Like group practices everywhere, Cornerstone Health Care faces a dubious future of dwindling reimbursements, increasingly sick patients and, in the words of its CEO Grace Terrell, M.D., the imminent demise of fee-for-service payments. “Fee for service will go away sooner than you think,” Terrell told attendees at Health Data Management’s Healthcare Analytics Symposium.

In her talk, Terrell described how the Piedmont, N.C.-based multi-specialty group practice is attempting to prepare for the uncertain future that will ensue with these multiple marketplace shifts.

Rather than selling the practice to a hospital, Cornerstone opted to become what Terrell described as a “population management hub.” Armed with an electronic health record and a number of homegrown data analytics tools, the practice is building its own version of the patient-centered medical home. In this model, care coordinators pay close attention to very sick patients at risk for hospitalization and work to bring their chronic conditions under control. Terrell described this group of patients as being one of the primary cost drivers of health care inflation.

As part of the practice’s transformation, it is negotiating value-based payment contracts with its multiple payers. Those negotiations, Terrell said, are new territory for payers as well. The practice also modified physician reimbursement, embracing payment formulas wrapped in performance metrics and use of such tools as electronic prescribing. Customer service is another key ingredient, as Cornerstone offers some services 363 days a year. “Patients don’t want to see us on Christmas and Thanksgiving,” she said.

Terrell acknowledged that the practice is moving into unknown terrain, as she ticked off details of payer arrangements and other nuances. The EHR by itself is not adequate technology to adapt to the emerging marketplace, she noted, saying that data analytics will be the next important wave in I.T. development. And the data sharing across organizations that is also needed is not easy to accomplish. The practice currently enables emergency department physicians in local hospitals to access its EHR. Beyond that, the practice hopes to participate in a broader health information exchange. But some local hospitals, using the same EHR, just want to share data among themselves.

In the meanwhile, the practice will focus on controlling at-risk patients. “We can drill down and pull out our diabetics with blood pressure out of control who haven’t seen doctor for six months,” she said. “We have brought in a significant amount of patients to the clinics. It is a very early way of doing analytics. Instead of looking at databases, we can look at data that can be acted on in real time.”

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