Dr. Sean Rogers interview regarding Bend Memorial Clinic data warehouse project.
Sean Rogers, MD, discussed how Bend Memorial Clinic (BMC) partnered with Filius Bonacci to improve healthcare and financial performance. By creating a central data warehouse from the multitude of sources, such as electronic medical record, patient management system, accounting, lab, etc., a unified dashboard of actionable clinical data provides BMC the ability to measure and improve clinical and financial performance.
Tell me about the problem that BMC was trying to solve?
In 2010, the BMC senior administrative team recognized that we had a large amount of clinical data from disparate sources, but we had no way to bring that information together in one warehouse from which we could run clinically relevant reports. For example, we had no way for a provider to see how all their diabetics were doing. We needed to clean up our data and have access to it in a timely and reliable fashion. Additionally, we wanted to make that data visible to providers in order to drive improvements in quality and population health. We wanted to demonstrate improvements in quality of care but, at the time, we didn't even know what our baseline was.
We knew that we had to position the clinic for future success by moving from a traditional volume-driven financial model to a value-based approach. We recognized that we needed a method to demonstrate that value to all key stakeholders - patients, providers and payers. In order to successfully negotiate shared savings contracts with payers, we absolutely had to have a way to demonstrate quality improvements.
BMC was the first clinic in the region to have a robust Patient Centered Medical Home model. That model started with an innovative demonstration project with a local Medicare Advantage health plan that included fee for service, per member per month care management fees, quality-based bonuses, and a shared savings pool. At the time, it was truly ground-breaking.
What did you attribute the success of the project to?
The project was very successful. For the first time, it gave us true insight into the quality of care that our patients were receiving. The reports built by Filius Bonnaci had sophisticated drill-down capabilities. From a high-level dashboard, we could drill down to a particular specialty and provider. We could then drill down to individual patients under the care of specific providers. That degree of visibility into the data allowed us to use it as a platform for population health management. Our practice managers used this information to identify gaps in care for individual patients, contact them, and arrange for the appropriate follow up care. Thus, we now had the ability to proactively reach out to patients to ensure that we were managing their health effectively.
What metrics have been met post-Go Live?
Using data insights from this project, we were able to meet the metrics and successfully attest for Tier 3 (the highest a clinic can achieve) status for the Patient Centered Primary Care Home program administered by the Oregon Health Authority.
What were some of the key challenges that you faced with the project?
The biggest challenge upfront was developing a clear vision of what was needed and wanted. We had to define our current state and then think about our desired future state. Frequent and consistent communication with the developers was critically important.
Gathering the right sources of data to meet the report request that was made was also a challenge. All of the quality metrics were written in a narrative summary. That English explanation had to then be translated by myself in a way that the developers could understand so that they would know what data to incorporate into the report.
What did you do to successfully overcome those challenges?
In short, constant communication. We had frequent face-to-face meetings as well as email contact.
How did you achieve quick adoption by providers and staff?
We didn't experience any significant challenges from providers or staff because the validity of the data was quite good right from the beginning. Some of our providers were surprised by the number of patients that weren't meeting the quality of care goals but used the data to achieve improvements.
The doctors were given copies of the reports monthly to let them know how their patients were doing. We also provided the clinic managers with a front page summary report so that they could get a quick idea of how each provider was doing with regard to achieving the various quality goals.
If you did it again, what would you do differently?
I don't know that I would change anything. In retrospect, the project was challenging but highly successful. The largest potential pitfall lies in the educational and cultural differences between database guys and clinical guys. Frequent and clear communication is necessary to mitigate those differences.
