Alaska Provider Network drives value-based care success with SDOH and claims data
Over the past decade, healthcare – and more specifically primary care – has been at an inflection point. As the industry continues to transform with the evolution of digital records, alternative payment models, and the challenges of staffing and burnout, primary care practices face specific challenges in meeting these demands.
As a result, the industry has seen small, independent practices consolidate through acquisitions with larger hospitals and healthcare systems, ultimately losing their independence.
THE PROBLEM
Alaska Provider Network, a clinically integrated network, helps these primary care providers remain independent and autonomous as they transition to more complex payment and care delivery models, including value-based care.
“We are specific in meeting their needs by considering their unique market characteristics – from geography to cost structures to personal relationships,” said Jason Haugen, president of Alaska Provider Network. “As a former technology startup founder – both in and outside of healthcare – with a CPA and an MBA in finance, I knew data and technology had to be at the core of Alaska Provider Network’s mission.
“As such, we also saw the need to evolve from a clinically integrated network to a more robust ‘connectionist network’ offering that works with more practices that need support to increase revenue and improve operations – so we turned to athenahealth’s electronic health record and to predictive analytics with artificial intelligence and machine learning,” he continued.
These technologies will help Alaska Provider Network gain deep and valuable insights into high-risk, high-cost patients by measuring cost and quality of care to meet practice-specific and broader industry needs to remain autonomous, he added to it.
PROPOSAL
After connecting with athenahealth, Alaska Provider Network realized it needed a provider that was both a service organization and a software company, and athenahealth turned out to be just that, Haugen said.
“Athenahealth specializes in serving the needs of independent practices, and at the heart of the Alaska Provider Network, we believe above all that primary care should be the center of care,” he explained. “The industry often hears doctors say that it feels like they are working two jobs – both clinical and administrative. To make it easier for healthcare providers to focus on what they really want – patients – we adopted technology to make quality care easier through patient care. data sharing across the network, real-time patient insights and specialist dashboards for each of the practices.
“As previously mentioned, we were looking for ways to help primary care providers with the next evolution of healthcare, which includes not only value-based care, but also the interconnectivity of the parties that touch and influence care, as well as the deep learnings that come from making sense of Big Data,” he continued.
A critical component of value-based care is the ability to understand practice metrics and the impact on patients and physicians. The technology provides these insights, which might otherwise not have been possible for these practices, he added.
“That said, value-based contracts are certainly part of it, but it’s also broadly about taking patient and practice information and sharing it,” Haugen said. “Using athenahealth, we can do this in a way that allows providers to exchange clinical data between systems and quickly and easily access clinical and financial data optimized for extraction and analysis.
“Ultimately, to make more timely and informative decisions to improve care, patient outcomes and practice performance,” he added.
MEETING THE CHALLENGE
Alaska Provider Network uses real-time insights through electronic health records, social determinants of health and claims data to make delivering high-quality care easier.
“Our entity has been at the forefront of using technology for some time,” said Haugen. “While AI has been the most talked about term in healthcare lately, we have been using AI and ML for six to seven years.
“By combining clinical data, social determinants of health data, and payer claims data with AI and EHR expertise, we are able to create and improve care models, including those for predictive analytics and care management,” he continued. “By combining these elements, we can provide unique insights that are most valuable to payers.”
Athenahealth helped with the implementation and support. The provider organization has in-house data scientists who are experts in knowing how to combine the information and data exported from the platform with AI to bring together clinical and claims data for optimal decision-making and care delivery.
RESULTS
The data the EHR vendor helped uncover has enabled Alaska Provider Network and its practices to succeed in new payment and care delivery models by uncovering key metrics of success.
“We measure success by the cost component and the quality component of reducing costs to patients and the system overall to improve quality of care,” Haugen explains. “As mentioned, the metrics vary for each of the practices. By having the ability to create custom dashboards, we create and identify metrics critical to the success of value-based care so we can support all providers with a customized approach.
“By leveraging clinical care data, along with other data sources such as SDOH and claims data, with AI, we have created and improved care models across the network, including those for predictive analytics and care management,” he continued. “These models allow us to understand patient outcome models with a degree of accuracy up to approximately 70-80% at any time.”
By understanding which patients are most likely to end up in a hospital or emergency room, patients and providers can get more preventive care contacts, ultimately saving money and improving healthcare outcomes, he added.
“Over the past three years, we have experienced 200% growth within the groups we serve within and outside the network,” said Haugen. “While we were once based solely in Anchorage, we have since expanded to other parts of the state and into the lower 48 as we have scalable technology available to meet the needs of additional practices.
“Our growth strategy is completely organic, with the philosophy that if we provide the right partnership, it will sell itself,” he added.
ADVICE FOR OTHERS
For smaller primary care practices that may be wondering how to meet the demands of healthcare value-based care models or provide exceptional care while remaining financially healthy without succumbing to consolidation, there are “connectionist networks” such as those of Alaska Provider Network, Haugen argued.
“Being able to network EHR technology allows you to practice independently of your practice while maintaining your own unique culture,” he said. “Every primary care practice can choose the technology that is right for him or her. Sharing resources and big system data for the cost and value of care is necessary in the evolving healthcare landscape and allows providers to remain financially and culturally independent – this is true the autonomy lies .
“Because each of the providers on the network can create their own dashboard of metrics specific to their practice (e.g., referral management, clinical care, revenue cycle), EHR, SDOH, and claims data is invaluable,” he concluded. “While data does not treat patients, it is a tool to provide physicians with the information needed for quality patient care. My advice is to explore the options that best suit your practice and trust the data for your practice and patients.”
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