Health IT, Hospitals, Startups

Entrepreneur sees peer performance comparison as powerful way to engage doctors on best practice

As providers try to get their arms around how to shift from a fee-for-service model […]

As providers try to get their arms around how to shift from a fee-for-service model to pay-for-performance, there’s a lot of interest in technology solutions that will help make that transition smoother. The founder and CEO of Clinigence, which has has developed analytical and aggregation tools to automate reporting performance to payers, thinks that if physicians had access to clinical business intelligence that could highlight peer performance, show them how their performance stacks up with their peers and, more importantly, the why behind that analysis, it could be a powerful motivator to adhere to best practices.

In his presentation as one of seven startups in the New York Digital Health Accelerator, Kobi Margolin said its platform focused on three things: data integration, analysis and improvement. For physicians beginning to explore the pay for performance model, it provides a way automate these reports submitted to payers. It aggregates data from electronic medical records and calculates performance based on relevant criteria.

Its platform can also be used to help physicians manage performance. One aspect of its platform helps physicians compare their performance with peers in the same practice with a benchmarking tool. Margolin pointed out that physicians don’t tend to have easy access to that information. If they had a way to quantify the impact of following best practice guidelines in their own practices, it would make a more convincing case for their adoption.

For ACOs, Clinigence has a cloud-based service to help physicians aggregate data from electronic medical records and CMS claims data to inform physicians’ care decisions through an online dashboard. It flags up patients who would benefit from an intervention, who need to be seen, screened or immunized, for example, to avoid higher cost complications later on.

So far, it works with nine ACOs, 2500 providers representing 5 million patients.

As part of a broader plan to support the treatment of chronic care patients, CMS last month approved a billing code in the 2015 physician fee schedule that allows physicians to get reimbursed for oversight activities for patients with multiple chronic conditions. The management activities could include things like medication reconciliation.

Health IT businesses have taken a few different approaches to supporting the transition to pay for performance. Some of them include Health Catalyst, which has used electronic data warehousing to develop hypothetical outcomes for a particular condition across a certain patient population to help hospitals determine the most suitable drug or how to reduce unnecessary costs. Aledade, founded by Farzad Mostashari, the former head of the ONC, presents itself as an ACO toolbox geared to physician-led ACOs. Geneia takes a multi-pronged approach that combines analytical tools and care coordination.

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