Heritage Provider Network (HPN), one of the nation’s largest managed care organizations, uses information technology in a variety of ways to better manage how it delivers care to patients. Providing care for 1 million patients in California and two other states, and taking on full delegated risk with payers for 800,000 of those patients, HPN also administers an Accountable Care Organization with more than 125,000 members through a contract with the Centers for Medicare and Medicaid Services.
And information technology is key to managing these contracts, says Mark Wagar, president of Heritage Medical Systems, an affiliate of Northridge, Calif.-based Heritage Provider Network. The network is continuing to find ways to glean information from EHRs and other sources to give physicians data that enables them to make better care decisions.
Wagar recently discussed IT capabilities, challenges and how Heritage looks to use technology in the future with HDM Editor Fred Bazzoli.
Tell us a little more about Heritage’s structure.
Heritage is a physician owned and operated organization based in California that provides affordable, quality care to members. In addition to providing care, we do all the care management, and we do that for multiple payers—it’s something that we do differently than many others. We also have contracts with 30,000 other physicians.
What kind of IT do you use to support operations?
For the medical groups that we own, we use NextGen—we have proprietary applications that we use for care management and risk stratification. Because we pay the claims, we have all the information from the offices and labs. The systems we have are consistent with our needs under value-based care. For example, if I’m a senior with congestive heart failure, I may come to my doctor when I’m in need of immediate service. If 5,000 of our patients have congestive heart failure, we want to know everything about them right now before they feel worse. We also want to know anything that may interfere with their ability to interact with services. You have to have as many touchpoints out into the community as possible to manage care effectively.
2015 was a year in which the industry was hit by several huge cyber hacks. How has that impacted IT at Heritage?
Like many other healthcare companies, we are very concerned about information security and have taken measures to ensure that the information we transfer is protected. For example, I can’t send anyone an email from my system without it encryption. We don’t allow anything to go outside of our system without it.
So you placed a heavy emphasis on encryption as a defense?
People might say our approach to encryption is overkill, but you do things that you have to – similar to what we’ve seen happen with the tightening of security standards at airports over the years. With data security, it has become a part of our daily business. Ultimately, overkill or not, we have to do the best things for patients and the data.
You mentioned proprietary applications; what kinds have you developed and how did they originate?
Some we’ve developed entirely on our own; others we’ve acquired taking off-the-shelf systems and building into them our own modifications. You find that is pretty common across most of the industry.
QuotePeople might say our approach to encryption is overkill, but you do things that you have to.
Our physicians and clinical providers are involved in setting up the applications that we use, and we ask them, “What’s most useful to you? How would you like to be able to get data so you can improve the care and experience of our members? How can we intervene for members, whether through active treatment or just someone we want to engage?”
Making sure we have those answers is key before implementing or creating any of the technology that we use.
Isn’t it a challenge for existing applications to pull together these types of details?
We’re always continuing to refine and fine tune our data warehouse and adding more features to it. We’re trying to make it more accurate and even faster. We don’t wait for it to all be perfect. If have some information, we act on that.
There’s been a deluge of automatic and micro diagnostics capabilities, using capabilities like smartphones. I think those are going to be great assets as early warning systems and tracking systems. People aren’t stupid—if you can show them what’s happening to their bodies, they will collaborate with you. I think that you’ll have all kinds of things that will happen from your mobile phone, your iPad or connected to your television, but then it goes back to how do you make that secure? Patients, and particularly older frail patients, won’t use any of those if we don’t make it easy and secure.
ACOs have gone through some growing pains; some of the pioneer programs have dropped out of the federal program. What has been your experience?
We’re the single largest pioneer ACO, and have other shared savings ACOs, so we’re trying to demonstrate how we’re making a difference and share some of our key learning and best practices with others along the way. The reality is that whether you are getting it right or not, the work is never done. Populations are very different. Seniors are tied into their Social Security benefits. With Medicaid beneficiaries, they have different concerns, often based on where they live, and we have to find ways to engage them. We may need to find unusual places to meet them or send friendly community care workers to meet with them. We may say, “We’d like to have you come by the office so we can update your medication,” or “What happened to your last housing situation, and can we help you with that?” All these kinds of things may appear to be completely unrelated to a person’s healthcare situation, but they greatly impact their ability to access care and improve their overall health.
Based on the answers we receive, we may discover that the member isn’t picking up their prescriptions because they have lost their home or can’t get to a pharmacy. If we don’t get them the care they need in a way that works best with their life situations, they could very well find themselves in the emergency room or the ICU—both of which are damaging for the patient and the health care system.
What is the long-term prognosis for the ACO movement?
The overall movement is going in the right direction and has been positive. At Heritage, we’ve spent a lot of time and personal effort to help guide legislators toward what will be best for patients and health care overall, but ultimately we can’t keep having providers generate savings without being rewarded by their efforts. With the SGR fix, if attached to a more organized provider system, you will get paid more because it’s known to have a more positive effect on health status. It’s not moving as fast as we would like and the incentives could have been stronger, but that will happen over time as ACOs improve.
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