To continue improving the quality of care it provides, Mercy Health Select, LLC, needed to mine disparate data sources and identify at-risk patients so that clinicians could intervene quickly.
The organization selected the IBM Explorys Platform, which integrates claims and clinical data and then uses sophisticated analytics to identify and prioritize at-risk patients.
5.7% higher ACO overall quality scorecompared to Medicare Shared Savings Program average
Increases shared savingsby raising the organization’s ACO quality score
Enables care managersto quickly identify and prioritize patients whose risk scores have increased
Business challenge story
A focus on value
As an accountable care organization (ACO) for the Medicare Shared Savings Program (MSSP), Mercy Health Select, LLC, must demonstrate the ability to increase the quality of care while lowering costs. In 2014, the organization was one of the top ACOs in the US, and it remains committed to a value-based patient care model. One key way to increase the value of care is by identifying and proactively intervening with patients whose health is at risk.
One visit to a hospital or clinic can change a patient’s risk score dramatically, often after a particular test, procedure or event. However, not all of the affiliated PCPs in the Mercy Health Select network use the same electronic health record (EHR) platform, so it was difficult to share information about at-risk patients among facilities. Insurance claims can bridge these gaps in data sharing, but facilities must submit and bill the claims before PCPs receive them—a process that can take as long as three months.
Prioritizing at-risk patients
Mercy Health Select chose the IBM Explorys Platform from IBM Watson Health™ to help it in its journey toward value-based patient care. Using the Explorys Platform, Mercy Health Select can quickly gather all the pertinent claims and clinical information about its patients. J.D. Whitlock, vice president of enterprise intelligence at Mercy Health, comments: “With the IBM Explorys platform, we have the best of both worlds. We have breadth of data from the claims, along with freshness and depth from the clinical data.”
The IBM Explorys EPM: Measure® application then uses analytics to identify and prioritize high-risk, high-cost patients rapidly. “Explorys uses EHR data to update risk scores daily. So if a patient who was not previously a high risk patient has a stroke, we don't have to wait two months to find that out in claims data and we can follow up much more quickly.”
“We’re also starting to offer this information to physicians directly from within EHR workflow,” Whitlock continues. “They can just click on a link in the patient’s chart, the Watson Health patient summary pops up, and they can look at risk scores, gaps in care and more.”
Higher scores, more savings
Thanks to a commitment to value-based care and the tools and insight brought forth by the Explorys Platform, Mercy Health Select received an ACO score of 97.1 percent from the Centers for Medicare and Medicaid Services (CMS) in 2015. This is a full 5.7 percent higher than the average among all MSSPs, and it translates into a higher portion of shared savings for Mercy Health Select and a better standard of care for at-risk patients.
In the future, Mercy Health Select plans to add financial analytics to its Watson Health solution using the IBM Truven platform. “We’re really looking forward to allowing our financial analysts to do deep dives into the paid claims data. It’s going to round out our Watson Health portfolio nicely,” notes Whitlock.
Mercy Health Select, LLC
Based in Cincinnati, Ohio, and serving communities throughout Ohio and Kentucky, Mercy Health operates more than 450 health facilities, including 23 award-winning hospitals. Its services span all aspects of life, from maternity to senior care, and its net operating revenue in 2015 was USD 4.3 billion. Mercy Health Select, LLC, is an expanded network that supplements the organization’s 563 directly employed primary care providers (PCPs) with another 89 affiliated PCPs. In 2016, Mercy Health Select managed the care of nearly 150,000 patients in at-risk contracts.
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Take the next step
To learn more about the IBM Explorys Platform and the IBM Explorys EPM: Measure application, please contact your IBM sales representative or IBM Business Partner, or visit the following website: ibm.com/watson/health/explorys.