Across the industry, operating margins are getting slimmer while the demand to deliver high-quality care is increasing, leaving many organizations with no choice but to explore M&A. There is, however, another option. In 2014, three health systems joined to form Trivergent Health Alliance, an entity that enables them to maintain their identity as individual institutions while leveraging the purchasing power of big player. In this interview, David Quirke talks about how the concept came about, the pros and cons of being a “trusted advisor” to three organizations, and his biggest goals for 2017. He also discusses the work his team is doing in population health and patient engagement, and the benefits of having walked in different shoes before landing in the CIO role.
- 3 hospitals, 3 versions of Meditech
- NextGen, Allscripts & eClinicalWorks in ambulatory
- Trivergent as a “trusted advisor”
- Data sharing through CRISP
- “We see the core EHR being important, but not the end game.”
- Cybersecurity task force
- 2017 priority: “Staying true to the mission.”
- Benefits of “operating in different peoples’ shoes”
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
The more alike we are and the more we do things the same, the more effective and efficient we could be. But Trivergent Health Alliance is a services organization. And as such, it can present opportunities and benefits to each one of the member health systems, but by no means does Trivergent drive the strategy or the decisions.
When we look at some of the new, exciting tools that are out there in the market for care management, we see the core EHR in the community as being important but not the end game. We really see the care management tools that are burgeoning either as part of an EMR or as a standalone system as being critically important.
We’re doing real world exercises with the leadership team of each organization in terms of, okay, if all of our best efforts fail, how would we react and how will we respond? Let’s go through an exercise where we plan and accommodate for an event like that.
I think something that continues to serve Trivergent well is paying attention to the changes and the ebbs and flows in the political environment, and really staying core to deploying systems that are focused on quality, that are focused on outcomes, and that are focused on our patients and our caregivers.
Gamble: For the three partner hospitals, what is the picture as far as EHR systems being used?
Quirke: At this point in time, all three member organizations have Meditech as the acute care EMR. They’re all on different versions. One of our organizations, Meritus Medical Center, is in the selection process to replace their current Magic solution. They’re at the final stages of making that decision. The three vendors that were considered were Epic, Cerner, and Meditech, and that will be a Meritus decision solely. In the ambulatory world, each organization runs either the NextGen EMR, Allscripts EMR or eClinicalWorks EMR. There’s a plethora of other systems, of course, that go behind the scenes.
Gamble: Right. So there isn’t an expectation that the hospitals will be on the same system or even instance of an EMR?
Quirke: I think it would be reasonable to assume that the more alike we are and the more we do things the same — be it workflows, be it formulary, or for that matter, EMR systems — the more effective and efficient we could be. But Trivergent Health Alliance is a services organization. And as such, it can present opportunities and benefits to each one of the member health systems, but by no means does Trivergent Health Alliance drive the strategy or the decisions. It’s very much a trusted advisor Sherpa-type approach we take in terms of benefits that could be realized. So I think everyone would agree that if we are all on a common EHR, efficiencies could be realized and best practices could be shared somewhat more effectively than on multiple different systems. There’s no reason why that goal will not happen at some point.
Gamble: Now, in the meantime, what is the strategy for making sure that data can be exchanged?
Quirke: I think the HIE is going to be a major component. When we look at some of the new, exciting tools that are out there in the market for care management, we see the core EHR in the community as being important but not the end game. We really see the care management tools that are burgeoning either as part of an EMR or as a standalone system as being critically important.
We are members of the statewide health information exchange, CRISP. I sit on the tech advisory board for that group and we’re very excited with the great work that they’re doing to support hospitals, practices, and, ultimately, the residents of the state of Maryland. We really see CRISP coming into its own in terms of its role in data sharing, and its capacity in terms of its own HIE capabilities. We’re excited with some of the initial reporting and activities we’re seeing coming out of the maturing CRISP model.
Gamble: Of the HIEs we hear about, CRISP has come up a lot as one that has a high level of participation and engagement, which usually can yield some good results.
Quirke: Right. Usually, when you have a state mandate requiring something or some state law requirement, it helps on the state level to encourage participation.
Gamble: Of course.
Quirke: If having a driver’s license was optional, I don’t think we’d do it.
Gamble: Absolutely. One of the areas that you mentioned as being able to share best practices is cybersecurity, and that seems like an example where Trivergent could offer a lot of benefits. Without obviously getting too much into the strategy, because I know people don’t really want to reveal too much, how are you addressing it?
Quirke: I’m very happy to talk about the structure and the governance that we have around it. I would be less comfortable talking about the specific tools and mechanisms that we’ve been using.
Gamble: Of course.
Quirke: But cybersecurity is a reality. Our colleagues at MedStar, which is not too far from us, had an incident last year that certainly brought some extreme focus to the challenge we face. We have created a Trivergent-wide cybersecurity task force that is made up of the compliance officers at each organization. We built our own cybersecurity team, with local representation at each member organization, and with overall leadership in that area. We have a new CSO that’s dedicated and focused in that role.
We ramped up the training and orientation we’re doing. For example, we’re doing fake phishing exercises across the entities where we’re trying to catch people and use that as an educational tool. Every new employee orientation gets a session on cybersecurity and what to do and what not to do. We’re also doing real world exercises with the leadership team of each organization in terms of, okay, if all of our best efforts fail, how would we react and how will we respond? Let’s go through an exercise where we plan and accommodate for an event like that.
Gamble: Definitely a situation where two heads — or three heads — are better than one for coming up with ways to solve this big problem.
Quirke: Sure, and it continues to evolve and change almost daily in terms of the kinds of threats that we’re facing.
Gamble: Right, and so education through different methods seems to be the key.
Gamble: Now, in terms of patient engagement, is that something where it’s really looked at from Trivergent’s perspective or is it more the individual hospitals just working to get those numbers up which is a key goal for a lot of organizations now?
Quirke: I think patient engagement and consumerism initiatives are becoming more and more critical as our patients and their family members, are being held more accountable for the cost of their care. They’re having a greater level of interest in their care, so I think there’s tremendous focus from each one of our member organizations in terms of their individual strategies around that approach. Certainly from a revenue cycle world in terms of clear billing and straightforward costs, we’re focused on that. On the technology side, we’re looking to continue to improve our online and mobile app offerings, right through to our pharmacy and therapeutics, where we’re looking at some of our home care models where we can support our patients and family members gain access to the most cost-effective medications.
Gamble: When you look at 2017, what would you say are the biggest things on your plate?
Quirke: Obviously, cybersecurity remains a major initiative for us all, and just staying focused. Even though the recent political changes are unnerving, especially here in the state of Maryland where we have the Medicare waiver, and despite the fact that there are some unknowns in terms of what will happen with the next administration, I think something that has served Frederick Regional Health System and continues to serve Trivergent Health Alliance well is certainly paying attention to the changes and the ebbs and flows in the political environment, and really staying core to deploying systems that are focused on quality, that are focused on outcomes, and that are focused on our patients and our caregivers, and adding value in the technologies that we deploy and the value that we bring to our health system.
I think staying true to purpose and staying true to mission, and not essentially losing sight on why we do health technology is critical. I certainly talk to my team about when there are concerns raised: ‘Is MACRA going to be here? What’s going to happen to meaningful use?’ Certainly, it’s important to be aware of that, but we’re here to help patients. We’re here to deploy technologies that help our caregivers, and that’s our focus for 2017, as it has been in 2016, 2015, and 2014. I think we’ve just got to connect to purpose and stay on course.
Gamble: Do you have people who part of the IT steering committee that focus on things like MACRA and are able to explain those changes, or does the responsibility spread out among more people?
Quirke: We have some folks dedicated in the ambulatory space who look at the MACRA world and what that would do to our existing Medicare Shared Savings Plan, how we adapt and what kind of model or plan we sign up for, how we’re positioned in terms of the specific data element reporting that we have, and what year we’re going to report in based on the status of our current Shared Savings Plan and our integrated care network. There are groups focused on that. We have a great team of ambulatory support folks, and they’re certainly focused on the minutia of that kind of detail. But I think staying true to the quality, value, and outcomes is something that will never put us in the wrong direction.
Gamble: Now, you’ve been at Frederick Memorial for about 10 years or so?
Quirke: I started in Frederick Regional Health System in 2007.
Gamble: Okay, so you’re obviously pretty familiar with the organization. And prior to that, you had some experience with consulting?
Quirke: Yes, I was with First Consulting Group for about seven or nine years in their consulting and outsourcing world.
Gamble: Do you feel like you’ve been able to really draw upon that experience in your current role?
Quirke: I think anybody who operates in different people’s shoes, irrespective of what your career is, will benefit. And I think if you enter any job with a consultative service-oriented approach, I think it helps. I think in having a health consulting and outsourcing background, a lot of consultants sometimes find it challenging going into an operating role. I had a soft landing going from consulting to outsourcing to operations. I’ve seen all three sides. But I think any kind of focus on customer service, any kind of focus on the consultative approach to the work we do is helpful, especially in a managed services organization role where you are this kind of trusted advisor, operator, and consultant, all wrapped into one. It’s an interesting model.
Gamble: Don’t forget Sherpa, I like that one.
Quirke: Yeah, Sherpa.
Gamble: Okay, well, that covers what I wanted to talk about. Really interesting work that your organization is doing. It will be interesting to see how things evolve in the coming years. Thank you for your time, we really appreciate it.
Quirke: It was great speaking with you, Kate. Thank you.