Mature HIE helps Indiana physician-hospital organization become ACO

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Health information exchange is what makes an Accountable Care Organization work, according to Dr. Brian Moloney, medical director of Select Health Network, a physician-hospital organization based in South Bend, Ind. Select Health participates in both the Franciscan Select Health Network ACO and the region’s Michiana Health Information Network, a health information exchange that has been around since 1998.

Michiana is the local name for the adjacent parts of Northern Indiana and Southwest Michigan.

“Accountable care is all about population health management,” said Moloney. “There’s no way you can do this without a good HIE.” Management buy-in also helps.

Select Health is co-owned by Trinity Health affiliate Saint Joseph Health System and the 720 providers who make up the PHO. Nearly five years ago, Saint Joseph brought in a new CEO, who said the organization needed to be at the forefront of the ACO movement. “The problem is, there has to be a lot of infrastructure,” Moloney recalled.

MHIN and electronic health records vendor Cerner brought that infrastructure and network reach. When Cerner saw an opportunity to get into the two competing health systems in the South Bend market in the early part of this decade, MHIN approached Select and offered to host a cloud-based implementation of Cerner EHRs for the organization’s doctors, Moloney said.

Meantime, Franciscan Alliance, a 13-hospital network in Indiana and Illinois, was looking for a partner in the northern part of its home state. Select has had two decades of experience with risk-based contracts, and about a year and a half ago, Franciscan and Select launched their ACO.

“The docs in MHIN have fully embraced risk-based reimbursement,” said Moloney, who used MHIN himself until retiring as a family practitioner in July 2014. Still, the majority of insured patients carry fee-for-service coverage, even though that is changing.

“The problem is, because we’ve done such a great job, we get less money,” Moloney said. “We lost money the first year” operating the ACO.

Select would not even have launched the ACO without the health information exchange, which currently lets case managers and executives keep track of patients and a limited number of quality indicators.

“At this point, it could be a lot better,” Moloney said, adding, “Without reliable data, it would be impossible to do it.”

Select will be switching to Cerner registries later this year and Cerner analytics at some point next year, hopefully making the system easier to use. “When the EHR is working well, you get more information and you accept it more,” Moloney said. There is a lot of time saved from not having to look at registries, he added.

To date, Select has only been able to pay bonuses for outcomes by department or disease state. “We haven’t had good enough analytics to bonus docs on an individual basis,” Moloney said. The technology upgrades will allow for a more accurate incentive program. “We will be able to incent people on an individual basis if they make a profit,” he said.

Utilization metrics also will be easier with the new platform, Moloney said.

On the flip side, the more physicians making full use of MHIN, the better the HIE works for all participants, according to Hannah King, director of development, marketing and grants for MHIN.

“Our predominant data sources to date have been hospitals and labs,” King said. “We are trying to increase data from practices and long-term care and post-acute care.”