Dr. Bragg Leverages Health IT to Improve Provider Performance
Dr. Frank Bragg is a board-certified internal medicine physician at Eastern Maine Medical Center (EMMC), which is part of an eleven-hospital Accountable Care Organization (ACO) in northeastern Maine. The ACO cares for a largely rural population with many patients enrolled in both Medicare and Medicaid. As the ACO’s Performance Improvement Coordinator, Dr. Bragg led the ACO’s effort to leverage Health IT to improve provider performance and health care quality.
Securing Buy-In in a Changing Health Care Landscape
EMMC and its fellow hospitals are well aware that health care is evolving. With the rise of new health care improvement programs, such as the Pioneer ACO Model, providers and provider organizations are being asked to improve health care quality and spend health care dollars more wisely. With several significant changes on the health care horizon, Dr. Bragg and his colleagues believed a commitment to performance improvement would be even more important than before.
To get started with the ACO’s performance improvement process, Dr. Bragg worked to establish a collaborative organizational culture among the hospital leaders. He made sure they got to know each other “on a first-name basis” by encouraging open discussion at each of the ACO’s meetings and keeping the meetings “informative, but also light and not too serious.” If the ACO was going to successfully improve provider performance, the hospital leaders had to agree on a uniform set of provider performance standards. Dr. Bragg noted, “If you want members to agree on quality metrics, it’s important to develop buy-in by letting everyone participate in the discussion.” After securing buy-in from each of the eleven hospitals, the ACO was ready to start improving health care quality.
Raising the Bar on Provider Performance
With EHRs, Dr. Bragg and his colleagues are able to generate detailed provider performance reports and share the reports among the hospitals in the ACO. “The positive effect of sharing data is that the hospitals can share experiences and learn from each other,” Dr. Bragg said. Each measure in the performance reports – which the hospitals call “Christmas Tree Reports” due to the color coding –is marked green if the hospital meets the target, yellow if the hospital is below the target but within ten percent, and red if the hospital is more than ten percent below the target. Any hospital with a measure more than ten percent below the target is asked to develop a 90-day performance improvement plan.
The hospitals, for example, are currently working to better manage patients with high LDL cholesterol levels. After struggling to help patients with diabetes, ischemic vascular disease, and coronary artery disease lower their LDL cholesterol levels, Dr. Bragg and his colleagues developed a tool for the EHR system. The tool enables providers to create lists of patients with high LDL cholesterol levels who are due for a cholesterol check. Providers can use these lists to implement targeted health interventions to lower LDL cholesterol levels.
Thanks to EHRs, the hospitals have the information they need to improve provider performance and health care quality. “Once we agreed on performance measures, we shared best practices, tips, and tricks. We have all noticed improvement in our performance and it has been especially gratifying to see the effect of the 90-day performance improvement plans on health care quality,” Dr. Bragg explained.