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Northeast Physician Hospital Organization, a Beverly, Mass.-based case management services agency, offers quality reporting services, among other functions, to a two-hospital delivery system and an independent practice association of 116 practices with 315 physicians.

Those provider organizations maintain considerable electronic data from their respective claims systems, the Centricity ambulatory electronic health records software of Waukesha, Wis.-based GE Healthcare and hospital information systems from Westwood, Mass.-based Meditech Inc.

What they didn't have was a way to assemble all that data to properly manage chronically ill populations and adequately measure the quality of care. That prompted them to turn to the PHO.

"The first challenge was identifying patients," says Todd Lowthers, manager of physician services at Northeast PHO. "I recall going into practices that had shoe boxes of listings identifying their chronic patients."

Now, two-hospital Northeast Health System, and the New England Community Group IPA, both in the Boston area, can pull, analyze and benchmark treatment, quality and outcomes data from their various information systems.

The PHO is using data analytics software from Waltham, Mass.-based MedVentive Inc. The quality reporting data is helping the hospitals and practices compete more effectively with Partners HealthCare System and Leahy Clinic, among others, says Ann Cabral, provider relations manager at Northeast PHO.

The software, embedded with HEDIS quality reporting requirements and pay-for-performance contract terms, also is generating revenue. Northeast PHO members participate in the P4P programs of four major insurers that have 85% of the commercial business in the service area.

With the software, the PHO recently documented that physicians now prescribe generic medications when appropriate 75% of the time, a slight increase from 18 months ago. That performance improvement alone has saved contracted health plans $2 million and helped increase hospital and physician pay-for-performance payments. "We probably would not have achieved our P4P performance without the analytics software," Lowthers says. "We would be participating in P4P programs but not getting much from them."

Multiple Sources

The MedVentive analytics software pulls data from multiple information systems into a data warehouse and provides the tools to analyze data and report findings. In essence, data from different silos across the hospitals and physician practices now is accessible in a single silo.

When Northeast PHO went live with the software in early 2007, the first focus was to identify all patients with diabetes and place them in centralized registries. It then determined how often they were screened for hemoglobin and cholesterol levels, eye exams and kidney function tests.

Northeast PHO also uses the software to focus treatment efforts for patients with other common conditions, such as chronic obstructive pulmonary disease, cancer and hypertension. It's starting new quality programs, such as identifying patients who should have a mammogram during 2009.

The ability to have electronic patient registries-rather than names stuffed in a shoebox-is enabling Northeast PHO's member organizations to continue to score well against established HEDIS benchmarks, Lowthers says.

Between 2005 and 2007, for instance, the percentage of diabetic patients being screened for kidney function rose from about 80% to 89%. Eye exams rose from about 80% to 84%. Hemoglobin screenings, already at about 95% in 2005, dipped the following year and rebounded in 2007. Cholesterol screenings, at 90% in 2006, hit 92% one year later.

Improving Outcomes

Besides improving the collection and reporting of quality measures, the analytics software also enables a better understanding of patient outcomes and gives a clear picture of the health status of specific populations, Cabral notes.

The PHO, for instance, can compare prescribed cholesterol-controlling statins and their dosages against patient outcomes, enabling physicians to increase the dose or change the statin if warranted. "We also can look at where the primary care physician ordered a certain statin and alert him that the patient hasn't filled the prescription," she adds. "That's something that has been very useful to help our physicians close the loop."

Northeast PHO distributes information on what is learned through data analysis to physicians via monthly meetings and secure messaging that can flag a notice on a patient's electronic medical record. The physicians are open to getting such messages because they come from a clinical pharmacist at the PHO who has gained their trust, Lowthers says. "They look to me for financial numbers, but they look to Carol Freedman, our pharmacist, for medication management."

Northeast PHO staff originally did all research using the patient registry and data analytics software. The organization a couple years ago rolled out the Web-based registries to physician practices so they could do their own practice-specific queries against the patient registries. The analytics software also enabled the creation of letters to send to specific patient populations asking them to schedule an appointment.

Rolling out the MedVentive software to physician practices was part of a new direction in how Northeast PHO and its member organizations use the data.

The PHO originally had a centralized approach to using the software. Physicians would review at monthly meetings paper reports, such as a list of patients not yet screened for particular conditions, and PHO staff would manually enter the updates.

Now, in addition to physicians doing their own research on their patient populations, physician practices enter updates. This improves the timeliness and accuracy of data. Further, integrating Meditech lab data into the analytics software saved about 20 hours of data entry a month, Cabral says. She suggests other organizations start similar initiatives with the decentralized approach.

Using MedVentive's pharmacy analytics tools right from the start four years ago turned out to be a good move, Lowthers says. For instance, enabling pharmacist Freedman to pull a patient's pharmacy profile to see where generic drugs could appropriately be substituted increased medication adherence and cut costs. "It was a quick win right out of the gate for us," he adds.

Physicians now can access electronic health records data at the point of care as well as analyze the data to identify gaps in care, which is a powerful combination, Lowthers says. "They have learned to be more proactive with patients at the point of care. Now, doctors can see what tests were done and order them if needed."

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