Portraits of Success

Stephen Gorman, DO
President of Specialty Solutions
IMPROVING DOCUMENTATION

Success in value-based care requires accurate data about the health of our patients. Clinical documentation, in the form of diagnosis codes, is the primary source of these data. More precise and detailed coding can better direct care management resources, ensure providers see the sickest patients frequently and identify patients who are eligible for additional health plan benefits for their chronic conditions.  Appropriate documentation is also critical for payers to set more accurate financial targets based on expected costs to manage patient populations.  In 2019, the ACO launched several initiatives to improve clinical documentation, including a unique partnership with Specialty Solutions, the multi-practice specialty group with more than 275 providers participating in the ACO.

“We were happy to collaborate with the ACO on this project,” says Stephen Gorman, DO, president of Specialty Solutions. “More specific documentation holds benefits for practices, providers and patients, and it’s a common denominator that all practices, regardless of specialty, can seek to improve.”

It’s a great example of how practices can work hand-in-hand with the ACO to create measurable improvement.The project began by analyzing diagnosis coding that occurred at Specialty Solutions practices in 2018, revealing opportunities to improve coding specificity. The project team then worked with practices to create coding cards for each specialty and recruited dyads – a provider and an administrator – at each practice to act as “documentation champions.” Equipped with the coding cards, the project team conducted on-site trainings that were then reinforced by the dyad members.

The team created a total of 12 specialty-specific coding cards and conducted trainings, along with the local champions, at seven of the practices. Several months later, four practices achieved significant improvement in coding quality, ranging from 4 to 18 percentage points.

“I think the outcome data show that the project was effective, particularly for practices that had active physician and administrative leadership boosting engagement,” says Stephen. “It’s a great example of how practices can work hand-in-hand with the ACO to create measurable improvement.”



Dawn Whitten
Director of Quality and Patient Safety,
New England Cancer Specialists, Scarborough
A DEEPER UNDERSTANDING OF PATIENTS

In the summer of 2020, New England Cancer Specialists (NECS), a MaineHealth ACO participant, contacted the ACO with a problem.

“Because of the patchwork of incompatible electronic medical records held by different providers, we didn’t always have a complete view of our patients,” says Dawn Whitten, director of quality and patient safety at the NECS practice in Scarborough. “We sometimes were blind to their underlying conditions. And we didn’t always know when they were admitted to the emergency department. These are crucial data points that help us tailor and adapt our cancer therapy to each patient’s unique needs and clinical profile. We wanted consistent access to this information, so we reached out to the ACO for help.”

Arcadia reports have been a game changer…Eiren Menhennitt and Joanne O’Neil from the ACO’s Contract Operations and Data Operations teams collaborated with Dawn to get NECS the access it needed.

“We identified two primary sources of data that would be helpful for Dawn – access to Epic, MaineHealth’s electronic medical record, and access to the vast claims and clinical data stored in our Arcadia population health management tool,” says Eiren. “We connected Dawn with the SeHR team at MaineHealth to establish read-only Epic access for the practice so care teams can be notified of patient activity within the MaineHealth system. Joanne and I were also able to generate custom reports out of Arcadia. First, we ran a list of patients with high emergency department and inpatient utilization within the last year. This list served as a starting point for Dawn and her team to add their providers as care team members in Epic. The second list identified patients who could be at high risk of future utilization. This list included the patient risk score, chronic conditions and ICD-10 coding opportunities.”

“Arcadia reports have been a game changer,” says Dawn. “And Epic access will influence workflow changes in our EMR. We look forward to having more complete information about our patients, allowing us to adjust care plans to provide the highest level of care.”

 

 

Kathryn Galbraith, MD
Galbraith Family Medicine, Limerick
A HELPING HAND DURING THE PANDEMIC

When health care shut down in the middle of March, small private practices like Galbraith Family Medicine in Limerick had to quickly find a way to see patients remotely or risk financial ruin. Telehealth was clearly the answer, but the barriers to standing up a telehealth system rapidly were immense.

“We were in trouble,” says Kathryn Galbraith, MD. “Our patients needed care but many were too scared to come in.  Telehealth offered a possible solution but it was new to us, and there was great uncertainty about whether we could get adequate reimbursement with telehealth to sustain the practice.  Answers were hard to find.”

“We saw an opportunity,” says Rob Chamberlin, MD, the ACO’s chief medical officer. “We quickly formed a team dedicated to finding and delivering telehealth info to our private practices.”

[The ACO's digest] absolutely saved me dozens of hours of frustration on multiple payer websites…On April 2, the first telehealth support digest went out to more than 130 providers in private practices associated with the ACO. It provided access to telehealth start-up guides, billing information, documentation tips and connections to peer networks. Throughout April and May, when telehealth resources were rapidly developing, the ACO sent digests every week.

“The ACO’s digest became our most useful resource,” says Kathryn Galbraith. “It had practical information on how to use telehealth and, most importantly, consolidated payer information to make billing and getting paid for telehealth visits efficient and accurate.  It absolutely saved me dozens of hours of frustration on multiple payer websites to gather the critical information I needed to survive as a practice during this unprecedented and stressful time.”

 

 

2020 Annual Report

Stephen Gorman, DO
President of Specialty Solutions

IMPROVING DOCUMENTATION

Success in value-based care requires accurate data about the health of our patients. Clinical documentation, in the form of diagnosis codes, is the primary source of these data. More precise and detailed coding can better direct care management resources, ensure providers see the sickest patients frequently and identify patients who are eligible for additional health plan benefits for their chronic conditions.  Appropriate documentation is also critical for payers to set more accurate financial targets based on expected costs to manage patient populations.  In 2019, the ACO launched several initiatives to improve clinical documentation, including a unique partnership with Specialty Solutions, the multi-practice specialty group with more than 275 providers participating in the ACO.

It’s a great example of how practices can work hand-in-hand with the ACO to create measurable improvement.

“We were happy to collaborate with the ACO on this project,” says Stephen Gorman, DO, president of Specialty Solutions. “More specific documentation holds benefits for practices, providers and patients, and it’s a common denominator that all practices, regardless of specialty, can seek to improve.”

The project began by analyzing diagnosis coding that occurred at Specialty Solutions practices in 2018, revealing opportunities to improve coding specificity. The project team then worked with practices to create coding cards for each specialty and recruited dyads – a provider and an administrator – at each practice to act as “documentation champions.” Equipped with the coding cards, the project team conducted on-site trainings that were then reinforced by the dyad members.

The team created a total of 12 specialty-specific coding cards and conducted trainings, along with the local champions, at seven of the practices. Several months later, four practices achieved significant improvement in coding quality, ranging from 4 to 18 percentage points.

“I think the outcome data show that the project was effective, particularly for practices that had active physician and administrative leadership boosting engagement,” says Stephen. “It’s a great example of how practices can work hand-in-hand with the ACO to create measurable improvement.”



Dawn Whitten
Director of Quality and Patient Safety,
New England Cancer Specialists, Scarborough

A DEEPER UNDERSTANDING OF PATIENTS

In the summer of 2020, New England Cancer Specialists (NECS), a MaineHealth ACO participant, contacted the ACO with a problem.

“Because of the patchwork of incompatible electronic medical records held by different providers, we didn’t always have a complete view of our patients,” says Dawn Whitten, director of quality and patient safety at the NECS practice in Scarborough. “We sometimes were blind to their underlying conditions. And we didn’t always know when they were admitted to the emergency department. These are crucial data points that help us tailor and adapt our cancer therapy to each patient’s unique needs and clinical profile. We wanted consistent access to this information, so we reached out to the ACO for help.”

 

Arcadia reports have been a game changer…

Eiren Menhennitt and Joanne O’Neil from the ACO’s Contract Operations and Data Operations teams collaborated with Dawn to get NECS the access it needed.

“We identified two primary sources of data that would be helpful for Dawn – access to Epic, MaineHealth’s electronic medical record, and access to the vast claims and clinical data stored in our Arcadia population health management tool,” says Eiren. “We connected Dawn with the SeHR team at MaineHealth to establish read-only Epic access for the practice so care teams can be notified of patient activity within the MaineHealth system. Joanne and I were also able to generate custom reports out of Arcadia. First, we ran a list of patients with high emergency department and inpatient utilization within the last year. This list served as a starting point for Dawn and her team to add their providers as care team members in Epic. The second list identified patients who could be at high risk of future utilization. This list included the patient risk score, chronic conditions and ICD-10 coding opportunities.”

“Arcadia reports have been a game changer,” says Dawn. “And Epic access will influence workflow changes in our EMR. We look forward to having more complete information about our patients, allowing us to adjust care plans to provide the highest level of care.”

 

Kathryn Galbraith, MD
Galbraith Family Medicine, Limerick

A HELPING HAND DURING THE PANDEMIC

When health care shut down in the middle of March, small private practices like Galbraith Family Medicine in Limerick had to quickly find a way to see patients remotely or risk financial ruin. Telehealth was clearly the answer, but the barriers to standing up a telehealth system rapidly were immense.

“We were in trouble,” says Kathryn Galbraith, MD. “Our patients needed care but many were too scared to come in.  Telehealth offered a possible solution but it was new to us, and there was great uncertainty about whether we could get adequate reimbursement with telehealth to sustain the practice.  Answers were hard to find.”

“We saw an opportunity,” says Rob Chamberlin, MD, the ACO’s chief medical officer. “We quickly formed a team dedicated to finding and delivering telehealth info to our private practices.”

 

[The ACO's digest] absolutely saved me dozens of hours of frustration on multiple payer websites…

On April 2, the first telehealth support digest went out to more than 130 providers in private practices associated with the ACO. It provided access to telehealth start-up guides, billing information, documentation tips and connections to peer networks. Throughout April and May, when telehealth resources were rapidly developing, the ACO sent digests every week.

“The ACO’s digest became our most useful resource,” says Kathryn Galbraith. “It had practical information on how to use telehealth and, most importantly, consolidated payer information to make billing and getting paid for telehealth visits efficient and accurate.  It absolutely saved me dozens of hours of frustration on multiple payer websites to gather the critical information I needed to survive as a practice during this unprecedented and stressful time.”