As VP of the Center for Health Information Services, Tina Esposito knows very well the value of digging deep into analytics to find answers. But she has found that when it comes to learning what clinicians actually need, the best course is to simply ask them. By going “to the source” instead of making assumptions, leaders can help provide what those on the frontline need, says Esposito. In this interview, she talks about how the Center came about, the change in thinking that was needed to become an ACO, and the interoperability challenges that come with multiple EHRs. Esposito also discusses the concept of patient-centered care, why her team is focused less on HCAHPS and more on building loyalty, and why she’s excited for the future.
- Patient-centered care
- “The shift to value-based payment has started to ensure we stay true to that.”
- From episodic to holistic care
- Interoperability challenges with multiple EHRs
- Looking “beyond the financial benefit” with big data
- Focus more on patient loyalty, less on satisfaction
- Leveraging technology to follow patients
- “It can’t get any more rewarding.”
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
It’s no longer, did I deliver on a key process? Certainly, that’s important, but now I have the ability to actually take it down to a patient and understand what efforts were put forth to ensure the best outcome. I can now do that. I can now see that.
Physicians absolutely want to make sure that we are fiscally responsible, but that’s not what gets them out of bed in the morning. They want to make sure that they’re doing the best they can for the patients they’re serving. And so, it’s vital to have a very balanced approach on ensuring, measuring, and assessing data.
As the consumer has more and more of a choice on where they would like to go and what clinician they would like to see, it becomes very important that we are aligned with their values and their needs from a healthcare provider. I think it’s the gradual shift around reimbursement that really has allowed this change in the way that we view that.
We can’t provide a nurse for every patient that we see, but is there a way we can leverage technology as resource, as a way to ensure that every patient is followed and is supported well beyond just visiting a hospital or seeing a physician in an office?
At the end of the day, big data and analytics is a means to an end, and that end has to be where you, as an organization, see yourself.
Gamble: One of the terms we hear a lot is patient-centered care. When you talk about that as a goal or as a pillar, what does it mean as far as being able to provide patient-centered care?
Esposito: I’ll give an example, something that occurred to me as a little bit of a light bulb. It’s a term we throw around all the time. We think we know what that means — it means putting the patient in the center, but I would say that this shift to accountable care and value-based payment has really started to ensure that we stay true to that.
I’ll give you an IT example. I’ve been here 18 years, and I can remember a time where much of my analysis, data pull, evaluation, and measurement really reflected process. We wanted to understand how we’re doing with DRG 475 or whatever heart failure diagnosis it may be, and it was a very episodic view of care being provided. Fast forward now to the accountable care world where it really is about how are we doing with this patient? What care has been provided to that patient — not just what DRG were they when they hit our hospital one out of 10 times, but let’s think about what was the total outcome of all the care being provided? What was the final outcome of that patient? Did we get them back to the level of baseline they enjoyed before the hospitalization? What happened a year before that hospitalization? Could we have prevented an unnecessary admission? What happened after that — could we have better facilitated a more appropriate transition?
It trickles all the way down to IT systems. And to me, it’s just been such an ‘a ha’ to say, now this is patient-centered care. It’s no longer, did I deliver on a key process? Certainly, that’s important, but now I have the ability to actually take it down to a patient and understand what efforts were put forth to ensure the best outcome. I can now do that. I can now see that. I wasn’t able to do that back in 2010 or 2011 before this work started.
Gamble: Right. That’s a real change in thinking. Now, as far as the interoperability piece, with the 12 hospitals and all the sites of care, I’m assuming it’s not one version of the same EHR. So that’s a whole other effort that has to be dealt with.
Esposito: Absolutely. We certainly are not on a single EMR platform at Advocate. Depending upon where you look, it’s a different vendor. On the inpatient side, we are primarily Cerner. We do have two facilities in Central Illinois — a critical access hospital and a community hospital — that are on Meditech. Our employed physicians are on Allscripts, our aligned physicians are on eClinicalWorks, and our home health division is on yet another installation of Allscripts. We also have a fairly large physicians’ group on Epic.
You’re right, it is fairly daunting. At first it was, could we put all this data together? I think we’ve been able to deliver on that and see that that was truly the case. But you’re right, interoperability will continue to be a really important topic. I don’t think it’s only for organizations where we have multiple EMR vendors. I think any organization that continues to grow will likely find itself in a position where they have now a new acquisition or a new merger that isn’t on the same system. Or perhaps affiliated physicians that may not be employed by the organization but rather are affiliated through a clinical integration program and they may not be in the same EMR platform.
I think with some of the work that’s going on with SMART on FHIR, interoperability is something that is continually discussed and understood as a necessity. I’m excited about what may be in the future. I can’t say we’ve fully figured that out yet for sure, and I don’t think we’re alone in that comment. I think that’s true across the industry.
Gamble: Definitely. Now, going back to big data and analytics, in the past a lot of the focus has been on getting metrics and showing the financial angle. But what about the benefits that are a little bit tougher to measure, like improvements to patient care and clinician satisfaction? How can leaders start to shift the focus to those benefits when they’re not as easily measurable?
Esposito: You have to always look beyond just the financial benefit. I think it’s really important need to ensure that it’s the right structure. We just talked about being patient-centered, and we need to make sure we stay true to that, so what was the outcome of the patient? It’s clearly an important metric. I think also from an engagement standpoint, physicians absolutely want to make sure that we are fiscally responsible, but that’s not what gets them out of bed in the morning. They want to make sure that they’re doing the best they can for the patients they’re serving. And so, it’s vital to have a very balanced approach on ensuring, measuring, and assessing data. It’s not just the financial play, it’s ensuring that we are staying at a level of quality and safety that is as high as it possibly can be.
I don’t know if it’s necessarily too hard; I think it depends on what you’re looking at. I think the notion of measurement will change as we continue to think about what’s important to the patient. The patient may not necessarily look at some of these core measures or other perhaps national measures that are out there and are publicly transparent, but rather, they want to understand if they can get back to what they were doing before hospitalization or surgery, things like functional status.
The other area that we’ve explored is likelihood to recommend, and why it’s important from ensuring we’ve done everything we can from that patient’s perspective to a point where they are likely to recommend us to others. There’s some of that with HCAHPS questions, or what some people call Net Promoter Score, but we think it’s really important, because it ensures that you are aligned with what the patient values or the consumer values in seeking your care.
We don’t use the Net Promoter Score. We use a proxy that basically look at likelihood to recommend or patient loyalty. The ability to create these lifelong relationships with patients is absolutely is vital as you think about measuring and continuing to put the patient in the center.
Gamble: That’s really interesting. I saw an article by you and two others from Advocate that talked about the idea of moving away from the traditional patient satisfaction measures. Was there something particular that motivated you to go in that direction?
Esposito: I think it’s happened as we’ve continued to be more patient-focused, patient-centric, and look beyond a very specific acute care visit or physician visit, which tends to be what HCAHPS surveys look at. Now, it’s not to say that’s not important. We do value that, and I think the notion of service reliability and ensuring we’re doing everything we can to make that stay or visit the best it can be is important. We haven’t completely lost sight of that. We still do look at it, but as the consumer has more and more of a choice on where they would like to go and what clinician they would like to see, it becomes very important that we are aligned with their values and their needs from a healthcare provider. I think it’s the gradual shift around reimbursement that really has allowed this change in the way that we view that.
Gamble: Can you talk about some of the initiatives that have been put in to try to increase that loyalty, things like promoting price transparency?
Esposito: That’s exactly right. There’s some price transparency efforts underway; we’re doing quite a bit of work around how we transform the way we’re providing care. One pilot we’ve leveraged is this use of a smartphone-enabled care plan. It gives us the ability to ensure that a patient is feeling supported well beyond a discharge from the hospital, well beyond a follow up visit, using technology to follow them even at home, after they’ve had hip surgery or hip replacement surgery or knee replacement. It’s checking in on the patient electronically to say, ‘have you gotten up and been able to walk 100 yards or to the bathroom and back today?’ ‘How does your incision site look today? Is it red? Does it look inflamed? Does it look like it’s infected?’ It’s being able to triage an issue perhaps before it occurs and get that patient to a physician.
What’s great about that, in my mind, is like any industry, we’re resource-constrained. We can’t provide a nurse for every patient that we see, but is there a way we can leverage technology as resource, as a way to ensure that every patient is followed and is supported well beyond just visiting a hospital or seeing a physician in an office? I think that’s a really good example of how we’re trying to build out and transform care in a way that would help increase loyalty, but also meet the needs of patients in a much different way.
Gamble: Right, and really moving towards what people have been talking about for a while in terms of with making healthcare as user-friendly as some of the other organizations and giving patients more options and making it easier for them to access information.
Esposito: Absolutely. Reducing the hassle map, if you will.
Gamble: Right. Now, you spoke before about the visioning sessions on readmissions. Are there specific areas you tackle in buckets? How does that work as far as determining the next focus?
Esposito: We align as much as we can with the strategy of the organization — in this case with the Advanced Analytics group — around what are the strategies of accountable care organizations, and what’s needed from their perspective. I think at the end of the day, big data and analytics is a means to an end, and that end has to be where you, as an organization, see yourself. We align very closely with strategic efforts and initiatives that the ACO has, and certainly with Advocate.
Readmissions was something that has been identified as an opportunity for the organization. Certainly, when you think about lower cost, high level of readmissions is not a good thing; it doesn’t align with that effort, but I think if there are unnecessary readmissions, it’s not really a great outcome as well. So that was clearly an opportunity. I think we have a very good direct line of sight to where the strategy is, and ensure that our efforts are 100 percent aligned. However we can support the organization in those efforts, that’s where we focus our attention.
Gamble: Right, and there is certainly no shortage of areas to focus on.
Esposito: No. There’s plenty of opportunity, absolutely.
Gamble: As a final point, you’ve been with this organization for a while, and I want to get your take on what you’ve seen in the last couple of years as far as where the industry is headed, and whether you think things seem to be moving in the right direction.
Esposito: I think so. At the end of the day, it’s all about aligning incentives. When you do that, I think the notion of being truly patient-centered starts happening, but it took that change in payment and alignment of incentives to ensure that we went down that track. So I’m excited. I may not be directly involved in caring for patients, but having this new level of alignment helps me see the difference that I’m making. Even from a technical analytic perspective, it’s exciting. It helps you get out of bed in the morning to say, ‘I may not be having a direct impact, but the way in which we are supporting our clinicians in the organization almost in some ways seems like a direct way of improving patient care.’ What more can you ask for? It can’t get any more rewarding than that.
Gamble: Right. Well, your organization is really doing some interesting work and it’s been great hearing about it. I appreciate your time. Thanks so much.
Esposito: You’re welcome. Thanks so much for the opportunity. I really appreciate you reaching out.
Gamble: Sure thing. And I’d like to reach out to you again down the road to see where you guys are.
Esposito: Absolutely. That would be excellent.