Nebraska Medicine takes the dive into population health

A little more than three years ago, two-hospital Nebraska Medicine implemented the Epic electronic health record system. It’s come a long way in a short time—it’s now is at Stage 7 of the HIMSS Analytics scale of EMR adoption with its inpatient facilities, and at Stage 6 for ambulatory providers.

Now comes the next step, with the delivery system putting in Epic’s population health management platform. The move is intended to help hospital care managers and practice-based care managers who work with most of its 1,100 affiliated private-practice physicians, succeed in population health along with becoming compliant with the MIPS and MACRA programs that tie reimbursement levels to quality of care.

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Six vendors were considered for the population health management program, says Michal Ash, MD, chief transformation officer and previously a long-time employee at Cerner. Brian Lancaster, executive director of information management, also had a long career at Cerner before going to Nebraska Medicine. So how did Epic get the new contract?

Besides Cerner and Epic, the other vendors getting a look included Optum, Phytel, Explorys and Infor.

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Ash says he and Lancaster were familiar with what all these large vendors offer, but Epic had several advantages over the others. Its interoperability within the Epic client base is good, and the vendor doesn’t get enough credit for interoperability outside the client base, Ash contends. Between Epic and the Carequality interoperability service of the Sequoia Project, Nebraska Medicine and its affiliated physicians can exchange information with whomever they want, which is especially important because the organization also serves as a donor transplant center.

Epic, which has a dominant presence among hospitals in the state, also supplies data to support analytics for population health management and other purposes.

And despite concerns about the cost of Epic, the vendor was actually more cost-efficient than its rivals, Ash notes. While other suitors wanted to charge a monthly fee for each member on the population health management platform, Epic didn’t have that requirement, “so the cost was very attractive to us.”

Costs were further reduced by giving affiliated physicians web access to the Epic population health management platform, even if they work on a different core electronic health record system. Web access is easier and considerably less expensive via the Web than through specialized remote connectivity vendors such as Citrix, Ash says.

Lessons learned during the journey to population health management include finding Epic had better connectivity than believed. “When we started, we thought all these other systems would be more interoperable.”

Nebraska Medicine also learned the need to create a balance of benefits for the patients while minimizing disruption of physicians’ workflows by focusing on offering efficient care management apps that also are cost effective. “I can’t add five more minutes of work on a physician; that’s why a web version is so important to care managers and physicians.”

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