To optimize their full potential for improving population health and care delivery, clinically integrated networks (CINs) must take a strategic approach that encompasses workflow redesign, quality metrics, technology and a centralized care management platform.

In this PeerView, Rush Health CIO Julie Bonello, CHCIO, discusses Rush Health’s care delivery transformation model, one of the four pillars of the IT strategy supporting the organization’s CIN success.

Julie and her team support Rush Health, a CIN composed of four hospitals and 1,400 providers. Originally formed in the 1990s as a physician hospital organization responsible for negotiating all payer contracts, Rush Health transitioned to a CIN in 2008, positioning the network for value-based care. Its goal is to improve health by delivering efficient, high-quality services across the continuum of patient care.

CDW: Creating a clinically integrated network nearly 10 years ago makes Rush Health a pioneer. What motivated its formation?

JULIE: Rush Health has been negotiating the payer contracts for our members. Those have been predominantly fee-for-service contracts with pay-for-performance programs, which enable our clinicians to earn annual incentive payments based on quality. Becoming a recognized CIN by our payers allowed us to negotiate value-based contracts to better coordinate all the pieces required to manage patient care across the continuum.

CDW: As CIO, how can you best support this clinically integrated network?

JULIE: The key question is, “How do we integrate technology while designing clinical transformation to support value-based care?” We need to leverage technology differently for new care delivery processes. Implementing an innovation methodology that combines care design and technology with incremental deployment has been crucial to our success. It’s important for the CIO to partner in the care transformation and provide the systems that will allow us to capture and report performance about our care across the continuum, including standard metrics for clinical quality, patient engagement, care coordination, resource utilization, provider engagement and financial stability. I was hired to create a population health IT strategy that leverages the huge amount of data Rush Health had accumulated. We completed a strategic plan that identified how we were going to grow under value-based care, and we’ve signed our first two accountable care organization contracts. My department worked collaboratively with the Population Health and Management Committee to identify the six key components of care that need to be redesigned for value-based care.

CDW: Tell us more about these six components you identified as key to redesigning care and driving success for your CIN.

JULIE: I break them out this way:

  1. Number one is defining populations. We build population registries with an up-to-date member roster for each value-based contract we use to manage and monitor the care of our patients across all contracts.
  2. Number two is stratifying risk or identifying patients who need specific care services based on risk factors. We’ve standardized our risk screening and assessment tools to stratify patients who need care management services.
  3. Number three is providing access — ensuring our patients have access to the clinicians they need to see in a timely fashion.
  4. Number four is patient engagement, or providing the environment in which a patient is willing to receive care. We’ve implemented standards for patient portals and have been developing a telehealth strategy.
  5. Number five is managing care. We provide care coordination across the continuum, with a longitudinal care plan for the entire care team as well as the patient.
  6. And number six is measuring and monitoring performance at the point of care, namely by building metrics for clinical quality, care coordination, patient engagement and resource utilization. We have a highly structured program for validating our electronic clinical quality metrics (eCQM), which is especially crucial under MACRA.

CDW: Clearly technology serves as a linchpin for all these activities. Can you discuss how you leverage IT to improve collaboration and achieve your care management goals?

JULIE: Rush Health Connect, our technology and service platform that facilitates secure and efficient data sharing, is our foundation for effective collaboration and care management. One of our guiding principles is to make sure our providers have the right data, at the right time and in the right place. That means interoperability is essential. So we spent significant time determining what an EHR needed to have in order for providers and practices to join our network, and we even created an interoperability readiness assessment. About 80% of our members use Epic, while 20% use other systems. However, we built a centralized care management system that’s used by all the care coordinators who support our value-based contracts, whether or not their practices use Epic. We’re also leveraging our private HIE to provide longitudinal clinical data to our EHRs.

CDW: And how do you integrate the six components you described into this technology initiative?

JULIE: For starters, we defined standard workflows of care for each component, which we then integrated into our EHRs and other technology tools. This enables us to support quality care delivery based on real-time performance data. Using real-time clinical data rather than claims data is particularly important for an effective population health strategy. Our care management system also has a dashboard of quality metrics that we can track and use to improve care coordination and follow-up.

Since the care management system is integrated into the EHR, practices know when they have a new ACO member. They contact the patient for a standard risk screening that’s been agreed upon network-wide. The results of that risk screening automatically stratify and notify care management of patients needing services.

CDW: What role does telehealth play in your integrated approach?

JULIE: When we think about ambulatory care in the future, we believe much of it will be centered in the patient’s home. We are working closely with our member organizations on their telehealth pilot projects, including implementing Vidyo solutions to connect patients and their providers. Those projects will be very helpful to us in understanding how we want to actually change the way we deliver care to our patients.

CDW: Can you elaborate on the relationship between technology and innovative methodologies?

JULIE: When you’re implementing new care design and new care services, they must be strategically driven, not technology-driven. Some technologies may actually fragment care further, so you have to look carefully at every piece of technology and know how it fits in with the entire workflow. Part of our innovation methodology is really integrating redesign knowledge along with technology. To go back to the telehealth pilots, for example, once you figure out a methodology to rapidly implement pilots and learn from them, you can identify the operational plans necessary to support the end workflow and then deploy technology successfully.

CDW: What advice do you have for peers that are seeking to effectively use technology to support integrated care?

JULIE: The IT partnership is changing. If you think about the technology adoption curve — or what is now often called the “innovation adoption” curve — you know there are various phases. When you get into the innovation and early adoption phases, you’re not just trying to sell a widget. You have to understand how the technology actually supports a new way of delivering the service — and you even have to help in defining that service. It’s a matter of working together to figure out how to deliver care in an integrated way.

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