-modernized-hie","status":"publish","type":"post","link":"https:\/\/newed.any0.dpdns.org\/en-us\/industry\/blog\/healthcare\/2018\/01\/31\/holston-medical-group-transforms-teamwork-with-modernized-hie\/","title":{"rendered":"Holston Medical Group Transforms Teamwork with Modernized HIE"},"content":{"rendered":"\n\n\n
<\/a><\/td>\nDownload the free eBook: Care Coordination<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The decisive shift toward\u00a0value-based care and population health\u00a0requires health systems to\u00a0reach\u00a0beyond their four walls and\u00a0into the medical neighborhood to proactively coordinate care and improve population health.\u00a0\u00a0\u00a0But that\u00a0requires\u00a0a new\u00a0community-integration\u00a0capability\u00a0that\u00a0complements\u00a0their existing\u00a0EHR investments.\u00a0\u00a0Think of\u00a0a\u00a0\u201cCHR\u201d (community health record)\u00a0as a modernized\u00a0health\u00a0information\u00a0exchange (HIE)\u00a0designed to\u00a0support\u00a0value-based care.\u00a0\u00a0<\/span><\/p>\n

To coordinate care,\u00a0CHRs have\u00a0to do more than merely\u00a0exchange\u00a0information\u00a0between facilities.\u00a0\u00a0They must also\u00a0empower the clinicians accountable for care to\u00a0digitally communicate with each other<\/i>, easily and instantly,<\/i>\u00a0around\u00a0<\/i>a common care plan<\/i>\u00a0that\u2019s continually\u00a0updated\u00a0based on\u00a0the ever-changing\u00a0needs and health status of each patient.\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

In\u00a0as\u00a0much as I\u2019ve talked about the merits of a\u00a0CHR\u00a0like this, I have to admit that I\u2019ve never heard of one that\u2019s fully operational \u2013 until\u00a0I recently\u00a0had the pleasure of\u00a0interviewing\u00a0Wesley Combs<\/a>, CIO of Holston Medical Group<\/a>\u00a0(HMG).\u00a0 As he described\u00a0how\u00a0their\u00a041 sites of care from\u00a0Tennessee\u00a0to Virginia\u00a0are using their\u00a0HIE,\u00a0it became obvious\u00a0to me\u00a0that\u00a0the platform HMG is using\u00a0from health IT leader, Allscripts<\/a>,\u00a0is no ordinary HIE.\u00a0\u00a0Unlike most HIEs operating today, this one was designed\u00a0for\u00a0virtualized care teams of the future, not the past.\u00a0\u00a0Not only does it\u00a0move information\u00a0from\u00a0point to\u00a0point, it\u00a0truly empowers clinicians to collaborate with each other and coordinate care in real time\u00a0across the medical neighborhood.\u00a0\u00a0The following is\u00a0a transcript of my conversation with\u00a0Mr. Combs.\u00a0<\/span><\/p>\n

Schmuland: Before we get started, could you\u00a0give me an overview\u00a0of\u00a0your role and\u00a0the\u00a0vision and\u00a0scope of services at Holston Medical Group?\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0I\u2019ve\u00a0served as\u00a0the CIO of HMG\u00a0since 2012\u00a0and when I arrived,\u00a0I was challenged with providing\u00a0a\u00a0communitywide\u00a0system that enables providers to execute in a value-based world while maintaining and improving the fee for service execution that pays the bills.\u00a0\u00a0\u00a0<\/span><\/p>\n

Holston Medical Group is a multispecialty\u00a0practice\u00a0made up of\u00a0165\u00a0practitioners that serve\u00a0more than\u00a0200,000\u00a0patients\u00a0at\u00a041\u00a0sites\u00a0across\u00a0a\u00a0100-mile\u00a0radius\u00a0in northeast\u00a0Tennessee and southeast Virginia.\u00a0\u00a0Founded in\u00a01977\u00a0by Dr.\u00a0Jerry Miller,\u00a0the practice\u00a0grew\u00a0from 5-6\u00a0providers\u00a0to\u00a0one of\u00a0the largest multispecialty groups in the southeast\u00a0and the first\u00a0level 3 NCQA recognized\u00a0patient-centered medical home\u00a0(PCMH)\u00a0in Tennessee.\u00a0\u00a0We\u00a0believe\u00a0it is important for\u00a0physicians to remain independent so they can fully focus their time and resources on their patients.\u00a0Our\u00a0strategy is to give our physicians\u00a0the tools they need to remain independent.\u00a0<\/span><\/p>\n

Schmuland:\u00a0How far along on\u00a0the journey from fee for service to\u00a0fee for value\u00a0would\u00a0you say that HMG has come?\u00a0\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0With an increasing number of incentives to move toward risk-contracting, approximately\u00a020% of our\u00a0contracts are risk-based with more than half of those including downside risk.\u00a0\u00a0Value-based contracts encourage\u00a0physicians\u00a0to think harder about\u00a0the cost and quality of the care provided.\u00a0\u00a0\u00a0<\/span><\/p>\n

Schmuland:\u00a0It sounds like HMG is a large federation of independent physician practices that are sharing risk as a clinically integrated network, right?\u00a0 But to share risk in Clinically\u00a0Integrated\u00a0Networks, each practice needs a friction-free way to share records and communicate to coordinate care and ensure care continuity.\u00a0\u00a0 By now, most practices in CINs have organized and integrated under a local hospital system to exchange medical records and coordinate care plans.\u00a0 Is that the case with HMG?\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0 Not at all \u2013 at HMG it\u2019s just the opposite. We\u2019ve\u00a0leveraged\u00a0a\u00a0community record\u00a0for the medical neighborhood\u00a0\u2013\u00a0the\u00a0dbMotion\u00a0Community via\u00a0OnePartner<\/a>\u2013\u00a0that\u2019s\u00a0available not only to physicians practicing within HMG, but it\u2019s open to all physicians and healthcare organizations throughout our region, including the hospitals. Currently, we\u00a0have 1,820\u00a0providers contributing records to the system and nearly 1,000 of those have access to the information at the point of care.\u00a0\u00a0From a workflow efficiency standpoint, access to the community record\u00a0nearly eliminates\u00a0the\u00a0staff\u2019s\u00a0time and\u00a0frustration\u00a0of hunting\u00a0down\u00a0medical records.\u00a0 Now, they are able\u00a0to access these records\u00a0instantly. Physician\u00a0users\u00a0can\u00a0deliver higher quality care\u00a0that\u2019s\u00a0also\u00a0highly efficient\u00a0and cost effective.\u00a0<\/span><\/p>\n

Schmuland:\u00a0At a time when most physicians seem to be selling their practices to regional health systems, HMG seems to be\u00a0bucking\u00a0that trend\u00a0by enabling physician collaboration.\u00a0\u00a0What\u00a0are you providing\u00a0to\u00a0these groups\u00a0that\u2019s keeping them\u00a0independent?\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0Independent\u00a0single and multispecialty practices are inundated\u00a0with\u00a0clinical\u00a0and\u00a0financial\u00a0reporting requirements\u00a0thrown at them by nearly every payer\u00a0contract\u00a0\u2013 and\u00a0they\u2019re\u00a0not consistent across contracts.\u00a0\u00a0The\u00a0Medical Group Management Association\u00a0(MGMA) issued a study last year\u00a0reporting\u00a0that physicians and their staff\u00a0now\u00a0spend\u00a0about\u00a0785 hours each year dealing\u00a0with\u00a0quality reporting measures alone,\u00a0mostly consumed by\u00a0entering data.\u00a0\u00a0If you translate that into time\u00a0taken\u00a0from\u00a0patient care\u2014it\u2019s about\u00a09 patients per week\u00a0that\u00a0physicians have to surrender to administrative reporting.\u00a0\u00a0The cost\u00a0of lost patient care for\u00a0each physician\u00a0amounts to\u00a0$40,000\u00a0per\u00a0year, not to mention the access issue it creates for patients.\u00a0\u00a0And that was before MACRA,\u00a0Medicare\u2019s\u00a0new\u00a0Quality Payment Program,\u00a0which we believe could double the work burden.\u00a0\u00a0\u00a0<\/span><\/p>\n

We\u00a0help other groups with their\u00a0IT integration,\u00a0data reporting and value-based contracting models.\u00a0This\u00a0allows\u00a0these\u00a0groups to maintain their independence in light of the increased complexities of the business of healthcare.\u00a0Most independent physicians want to do what they went to school for \u2013 taking good care of people.\u00a0 Our team can help them refocus on doing exactly that with improved tools to help them succeed in the world of value.\u00a0<\/span><\/p>\n

Schmuland:\u00a0\u00a0How did you go about finding the platform you needed for your community record\u2014and how did you manage to\u00a0build\u00a0the\u00a0business case for each practice and facility to make the investment?\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0\u00a0When we started our search five years ago, we\u00a0knew that we\u00a0needed\u00a0real data\u00a0to\u00a0identify risk on patients, manage their costs, measure quality\u00a0and tightly coordinate\u00a0the\u00a0care\u00a0that required multiple specialties.\u00a0\u00a0We\u00a0needed\u00a0near real-time\u00a0interfaces\u00a0with\u00a0nearly every type of\u00a0EHR\u00a0in the neighborhood.\u00a0 That\u2019s\u00a0where\u00a0costs,\u00a0complexity, and vendor lock-in\u00a0can\u00a0break the bank.\u00a0\u00a0\u00a0<\/span><\/p>\n

After\u00a0conducting due diligence on\u00a0nearly every\u00a0vendor\u00a0that came close to our criteria, we\u00a0chose\u00a0the\u00a0dbMotion\u00a0Community via\u00a0OnePartner.\u00a0 There were\u00a0two big\u00a0advantages\u00a0of\u00a0the Allscripts\u00a0dbMotion\u2122 Solution\u00a0that made the decision easy:\u00a0\u00a0First,\u00a0it\u00a0had\u00a0the\u00a0best\u00a0and most scalable\u00a0and flexible\u00a0approach\u00a0to connecting clinics\u2014because a community record doesn\u2019t matter if it isn\u2019t connected.\u00a0\u00a0Second, it must work within a physician\u2019s existing EHR workflow.\u00a0Their\u00a0EHR Agent\u00a0Hub\u00a0floats on top of\u00a0the EHR and\u00a0allows for single sign on for the physician user, negating the need to go outside their existing workflow to \u201chunt\u201d for information.\u00a0\u00a0It\u00a0will alert the physician user if there is new information, outside of their local\u00a0EHR, within the Community Record, which may be of interest to them at the point of care.\u00a0Custom physician designed analytics tools also exist within this platform\u00a0and they\u00a0are really geared towards population health strategies\u00a0that physicians\u00a0know\u00a0will work.\u00a0<\/span><\/p>\n

Schmuland:\u00a0 Everyone says that selling\u00a0technology\u00a0to physicians is\u00a0hard, let alone persuading them to use it.\u00a0\u00a0How did you\u00a0make the business case for your physicians?\u00a0\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0 That wasn\u2019t hard at all.\u00a0\u00a0Our physicians\u00a0know that\u00a0data is key in the new world of healthcare.\u00a0When\u00a020% of the patients\u00a0they\u00a0see are\u00a0chronic complex patients\u00a0under\u00a0risk contracts,\u00a0and are consuming 80% of\u00a0the\u00a0money\u00a0they are\u00a0at risk for, they quickly realize that this is the sweet spot of people to influence to execute on those risk contracts. By having the data, they can execute on key\u00a0opportunities to engage the patient face to face\u00a0on\u00a0steering them to\u00a0cost effective specialists, places of services and medications just to name a few.\u00a0This year alone the technology has helped HMG move their risk score up by 10 points, put HMG\u2019s admits per 1000 20% below market and helped increase ambulatory E&M visits by 4.2%. These factors help lead to better Fee for service payments and larger Value based gain shares. Add to that the patient\u2019s satisfaction of less hospital visits and a more engaged and personalized primary care experience,\u00a0we believe this is a big win.\u00a0<\/span><\/p>\n

Schmuland:\u00a0It looks like you\u2019ve turned\u00a0the\u00a0conventional\u00a0HIE\u00a0model upside down where, instead of the\u00a0medical neighborhood\u00a0facility\u00a0as\u00a0a spoke\u00a0centered around a\u00a0hospital system\u00a0hub,\u00a0the patient is truly\u00a0the hub and every facility is a spoke.\u00a0\u00a0\u00a0Do you have any hospital spokes?\u00a0\u00a0<\/span><\/p>\n

Combs:\u00a0Yes,\u00a0our community record is integrated with\u00a0the\u00a0regional\u00a0hospital\u00a0system \u2013so\u00a0notifications\u00a0of\u00a0admits,\u00a0transfers, and discharges are\u00a0sent straight to the point of care via the\u00a0EHR\u00a0Agent\u00a0where care providers are notified of\u00a0what happened\u00a0along with other metrics like LACE, Risk Score and Stratification level.\u00a0 Before implementing\u00a0the solution,\u00a0we struggled to even identify all our patients in the hospital and had a hard time hitting the 14-day mark to perform the transition of care. Now the average transition of care time is down to 5 days on 100% of identified discharges which is huge on the patient front because they are surprised we called so quickly. It led to more service revenue that wasn\u2019t being captured and helped in some quality measures.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Learn how modernized HIE helps empower more than 1800 ambulatory clinicians to digitally coordinate care across the medical 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Transforms Teamwork with Modernized HIE - Microsoft Industry Blogs<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/newed.any0.dpdns.org\/en-us\/industry\/blog\/healthcare\/2018\/01\/31\/holston-medical-group-transforms-teamwork-with-modernized-hie\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Holston Medical Group Transforms Teamwork with Modernized HIE - Microsoft Industry Blogs\" \/>\n<meta property=\"og:description\" content=\"Learn how modernized HIE helps empower more than 1800 ambulatory clinicians to digitally coordinate care across the medical neighborhood.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/newed.any0.dpdns.org\/en-us\/industry\/blog\/healthcare\/2018\/01\/31\/holston-medical-group-transforms-teamwork-with-modernized-hie\/\" \/>\n<meta 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