Western Slope consortium featured for improvements in HIT, quality

Monday, July 01, 2013 12:21 PM

The Commonwealth Fund published a case report in April spotlighting the Colorado Beacon Consortium (CBC) and how its culture of collaboration and integration of health information technology has increased quality and reduced the cost of care for patients on the Western Slope. CBC is one of 17 regions across the country participating in the three-year, federally funded Beacon Community Program, which aims to demonstrate that strengthening local HIT infrastructure can support care coordination and population health management.

But CBC isn’t just about technology, said Patrick Gordon, associate vice president at Rocky Mountain Health Plans (RMHP) and director of its government programs. While one objective was to spread HIT and strengthen the HIE infrastructure to support analytic capabilities, the other was to help redesign primary care practices by bringing them together in a learning collaborative that focuses on the effective use of electronic health records and analytics tools to implement team-based quality measurement and improvement.

The consortium brings together 51 primary care practices in seven largely rural counties spanning 17,500 square miles. The region’s predominant payer, RMHP, is the lead sponsor of the consortium and of CBC’s clinical transformation activities, one distinction from the other communities.

They place heavy emphasis on primary care, population-health management and shared registry technology, and have “a very high level of engagement, particularly with independent, old-fashioned, private and network practices,” Gordon said. “Then, last, we actually have moved some quality metrics. There’s nothing all that sophisticated about it, we just focused on coaching and other resources to create a metric-driven component for the transformation process.”

Improving care

The Commonwealth Fund’s report shows in preliminary results that participants improved quality of care in eight objective quality metrics, with relative improvements of 17 percent to 75 percent between the first and last three months that cohorts of primary care practices participated in the collaborative.

The biggest challenge was geography, said Gregory C. Reicks, DO, FAAFP, a family physician at Foresight Family Physicians in Grand Junction and president of the Mesa County Physicians Independent Practice Association (IPA). The quality improvement advisers had to travel long distances to reach the practices in the remote areas.

The second challenge was the technology, or more specifically learning how to use it better. These practices were the ones that perhaps needed the outreach the most, as rural practices tend to lag behind in their adoption of technology, he said.

“When we first started the project, many of the physicians were just doing free text transcription about preventive care activities. For example, ‘I talked to the patient about exercise; here’s what we talked about.’ Or, ‘I talked to the patient about diet; here’s what we talked about.’ Using the free text tool, there’s no way that we can push that information out into the registry to document that the activity occurred. So the physicians really had to relearn how to document a number of things they were doing in an encounter so we were all reporting in the same manner and the reports were more accurate.”

RMHP collaborated with other sponsors to obtain the $11.9 million federal grant, including Quality Health Network, the health information exchange for the region; Mesa County Physicians IPA, representing roughly 85 percent of the county’s physicians; St. Mary’s Hospital and Regional Medical Center, a 277-bed facility in Grand Junction; and Club 20, an association of business and civic leaders. Community hospitals, mental health agencies, long-term care facilities, home health agencies and allied health providers serve as collaborating and supporting organizations.

Gordon said he appreciates the flexibility of the Beacon program. “It really did live up to the billing as a public-private partnership with the federal government; they allowed the communities to define their own projects. We were held accountable for performance for achieving certain benchmarks, but we had a lot of latitude in how we chose to get there.”

“It gave us the ability to put a coaching resource in place in the workforce, and data extraction and supports for care management at the point of care,” he added. “Then, all of that allowed us to create a region-wide learning collaborative structure with a lot of engagement and leadership that will provide a nice frame for the future.”

Framework for the future

The first opportunity to leverage these lessons came in the form of the Comprehensive Primary Care Initiative (CPCi), a separate multi-payer initiative to strengthen primary care. Using their foundation in the Beacon program, some CBC practices were able to move to more rigorous care management and population health management objectives and will receive additional compensation from payers. Reicks’ practice qualified for CPCi and he anticipates the funding will allow them to expand their resources further in care coordination, health coaching, and patient engagement and activation tools, which they believe will continue to improve outcomes in their patient population.

As the Commonwealth Fund case study concludes, CBC’s approach “drew upon universal principles of collaboration, physician leadership, and community action to help empower each medical neighborhood to define its own approach using common tools and technology.” To be replicated in other communities, they will also need to adapt these principles to their local needs.

Gordon’s advice to others is just to jump in and start. “Start with a project, be willing to work outside your own walls, be willing to try something new, be willing to accept failure as a positive part of the learning process and it will be possible to get this kind of transformation on a much broader basis.”