BOSTON--“Payer contracts are not aligned with evidence-based recommendations," said Adrian Zai, MD, PhD, MPH, clinical director of population informatics at Massachusetts General Hospital (MGH), speaking at the Big Data & Healthcare Analytics Forum. “Different payers have different metrics.”

As healthcare moves from volume to value, accurate and standards measures are more important than ever. Partners HealthCare--parent organization of MGH--launched three interventions to address the issue:

• Develop more clinically meaningful measures
• Create a population health coordinator program
• Implement TopCare population health management IT system

The goal was to improve clinical outcomes for all primary care patient populations, incentivize improvement over time and alleviate administrative burden on providers and practices.

"Partners has all these contracts presenting metrics to physicians but they made no sense so we created an internal framework," said Zai. To begin, they identified all the reasons the physicians called the old measures “stupid.” 

“We went through every practice and came up with more than 100 reasons why the old measures didn’t make sense.” Some said measures didn’t apply to their patients or that they weren’t appropriate. “We tackled every single reason so there would be no excuses for them not to achieve 100 percent.”

Then they created the population health coordinator (PHC) program to put 10-20 people in the role designed to tackle all the mundane stuff. That includes getting appointments scheduled and tests performed as well as following up when these things don’t happen. They also clean up EHR documentation which allows clinical providers to practice at the top of their licenses.

In the typical PHM IT strategy scenario, organizations purchase a software package for each of the four pillars: data aggregation, healthcare analytics, care coordination, and patient outreach. But, Zai said that software leads to segmentation. “We built our technology to pull systems together.”

Upon launch of the system on June 30, 2014, they went from managing 70,000 contract patients to managing about 300,000 patients belonging to the MGH Primary Care Network for a total of 30 practices and 1,500 providers.  Within six months, all of their clinical quality measures went up. They also estimated 76 lives and $3.2 million saved during the first four months—annualized, that’s 228 lives and $9.6 million in treatments avoided. That works out to about $20 per patient in savings for an initiative that cost $7 per patient.

Zai said physicians and staff are happier. When asked what impact the initiative had on the care they provided to their panel of patients, 85 percent said it had a positive impact. The TopCare clinical registry allows for real-time, actionable, rolling 12-month data, and more accurate attribution and diagnosis algorithms.

Partners is now payer agnostic, Zai said, and all of their quality measures went up within six months of launching their efforts. He attributes that success to the improved visibility into populations,

Zai offered several tips to the audience including the importance of targeting high-risk patients because it is very fruitful. Citing those with prediabetes, he said the risk there is low but earlier intervention is probably more cost-effective.

High risk for what is the question we need to ask, Zai said. High risk for readmission, non-adherence, low health literacy or multiple conditions are some of the options. Is that risk really modifiable? Identify the services you have to see if you have an intervention available and determine whether that intervention is effective.

You also should invest in a system to measure the effectiveness of your interventions, Zai recommended. “Otherwise you’re working in a void.” Look at how quickly your low-risk patients become high risk and make sure you match the right high-risk patients to the appropriate interventions. Providers also should engage multiple interventions because high-risk patients keep feeding into the system—it’s not a closed loop.

“The devil is in the details,” Zai said. “It’s mindboggling the amount of time you can spend doing something unproductive.”