Jenny Carney, VP, Finance and Analytics, BIDCO, Chapter 1

Vice President of Finance and Analytics: It’s a job title not often seen in healthcare. In fact, most organizations keep the two departments separate, which for many years has made sense. Now, however, as the industry inches closer to value-based care world — and data integration becomes a key priority — it’s more important than ever to marry the two worlds.

It’s precisely why Jenny Carney’s first objective was to establish a performance, analytics, and medical economics team that was tasked with bringing together the mountains of data housed across Beth Israel Deaconess Care Organization and turn it into actionable information for providers. In this interview, Carney talks about the “multi-year journey to integrate clinical data” across BIDCO, what she believes are the keys to success with accountable care, how scorecards can be leveraged to build buy-in among providers, and the importance of creating and maintaining strong vendor relationships. She also shares her thoughts on the evolving role of the data analyst, the role of communication in achieving positive outcomes, and the “tremendous” opportunity that exists for young women.

Chapter 1

• About BIDCO
• Clinical & financial aspects of risk-sharing
• Establishing a performance, analytics & medical economics team
• Pulling together analytics to make “a big impact on total cost of care.”
• MassHealth ACO initiative
• Partnering with pop health vendors: “They do the heavy lifting, and we can get in there and toggle around.”
• Social determinants of health & Medicaid patients
• Maintaining a “continuous flow of feedback”

Bold Statements

The interaction is a twofold. On the clinical side, it’s identifying opportunities for reducing total cost of care and getting to the best clinical outcomes for our patients. On the financial side, it’s understanding the contracts we’re involved in and the incentives to providers and hospitals for participating in value-based care arrangements.

There are so many sources of data in healthcare that, when brought together, can produce some really rich information. What our medical economics team strives to do is turn that data into value so that we can work with clinical leaders to inform decisions and move toward positive outcomes.

It’s not about dumping reports on them that are full of data points; it’s providing focused analytics and laying out the next steps providers and practices need to take. It’s bringing value to the data.

There’s a continuous flow of feedback with physicians, the office staff, and the hospital as to where opportunities exist, and what are the next steps. I think a key step in all of this is communication and getting buy-in from the physicians. If you don’t have buy-in, it’s hard to go any further.

Gamble:  I think the best place to start is with some information about the organization. Can you provide a high-level overview of Beth Israel Deaconess Care Organization?

Carney:  Beth Israel Deaconess Care Organization (BIDCO) is a value-based physician and hospital network and accountable care organization located in Westwood, Mass. Our network is comprised of eight hospitals and more than 2,700 physicians. We manage value-based risk contracts for more than 200,000 covered lives in commercial, Medicare, and Medicaid. We share about $1.5 billion in risk revenue.

All of our hospitals — including Beth Israel Deaconess Medical Center, which is our downtown facility in Boston — share in risk arrangements with physicians and work closely with them in their communities to set that up. We’re heavily focused on collaborating to provide the best possible care in the local setting.

 

Gamble:  There are a lot of moving parts, I would imagine. Can you talk about some of the interactions that take place among different facilities and departments to make this work?

Carney:  There’s a lot of complexity that goes into managing risk in value-based contracts, both in the clinical and financial worlds. And the interaction is a twofold. On the clinical side, it’s identifying opportunities for reducing total cost of care and getting to the best clinical outcomes for our patients. On the financial side, it’s understanding the contracts we’re involved in and the incentives to providers and hospitals for participating in value-based care arrangements, and how those fund flows will work. So there’s a lot of integration between the parties, as well as BIDCO management. We’ve realized that for BIDCO to be successful in our value-based contract arrangements, it takes leadership from both sides of the house — the hospitals and physician networks — to come together in partnership.

 

Gamble:  Your role is interesting, as we don’t always see finance and analytics combined. Can you talk about how that came together, and what are your primary areas of focus as VP of Finance and Analytics?

Carney:  Sure. When I joined BIDCO in 2013, one of the first things I did was to establish the performance, analytics and medical economics team, which didn’t previously exist here. What that did was bring together all of the analytics related to working with the data and conducting analysis and pulling out the data-driven insights, which can help provide value to the clinical strategy and the decisions that come from that. We believe that’s where we can make a big impact on total medical expense and cost of care.

Of course, there are a lot of pieces to that. In a value-based care arrangement, the financial side of the house comes into play as we think about valuing our contracts and understanding all the levers that go into being successful. That ties in very closely with data analytics and identifying where opportunities exist, whether it’s reducing total medical cost of care, improving patient outcomes, or achieving success in our quality measures. All of those carry a different weight in the financial success of the contract as well. We work closely internally with our BIDCO members — both the physicians and hospitals — to determine how the incentives will be aligned for those participating in order to share in the surplus that we receive from our value-based payments, and have those funds flow and those incentives created to drive performance.

We also work very closely with the data integration teams here at BIDCO and at the hospitals to pull together all of the claims and patient-reported data. There are so many sources of data in healthcare that, when brought together, can produce some really rich information. What our medical economics team strives to do is turn that data into value so that we can work with clinical leaders to inform decisions and move toward positive outcomes.

 

Gamble:  Can you talk about what it takes to incorporate data from so many different sources and turn it into something that’s actionable?

Carney:  One of the things we’ve worked hard at over the last several years is perfecting that data integration piece. BIDCO is a very complex network when you look at the span of geography and practice types — some are owned, and some are independent. And we have 46 different instances of EHR databases that we work with. We’re not the model of all-employed physicians with one EHR, although that would make things a lot simpler from a data integration standpoint. We’ve worked very hard to tackle that and to put the technology in place to be able to integrate the data from the various sources, and bring in scheduling data.

About a year ago, we partnered with a vendor on an overarching population health tool that enables us to work with integrated data. It was a multi-year, multi-step process to get to where we are today with integrating all the clinical information. There were many steps involved, and it was very complex. But we’re in a good place now. With this population health tool, my team can use the information it gathers to perform analytics that will help identify where the opportunities exist for improved outcomes. By utilizing predictive analytics, we can better understand which patients might be high cost in the future. And so we’re putting programs into place to develop a prescriptive analytics set that will help us drive the conversation.

 

Gamble:  Really interesting. What do you consider to be BIDCO’s primary focus right now?

Carney:  BIDCO has five core areas of function we’re focused on, one of which is medical economics and performance analytics tied in with that data integration. We’re really looking to drive success in our value-based contracts across all aspects, whether it’s total medical expense, reduction, or success in quality metrics. That’s the area we’re focused on.

Back in March, we started a new venture by going live with the MassHealth Accountable Care Program. So we now participate in the Medicaid value-based payment arrangement in Massachusetts, with Tufts Health Public Plan as our payer partner. This latest undertaking really required a whole new workflow and whole new way of collecting data. We’re now collecting information on social determinants, which plays into the Medicaid population and the differences in individuals who are part of that program. It’s given us an opportunity to partner closely with our vendor to build a population health tool that meet our needs, and helps us leverage the data we have to produce analytics that will steer us toward better outcomes.

For example, we’re putting into place an ARC score, where our vendor does the heavy lifting with data mining, and we can get in there and toggle around. We can turn the levers we want to be able to identify the individuals with the greatest potential for improvement. We want our clinicians — whether they’re nurse care managers or social workers — to be able to reach out to this population so that we can drive success in our programs.

We’re also looking at pulling in scheduling data from the various electronic health records across our system so that when clinicians see patients, they have a holistic view of their history and where they fall on the ARC score in terms of impactability and priority, and when they’re next visit is taking place. That helps a lot with outreach and workflow — if a patient is already scheduled to come in, we know we don’t have to call them.

It’s bringing all of these data sources together to be able to determine next steps and provide direction to providers as well as office staff. It’s a crucial aspect of what BIDCO does. It’s being able to say, ‘here’s where you should focus,’ and tying together all of the pieces. But not it’s not about dumping reports on them that are full of data points; it’s providing focused analytics and laying out the next steps providers and practices need to take. It’s bringing value to the data.

 

Gamble:  You brought up social determinants of health, which is such an interesting area. But I imagine it presents challenges when you’re collecting data from all of these sources, many of which fall outside the realm of traditional healthcare providers.

Carney:  It does. We’ve had to create new assessments within our tool, and work with physicians to make sure patients are completing those assessments. We’ve found that with our Medicaid population, it’s even more critical to connect with these patients and make sure we understand how social determinants can impact their overall health. Being able to capture that information gives us a more complete picture of the patient and helps us to direct the appropriate care. It also gives us an opportunity to connect the patient with other programs in the community that could be of assistance.

 

Gamble:  When you’re talking about integrating data, I can imagine it’s critical to have a process in place to facilitate communication between IT and physicians.

Carney:  It is. We have a number of committees, and several different touchpoints. I think communication is key to the success of BIDCO. We strive to communicate as often as we can, in as clear manner as we can. The data integration piece in itself was a huge challenge, because we’re collecting clinical information from the different EHRs and the different provider groups, and there’s a lot of communication back and forth to determine where to put the data that’s going to translate into the system in a meaningful way, and get a signoff that they accept the data. When you’re talking about quality measures and pulling in data, it’s making sure it’s clean and it’s accepted and that all the parties have signed off on the data flow; that this is now a source of truth for the data.

There’s a continuous flow of feedback with physicians, the office staff, and the hospital as to where opportunities exist, and what are the next steps. I think a key step in all of this is communication and getting buy-in from the physicians. If you don’t have buy-in, it’s hard to go any further.

Chapter 2