As contracts increasingly incentivize providers to take on risk for patient care, they’ll need to use more advanced population health management strategies and use data gathered from sources that come from outside the organization’s walls.
That’s the approach being used by the Staten Island Performing Provider System (SIPPS), which is participating in a Medicaid waiver program that aims to expand eligibility to the federal program and offer more clinical services to low-income residents.
SIPPS is relying on a data aggregation platform from SpectraMedix, which enables near real-time collection of data from electronic health records and a variety of other sources, such as health centers and emergency medical service systems.
SIPPS is one of 25 performing provider systems in New York State participating in the federal Delivery System Reform Incentive Payment (DSRIP) program. That initiative and other Medicaid Delivery Transformation Section 1115 Waiver programs seek to expand Medicaid eligibility and clinical services for low-income residents in participating states. In New York, as much as $6.4 billion is allocated to the state’s DSRIP Performing Provider Systems, with payments based on achieving performance improvement results in system transformation, clinical management and population health.
Medicaid pays 50 percent of the overall cost for the program, with the state paying the rest. New York has taken an ambitious approach to the program, asking participating healthcare organizations to achieve 25 percent reductions in admissions and readmissions, while reducing emergency department visits as well as meeting other goals, says Joseph Conte, executive director of SIPPS.
“We’re managing care for 180,000 lives, and we’re very much driven by outcomes,” Conte says. “We ingest and socialize all the data that we bring in. We’re a data sponge—for example, we bring in data from the New York Police Department for the number of people who have overdosed, and from school nurses on asthma patients.”
The SpectraMedix platform brings in the various types of data at midnight each day, and “this allows us to do hot-spotting and geo-mapping, and it allows us to create relationships with organizations serving those in need,” Conte says. He compares the provider’s role to that of a control tower at an airport, enlisting the help of community organizations to address factors such as helping those patients who are driving excessive utilization, who are coming to the emergency department instead of physician offices, or who need behavioral health support.
“The platform helps identify patients who have gaps in care or have gaps in hitting measures, and then we can get those gaps filled,” says Raj Lakhanpal, CEO of SpectraMedix. “The application’s ability to take in information and make it available to providers quickly also offers benefits, he adds. “Now, we are collecting information from clinical data, and that makes it very impactful.”
Clinicians can access information through dashboards or in any way that’s helpful to them, Lakhanpal says. “Some providers say, ‘Give me a PDF file with a chase list or showing gaps in care.’ Or some say, ‘Give me an Excel spreadsheet.’ We provide information in the form they want to consume.”
“There’s a global movement to value-based care, and it requires a different way of taking in information that we have in the fee-for-service world,” Conte adds. “Honestly, people have a hunger for this type of information. But it needs to be presented to them in a way that is user friendly and simple, and so that it matches what their role is.”
Lakhanpal and Conte will present a session at the HIMSS18 Conference and Exposition on SIPPS’ experience, entitled, “Transforming Medicaid Delivery on Staten Island: A Case Study,” at 11:30 a.m. Tuesday, March 6, in Delfino 4004 in the Venetian Convention Center.
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