Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

© 2014 Health Catalyst
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Dr. Greg Spencer & Dr. Scott Hines
Preparing for the Future:
Using Analytics to Drive Clinical & Operational
Excellence

Today’s Hosts
Dr. Gregory A. Spencer is the Chief Medical and Chief Medical Information
Officer at Crystal Run Healthcare and the Vice President of Medical Staff at
Orange Regional Medical Center (ORMC). Dr. Spencer graduated from the
Medical College of Wisconsin (Marquette University) Medical School and
completed his residency in Internal Medicine while in the U.S. Air Force at
Wilford Hall USAF Medical Center in San Antonio, TX. Dr. Spencer joined
Crystal Run as an internist in 1996 and was appointed to Chief Medical Officer
and Chief Clinical Information Officer in 2008. Dr. Spencer is board certified in
Internal Medicine and is a Fellow of the American College of Physicians.
Scott Hines, MD is Crystal Run Healthcare’s Co-Chief Clinical
Transformation Officer, Medical Director and physician leader for Crystal
Run Healthcare’s medical specialties division. Dr. Hines is board certified in
Internal Medicine, Endocrinology, Diabetes and Metabolism. Dr. Hines earned
his Medical Degree from the Wake Forest University in Winston-Salem, NC
and completed his residency in Internal Medicine at the Dartmouth-Hitchcock
Medical Center in Lebanon, NH. Dr. Hines completed his Endocrinology
Fellowship at the University of Maryland Medical Center in Baltimore, MD. Dr.
Hines joined Crystal Run Healthcare in his current capacity in 2006 to help
develop and implement the clinical programs necessary to deliver value based
care.

Topics
ACO progress review – national trends and Crystal Run1
Review of progress in data-driven decision making2
Review progress with key challenges3
Early results and wins4
What’s next?5

Poll Question
1. What best describes the organization you
belong to? 235 responses
a. Hospital – 21%
b. Health Plan – 11%
c. Physician Group – 13%
d. Provider Organization – 12%
e. Vendor – 43%

Crystal Run Healthcare
 Physician owned MSG in NY State, founded 1996
 325+ providers, 20+ locations
 Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep
Center, High Complexity Lab, Pathology
 Early adopter EMR (NextGen®) 1999
 Accredited by Joint Commission 2006
 Level 3 NCQA PCMH Recognition 2009, 2012
 Approved Health Plan (NY)

 Single entity ACO
 April 2012: MSSP participant
 December 2012: NCQA ACO Accreditation
 25,000 commercial lives at risk
 MSSP
 10,400 attributed beneficiaries
 82% primary care services within ACO

The mission of Crystal Run Healthcare is to improve the
quality and availability of, and satisfaction with, health care
services in the communities we serve. To accomplish this
goal, the practice emphasizes both traditional medical
excellence as well as responsiveness to consumer needs
through service excellence and patient empowerment.

ACOs – National Trends
• Explosive growth in the number of Accountable Care Delivery
(ACO) organizations nationally
• In 2014, there were a total of 626 public and private ACOs in the
US1
• ACOs now cover an estimated 20.5 million lives in the US1
• Strong physician involvement
• 51% led by physicians and another 33% jointly led by physicians
and hospitals.2
• This is probably not surprising giving that a focus on value means
a focus on the process of care.
• Strong, effective leadership from physicians is indispensible
• Crystal Run—physician led and physician owned
1. Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from
http://leavittpartners.com/wp-content/uploads/2014/06/Growth-and-Dispersion-of-Accountable-Care-Organizations-June2014.pdf
2. Colla, C., et.al. (2013). First national survey of ACOs finds that physicians are playing strong leadership and ownership roles. Health Affairs, 33(6): 964-971.

Growth of ACO Covered Lives
Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from

ACO Penetration by Hospital
Referral Region
Leavitt Partners. (2014). Growth and dispersion of Accountable Care Organizations: June 2014. Retrieved from

A World in Transition
• Majority of reimbursement still fee
for service (~80%) but beginning
to see a shift toward value-based
reimbursement (now ~20%)
• In anticipation of this new future,
we are implementing a strategy
focused on:
• Rapid growth (to better manage
risk)
• Aligning physician reimbursement
with favorable patient outcomes

Key Challenges
To effectively execute on growth and population
management strategies, need to continuously
improve on:
• Reducing clinical variation, enhancing operational efficiency, and
positioning the organization to better manage risk
• Supporting informed decisions by providing clinical and
operational decision-makers efficient and effective access to all
necessary information
• Using data from a “single source of truth” integrated from several
disparate source systems
• The use of “self service analytics” by decision-makers to avoid
unnecessarily prolonged decision-making processes

Current Areas of
Focus
Growth and
practice
expansion
Risk-based
contracting
Physician
compensation
Population
health
management

The Need for Data
Because data is a prerequisite for the data-driven
future, Crystal Run implemented:
• An enterprise data warehouse (EDW)
• Key foundational analytical applications to mine
and view data in order to answer key questions
and identify important trends
Key Process
Analysis
Cohort
Builder
Comorbidity
Analyzer
Population
Explorer

Poll Question
2. If you receive claims data from at least one
payer, how do you currently use this data
for population health management? 191
responses
a. We use an internally developed application –
34%
b. We use a third party application – 25%
c. We do not use the claims data we receive – 13%
d. Other – 28%

Poll Question
3. For those of you who do not receive
claims data, how do you determine the
cost of care for your patients, particularly
for services outside of your network? 106
responses
a. We use summary reports provided by our
contracted payer(s) and estimate costs – 22%
b. We attempt to extrapolate costs based on costing
information within our organization – 20%
c. We do not have insights into the costs of care
outside of our network – 23%
d. Other – 35%

Example – Growth & Practice Expansion
To support growth, Population Explorer helps:
• Identify growth opportunities
• Visualize population characteristics in a certain
geographic area
• Population size, demographics, case counts,
readmission rates, charges, revenue, length of stay,
likely visit types, etc. by zip code
• Assist physician hiring and placement decisions
• Marketing

Population Explorer

Population Explorer
Animate with circled ar

Example – Risk Contracting
To support growth, applications
like Cohort Builder and
Comorbidity Analyzer are used to:
• Ensure the conversations with
payers are more data-driven
and accurate
• Justify a higher PMPM to
support investment in
additional care infrastructure
• e.g., hiring more care managers
to help coordinate better care
for these patients

Comorbidity Analyzer

Example – Physician Compensation
To effectively and fairly address
important physician
compensation issues,
foundational analytics
applications are used to:
• Accurately assessment of the
care physicians actually
deliver (volume, risk profile,
subspecialty work, etc.)
Example: A breast surgeon who also does general surgery can be
more accurately benchmarked based on the volume of breast surgery
compared to the volume of general surgery, and the risk profile of the
patients they serve

Cohort Builder

Example – Population Management
To support population management, the Key Process
Analysis (KPA) tool is used to:
Can quickly visualize variation rates stratified
by physician and adjusted by risk to decide
what the biggest opportunities are so that the
variation reduction initiatives can be prioritized
Identify
inappropriate
variation
1
Enhance
physician
engagement
2

KPA Tool

Example –New Revenue Opportunities
The KPA and Cohort Builder tools were used to
identify new revenue opportunities (not previously
available)
• Example: CMS DSRIP incentive program
• Although Crystal Run as a practice did not exceed the
35% threshold for Medicaid and uninsured visits,
using Population Explorer and Cohort Builder, we
were able to show that individual specialties and
individual providers surpassed the threshold
• This allowed Crystal Run to apply for a waiver to be
included in the funding for the grant program.
• Application in process

Example – Improved Budgeting
To improve the budgeting process,
Crystal Run used data and analytics to
manage and predict productivity:
• Example: A seasonally adjusted budget
(“snow days”)
• In 2014, Crystal Run experienced a
profound negative financial effect
from snow days that impeded the
ability of patients to come in for care
• This necessitated a more proactive
and accurate seasonal budgeting
and physician productivity plan

Results –Time Savings
Office expansion
● The analysis would have taken a developer about 3 days to
complete; now completed in about 2 hours
● This informed a $30M go/no-go new office construction
decision ensuring optimal ROI
Physician compensation
● Aligned physician compensation with their actual work effort
● Ensures that personnel costs are properly matched to the
clinical costs, but also ensures the physician feels fairly
compensated improving satisfaction and retention.
● The specialty assessment previously would take half a day
to conduct, and is now completed in just 5 minutes .

Results –Time Savings
Medicaid grant petitioning
● Previously, the BI team would need to have spent approximately
one week to collaborate and design multiple SQL queries to create
a useful report.
● With the foundational applications this analysis was complete in
just one hour.
● This identified a multi-million dollar Medicaid grant revenue
opportunity.
Annual budgeting and productivity planning improvements
● Created a more accurate seasonally adjusted budget and
productivity plan
‒ Avoid having thousands of patients who need care to not be seen
during the months of severe weather, and
‒ Allow physicians to better balance their professional and personal lives.

Results – Improved Contracting
More effective negotiations on risk-based
contracts
● Crystal Run is now able to bring new
information to the table to drive more
data-focused and accurate
conversations
● Crystal Run needs to capitalize on
each shared savings and risk
contract they have
‒ Comorbidities and risk profiles will ensure
transparency around the financial risk
associated with those patients and more
appropriate per member per month rates can
be negotiated

Results – Best Practice
Facilitates reduction in inappropriate clinical variation while
ensuring utilization of evidence best practice
● Clinical variation initiatives are more easily prioritized
● Priority areas are identified within the KPA tool and
discussed with providers serving a specific domain (e.g.,
diabetes care)
● Physicians have ownership in the development of best
practices and are accountable for making changes in their
individual practice to better align with evidence-based
medicine
● Ultimately, aligning on best practices will result in less
variation in care and ultimately lower costs

What’s Next?
Goal – move quickly to value-based care
● Applying for HMO license to enable Crystal Run to become a
health plan ( “Crystal Run Health Plan”)
‒ Health plan will overcome some of the MSSP limitations (providers still
receive fee-for-service payments; patients free to be seen wherever they
want)
‒ The health plan will be a narrow network product to better ensure that
patient’s do not migrate inappropriately allowing accountability for their care
over long periods of time
‒ For patients on the new health plan, the majority of the care would be
performed by Crystal Run
‒ It is anticipated that this health plan will launch in January, 2015
● In order to manage the plan population effectively, maximize
quality and lower costs, will continue to leverage the EDW to
conduct robust analytics
‒ Requires multiple levels of drill-down capability

Placeholder, enter your
own text hereQuestions,
discussion,
comments…

Creative Commons Copyright36
Thank You
Greg Spencer, MD, CMO
www.crystalrunhealthcare.com
Contact Information
Scott Hines, MD
www.crystalrunhealthcare.com

Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence

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Preparing for the Future: How one ACO is Using Analytics to Drive Clinical & Operational Excellence