CASE STUDY

Great Lakes Physician Organization

Organization

Great Lakes Physicians Organization (GLPO) is a collection of four independent physician organizations in Michigan that formed one larger physician organization. GLPO is comprised of approximately 300 independent physicians throughout Mid-Michigan, covering 12 counties.

Great Lakes Physicians Organization participates in several incentive and quality programs from different payers throughout the state. One of the biggest has always been the Blue Cross Blue Shield of Michigan PGIP program, which is the Physician Group Incentive Program. As part of that, the organization has a lot of data requirements that need to be fulfilled with the payers, comprised of quality information and cost information on patient populations.

Need

Due to the organization’s unique characteristics, one of the requirements is that because it is a conglomeration of independent providers throughout the state, GLPO has a policy of bringing your own EMR to the table for each group. It does not enforce any standards regarding whether a provider must have a specific type of EMR or practice in a certain way. There are roughly 23 different EMRs that are independently managed and run, and as a result, the data requirements and needs can become very complex. It welcomes all providers throughout the state and, as a result, has many EMRs and different data systems for which interfaces have been built.

Jeremy Maney has been in healthcare IT for 16 years. He started at a local hospital and became the IT Director for GLPO. He has a Bachelor of Science degree in Information Technology from Central Michigan University and is passionate about improving healthcare for providers. He says: “I see a lot of the issues in healthcare, both from a hospital side as well as a provider side. And so I’ve got a real passion for figuring out solutions that enable providers to get back to doing what they went to school for, which is treating and caring for patients rather than dealing with the administrative burdens of healthcare.”

Jeremy adds: “So we did have some very complex requirements, and we needed to get to a point where we had a patient registry that would meet our needs to participate in these programs from the various payers.” The organization learned about HealthFocus from Huron Valley Physician Associates and decided to evaluate the product. The problem he was trying to solve was that as part of the incentive programs through the various payers, principally the PGIP (Physician Group Incentive Program through Blue Cross Blue Shield of Michigan), GLPO had to submit a large amount of quality and cost data to the payer. Based on that information and how well they did with those quality measures, they had to send a lot of data on the HEDIS measures.

Jeremy adds: “We have to submit a lot of quality data to support those measures as part of the program. And so being able to bring in, say, 75 providers and all of their quality and cost data into one repository to be able to run analysis on and then report back to the payer was something that we did not have the expertise nor the infrastructure or software to support and implement effectively. So, we did have to reach out to a patient registry. They’re able to aggregate our data, run analysis on it, present it in a front end so that our staff and our practices can review and see that information, but then also on the back end, they’ll aggregate all that information and send it off to the various payers as what we call, supplemental data, to support those quality measure programs.”

Solution

He says that the decision to proceed with HealthFocus was a joint one between himself and the Executive Director. Jeremy says: “We have had two prior experiences with patient registries that unfortunately did not work out well. I think it was a combination of the complexity of dealing with the data, bringing in the data, and then subsequently dealing with that information as well as concerns with data integrity. So, once you’re bringing in data from so many disparate sources, you have to start being concerned about whether this data is still accurate? Is this still useful? Is it still meaningful in some way? And so, we’ve had two prior experiences with patient registries. They did not work out. As a result, when we evaluated and got demonstrations of HealthFocus, we could lean back on that and say, “All right, here’s what we have today. Here’s what HealthFocus can do for us tomorrow.”

He adds: “And based on that, it checked the box for us in terms of meeting all of our needs for being able to submit the supplemental data. The ease of use of the system was a big thing for us. Patient registries can become very complex for end users at the practice level. That’s not their specialty. It needs to be accessible, and it needs to be easy to use because they don’t have a lot of time to spend searching for data. So, ease of use, the flexibility to bring in all of these disparate data sources, and they had experience dealing with that. The price was also an important factor for us. It was a very, very favorable pricing situation for us, especially through the lens of looking at our prior registry implementations.”

Jeremy says that one of the biggest standouts of the evaluation process for him was the ease of communicating and talking with the HealthFocus staff. “They talked us through what HealthFocus can do for us. Here’s what they can’t do, but here’s how we’re going to deal with that in the near future. Here are things we plan for the next couple of years. So based on that, it checked the box for him in terms of meeting all of their requirements.”

Results

GLPO has about 75 active users of HealthFocus and many more who receive reports from the product. He says the staff enjoys the system’s ease of use, being able to find information quickly, and all of the readily available information.

He adds: “One of the biggest things for us was that having been developed from a need through HVPA, who also participates in that PGIP, the Physician Group Incentive Program through Blue Cross Blue Shield of Michigan, this was custom designed from the ground up for these payer incentive programs that we are also participating in. So they know what we’re doing already. They know the type of data that we’re dealing with. They know the payers that we’re going to be sending data to. So it felt a lot more like a custom design solution specific to us as a result. With those things in mind, it checked all the boxes for us, and we decided to move forward.”

GLPO has been a HealthFocus customer now for three years. He says that from the time they signed their contract to the time they were getting meaningful results was about six weeks. He says that it was dramatically quicker than he would have expected.

Expansion

Based on their initial success, over the last two and a half years, GLPO decided to move all of their interface processing to HealthFocus. He had a prior vendor doing this, but unfortunately for them, they had a poor experience. Jeremy says: “What couldn’t be done with that project in nine to 10 months, Jim and his team had implemented and fully ingested all of that information within HealthFocus in one week. And so that was a huge, absolutely huge win for us. And then that kind of jump-started our internal processing where we said, let’s stop paying external vendors to do this on our behalf. We’ve developed our internal expertise and skillsets so that we can now do this in-house instead of paying somebody else to do this on our behalf.”

When probed about the derived benefits of HealthFocus, Jeremy goes back to the increases in the quality score, improved billing and revenue, and the reduced expenses associated with the data interfaces. But he also adds that GLPO is participating in the Michigan Health Information Network (or MHIN). He says that MHIN determines which patient goes to which provider and that HealthFocus relieves much of the stress of managing different interfaces to different payers. GLPO sends the data to one interface, and HealthFocus sends it to the payers. HealthFocus also handles the ADT (admit, discharge, and transfer) notifications. He adds that HealthFocus has been extremely helpful in meeting new requirements from various payers. He says that HealthFocus has handled that for them as the payers develop new programs or new use cases. He continues on to say that HealthFocus creates the cornerstone of everything that he does with the payers and that he keeps adding more and more to it in terms of programs from payers or incorporating new payers into the mix. That saves enormous time and effort and increases quality metrics and billing opportunities.

When asked what he would say to a potential reference for HealthFocus, Jeremy says: “I would say that it is, depending on the client’s needs, an extremely good idea to pursue. Being so flexible in meeting the client’s needs has been a real benefit to our organization, and I could see pretty much any client participating in these types of programs would find a lot of value in this system. Having a vendor that you have a seat at the table with puts a lot of people at ease when trying to decide what to do about new programs that may be coming down the pipe. So being able to say, “We now have this need for this accountable care organization; what can we do about that?” And being able to quickly say, “Yes, I’ve got a meeting with HealthFocus that’s coming up tomorrow, we’ll go ahead and bring that to their attention.” And having some assurances that, for the most part, they can meet the needs of whatever you bring to them. This is mission-critical for us.”