HERNDON, VA. – How do you use data and health information infrastructure to enhance the patient-physician relationship? According to Kevin Flanigan, PhD, medical director of MaineCare Services, Maine’s Medicaid program, if you don’t enhance that relationship, whatever infrastructure you impose on a system will not be a permanently integrated component in the decision-making process.
Participating on a panel titled “Core Competencies of Successful Accountable Care Organizations (ACOs) and Examples of State Participation” at the 2012 Healthcare IT Connect Summit on June 20, Flanigan shared MaineCare’s vision to reduce cost and enhance their targeted population’s health.
Before Flanigan began his presentation, moderator Natalie Ellertson, vice president at Optum Government Solutions, noted four key program elements for ACOs:
- Population health management infrastructure;
- Program governance;
- Performance improvement & clinical information: “What forum is there for sharing best practices?”; and
- Coordination across care continuum.
Ellertson went on to mention that these reform initiatives are more about behavior changes rather than technology itself. She shared what she believes to be critical success factors for ACOs:
- Incentives are aligned to support behavior changes;
- Key initiative champions are visible and committed for the long haul;
- Data-sharing partnerships;
- Analysis of historical utilization indicates clear opportunity for savings;
- Patient attribution and total cost of care calculation methods are transparent; and
- Underlying data is accessible for analysis.
With these factors setting the tone of the panel, Flanigan shared that in spring 2011, MaineCare Services stopped a managed care initiative that was in the final stages of being rolled out. In August 2011, they began designing a value-based project with the goal of cost containment to improve utilization of services.
Flanigan noted that the initiative needs a strong foundation of primary care services. “Without that, we don’t see how there’d be success with proving medical management of our members,” he said. A second key component that needs to be fortified is the transition of care. “Why do overutilization episodes occur and why do repeat episodes occur?” posed Flanigan, who answered there is not a good handoff in the care continuum. There needs to be continuity so providers have better ideas of who their patients are and where they’ve been.
When choosing services to provide, MaineCare didn’t define services first. Instead, they defined what their services wanted to accomplish: reduce avoidable costs, improve health outcomes and better coordinate care. With those points in mind, MaineCare Services built out its core components--inpatient, outpatient, physicians, pharmacy, mental health, substance abuse and community integration--to be assigned in their ACO.
He stated that the top 5 percent of members in MaineCare Services use 55 percent of its budget and the top 20 percent of members use 87 percent of their costs. Conversely, the bottom 80 percent of members use only 13 percent of the budget.
Flanigan gave goals to take the top 20 percent and improve service to them and realize lower costs and better use resources. To find a benchmark, he said if an organization takes data, for example, from the top 5 percent of members, and compares and matches patients with the same diagnosis, gender and community with the next 5 percent of patients to view the data with a factor of 10. “What services are the next 5 percent receiving that the top 5 isn’t receiving to drive them to overutilize,” he stated, adding this can help reduce overutilization.
Flanigan concluded that MaineCare Services is currently looking to improve the patient/physician relationship and looking at data and how it can be used to enhance that relationship and thus have the state realize an impact on its fiscal status.