CASE STUDY

Huron Valley Practice Affiliates

Organization

Huron Valley Physicians Association (HVPA) was developed in 1983 as an independent physician association (IPA) to focus on collective network payer contracts and to support the patient center care known as Patient Center Medical Home (PCMH) BCBSM model. Over time, the organization morphed into a Physician Hospital Organization (PHO) and ended up as a Physician Organization (PO) in 2005 and is one of 40 POs in Michigan. The organization currently has about 384 physician members, with twenty-five percent being Primary Care Physicians with patient attribution. This equates to 130 practices in total.

Debra Roberts has been the Executive Director since 2014 and with the organization since 2007. She has worked in the healthcare space for over 30 years as a Managed Care Administrator, Practice Administrator and has expensive financial and operational management knowledge. She understands payer contracting and the associated quality and cost programs.

Need

Roughly ten years ago, HVPA needed to establish a disease registry, now known as Population Management Data platforms or strategies. After much work surveying the market, HVPA decided to create its own data registry as they could not find a comprehensive solution. They internally had the leadership of physicians, other clinical teams, and data programmer expertise in-house to begin this venture. Debra says: “We weren’t getting the data we needed from other sources to bring the additional value to the PO or providers. I think what drives a population health platform is aggregating data from all sources and the work to integrate or interface with all data sources. When you can absorb all this data into your data warehouse and then push it out in an adaptable readable format to clearly see your quality and cost opportunities, this adds value. Now as we are moving from a fee-for-service (FFS) model to more of an “at risk” value-based model, this type of platform is critical to managing your patient population and payer contracts to gain shared-savings.”

Solution

She adds that as HVPA transitioned to modified risk slowly, they needed to close clinical quality gaps in care and better understand the populations’ disease burden and risk acuity to manage the associated costs and utilization effectively. She stated that this is where HVPA Executive Leadership and Board decided to invest funds to build its own data warehouse and measurement engine along with other components supporting population health management. This led to the product and company, now called HealthFocus Software Solutions, also known as HealthFocus. There have been several iterations of the product from initial development to today. The current version of the platform has the entire measure engine rewritten for flexibility to accommodate payer specifications which change frequently, and to accommodate modifications or enhancements more easily to the tool.

Debra shares that the data warehouse is the most comprehensive in existence, aggregating data from multiple sources. She adds: “It’s the concept of no data left behind.” The data sources can include but are not limited to eligibility lists, claims, lab, radiology, colonoscopy, Admission, Discharge, Transfer (ADT) feeds, payer opportunity reports, and multiple EMR interfaces to include CCDA files and much more.

Debra says: “HealthFocus will and can accept from all data sources. Once received, the data is staged and presented through the viewer within the product. It provides the end-user (physician/clinician) a complete view of the patient’s health record, from when services are due for preventive health and chronic disease metrics such as a female past due for a mammogram to managing a patient’s hemoglobin A1C level to addressing hierarchical code conditions (HCCs) gaps and risk acuity”.

She adds, “Using the application simply provides a direct but simplistic view for patient health management and allows the clinician to do this proactively and cost-effectively no matter the disease state.” Additionally, much more focus has been on capturing Social Determinants of Health (SDoH) and PHQ9 depression screening questionnaire results and pharmacy med-adherence data. This data is critical to know the patient’s overall care and to consider other applicable interventions that would support the compliance and cost-effective management of care.

Many questionnaires have been built within the EMRs and can be pulled into HealthFocus. Additionally, for those practices still not on an EMR, these forms have also been replicated within the tool. This information supports the emotional, economic, and other social impacts that may hinder a patient’s medication compliance and recommended care plan. Without it, it is much harder to effectively manage the patient and see everything you should know about the next steps and decisions for managing the patient’s health. Therefore, payers are emphasizing incorporating and tracking this data much more.

Debra says that HealthFocus is functionally different from an EMR but does integrate with all EMRs if the EMR is capable. Today’s EMRs capture what is done at point-of-care, documented in patient notes and billings. Some have lab feeds, and others can pull in other data feeds. However, HealthFocus aggregates the data from ALL sources, such as hospitals, MiHIN, individual feeds, lab, radiology, and other one-off data feeds. The EMR is not as comprehensive of a tool for aggregating the data and presenting in a format to know all open clinical gaps in care or to tell you where, in aggregate are your most significant financial opportunities, or the ability to present it from an all-payer perspective to a single-payer view. The EMR is simply not at the level of sophistication of population health management or identifying high-cost patients or populations by various disease states. EMRs are not a tool for companies trying to manage risk contracts or large multiplayer populations, but they add value to HealthFocus if they can interface with the platform.

Requests

The HVPA use of HealthFocus was so impressive that they began getting requests from other organizations. As more inquiries were made, the HVPA Board decided to approve the spin-off of a completely new company to be offered to other organizations. This led to the adoption of the tool by another eight physician organizations.

Debra now serves in two roles. She remains the HVPA Executive Director but also serves as a board member and operational lead of HealthFocus. She says as payers push towards value-based full-risk contracts, they want more organizations, be it a PO or a national company, to take more downside risk so that financial management becomes even more critical to creating optimal financial outcomes. This is where you need a comprehensive population health platform so you can best manage the population you are at risk for. You must understand your illness burden and risk adjustment factors (RAF scores). HealthFocus helps you do this and more.

Deb says this is a critical application. She shares that her physicians and HVPA as a PO could not perform at the required level they do today without HealthFocus. She adds that the physicians often comment on the tool’s additional value and ease of use as it gives them a more aggregate view and the ability to drill down to the specific patient details. She thinks this is what has created an increased demand for HealthFocus.

Future

Lastly, Debra adds that HealthFocus will continue to add data sources and improve the software as they or their clients identify them. She says that as an administrator, the company will continue to grow its footprint in a controlled manner to ensure that it does not impede the level of service and quality it provides its clients today. She says: “We will add sales team and IT resources as needed. HealthFocus certainly provides your organization and providers with a competitive advantage. It is vital to the company to remain a high-quality service provider. ” She also states that if you haven’t seen the HealthFocus platform, you should certainly consider doing so by requesting a demo.