Digital Transformation



Anderson Healthcare puts the emphasis on proactive care

The healthcare organization is making a transition from reactive to proactive patient care through comprehensive value-based care strategies.

This article is part of the July 2023 COVERstory.

The healthcare industry is acutely aware of the exhaustion from reactive care, and it sees the opportunity to provide proactive care through value-based care. However, many organizations are hesitant to take the plunge and implement effective strategies to reap the benefits of this alternate care model.

Success with VBC programs begins with buy-in from the top executives and extends out to clinicians. All stakeholders must look at the total return on investment of VBC, which is not simply to reap monetary gains but to look beyond to recognize the program’s impact on the organization, patients, providers and the community. This is what we at Anderson Healthcare have learned.

Return on investment. The initial expenditure in comparison to the monetary gains in that first year may be minimal. However, correctly implementing VBC is a year-over-year strategy, which will continue to yield a higher return with minimal expenditure in the following years.

Fatigue reduction. With physician burnout on the rise, enabling providers to practice proactive care instead of episodic care contributes to providers' sense of satisfaction and a general feeling that their work is meaningful.

Increased patient satisfaction. Receiving proactive care is a culture shift for patients and providers. Because our organization is engaging and empowering patients in their care, it makes us a differentiator in the community and a place where patients will want to continue to seek care.

Getting started

Anderson Healthcare in Maryville, Ill., is an independent, not-for-profit hospital ranked among Newsweek’s Best Hospitals in 2022 and 2023. We aim to provide the people of Madison County with a healthcare setting in which patients, their families and our medical staff all experience a strong quality of life and service excellence. As part of our mission, we aimed to implement a robust value-based care solution that would improve patient outcomes, deliver data-driven care and optimize workflows by leveraging the tools within our EHR.

We engaged stakeholders throughout our organization and assigned a project lead. Stakeholders included subject matter experts in the areas of registry, care coordination and physician documentation, a quality manager, coding analyst, data analysts and practice managers.

We engaged payers – Humana, Essence, United Healthcare and Aetna – to identify and stratify the target patient community. We then leveraged a combination of tools to proactively manage general wellness and at-risk patient panels for their Medicare Advantage (MA) population, positioning the organization for improved reimbursement, efficiency, patient satisfaction and incentive opportunities.

With providers on the front lines of value-based care, any successful program is heavily dependent on their buy-in. We engaged our electronic records system vendor, MEDITECH, to assign a physician informatics leader to help oversee our project and support us with the critical work of obtaining physician buy-in. The designated physician informatics lead had experience rolling out similar VBC programs and provided the credibility and experience staff needed to lean into the project.

By securing some early wins in standardizing and streamlining physician documentation and personalizing the provider experience, physicians were receptive to the overall project and trusting the process. Our ability to prioritize achievable and high-yield goals was a big win for us.

Defining the goal

We aim for the Medicare Advantage population attributed to the Anderson Medical Group (approximately 6,500 patients across four MA plans) to achieve a level 3 or greater STAR rating. The Star Rating program uses a five-star rating system, with five stars being the highest and one star being the lowest. The ratings are based on a set of quality measures across various categories.

Anderson is focusing on developing and implementing strategies to optimize the ED and inpatient follow-up, all-cause readmission and overall medication reconciliation components of the HEDIS quality measures. This includes:

  • Follow-up after an ER visit for all MA patients with multiple chronic conditions.
  • Patient engagement after inpatient discharge.
  • Medication reconciliation post-discharge.
  • Plan all-cause readmissions from any location.
  • We will further aim to reduce the number of provider attribution errors, increase annual visit documentation and improve overall chart integrity for all MA patients seen by the Anderson Medical Group in 2023.

    But, overall, our goal is more than just hitting specific metrics – it’s about creating a healthier patient population. It means changing the culture of patients and the overall health of those patients, making lives better and genuinely being that differentiator in the community. This goal aligns with Anderson’s mission and vision to provide area families with exceptional healthcare services.

    Building a system that works

    Many are familiar with the HEDIS and STAR measures. But how do you achieve that success? At Anderson, we started by implementing strategies for improved tracking and management of the Medicare VBC benchmarks and targeting the subset of patients we identified as covered by those specific insurance plans that provide reimbursement based on a VBC model.

    In building the program, we focused on staff development, communication strategy, and getting quality data delivered and incorporated into the natural workflow. We used what we referred to as the ABCDE philosophy: Attribution, Benchmark, Claims, Data and Execution.

    While there were several areas we focused on, a few critical elements of our approach involved the following efforts.

    Improvement in PCP attribution. To manage VBC programs, it's essential to ensure the patient’s PCP in our records matched up to the insurance company, so it was clear for which cohort of patients each provider was responsible. At Anderson, we started using attribution monitoring dashboards to track and improve attribution accuracy. These dashboards used data within the EHR to identify patients with specific insurance demographics and then to identify each patient’s provider. This process enables us to reduce the number of provider attribution errors. By leveraging dashboards within the EHR, we reduced the hours required to complete monthly reviews and reconciliations of recently seen patients. We also analyzed and optimized measure-based micro-strategies for each quality metric across MA payers from each dashboard.

    We optimized registry builds for all four MA payers to reflect all measures and facilitate follow-up and worklist management. Adopting MA registries by practice managers helped us improve workflow efficiency and reduce wasted time, movement and communication.

    Reducing readmission rates. The team used structured data within the EHR to create dashboards to track and improve 30-day readmission rates for Anderson Medical Group patients via each payer registry. Improvements to PCP attribution ensure that the appropriate provider complete all required patient documentation and follow-up.

    Equally important, or even more so, is follow-up and continued engagement after a patient presents for an ER visit. Our IT staff developed tools in the EHR to monitor follow-up after ER visits for all MA patients with multiple chronic conditions. We aimed to improve hospital and ED follow-up within the allotted time benchmarks for the cohort populations by implementing a quarterly scorecard review.

    We continue to work to ensure and improve the adoption of successful medication reconciliation processes post-discharge and identified the related CPT codes requiring follow-up visits. Our integrated EHR allowed us to develop a plan for all-cause readmissions from any of our locations. Ensuring documentation through the attributed PCP allowed for seamless continuity of care.

    Ensuring annual wellness visits. Patient wellness starts with ensuring patients are scheduling annual visits. So we developed a process to monitor, intervene and ensure annual visits occur for the identified population. Furthermore, continued wellness following each patient visit relies on appropriate documentation occurring during a patient’s visit. To that end, we optimized and standardized the PCP annual wellness workflow to increase the utilization of an annual wellness template with embedded quality measures for reporting. Standardization improves overall chart integrity, patient care integrity, and required benchmark reporting for all MA patients seen by the Anderson Medical Group in 2023.

    Realizing results

    While it will still be a few months before we have the metrics to measure our success against the HEDIS measures, our automation and standardization processes have given us several tangible time-saving benefits. These include:

  • A 50 percent reduction in both length and content within the review of systems and physical examination sections of our office visit documentation or primary care and both medical and surgical specialties.
  • A 95 percent reduction in ROS and 75 percent reduction in the PE sections for a secondary tailored model designed for post-operative follow-up. 
  • Using dynamic registries instead of static reports helps prevent fatigue from large office documents. It enables users to easily click into a patient's account to discover further information, leading to a reduction in "spreadsheet culture" and improved communication.
  • Using a decentralized VBC model enabled one ambulatory quality manager, with 12 practice managers across multiple ambulatory offices, to use the registry as both an integrated patient management solution, as well as an active communication system.
  • We saw at least one specific example in which we were able to reduce a payer roster reconciliation process from three days down to a singular afternoon. 
  • After launching changes to our ED follow-up and medication reconciliation strategy, we already see value in these newly implemented solutions. We continue to monitor our progress and make adjustments where necessary as we track toward our goals. We look forward to the results of our quarterly payer scorecard and the HCAHPS scores measuring patient and office satisfaction scores. These outcomes will clearly show the difference we are making in our community and the satisfaction of our physicians.

    Mike Ward is chief of information technology at Anderson Healthcare in Maryville, Ill.

    Return to the July 2023 COVERstory.

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