Alaska Provider Network achieving value-based care success with SDOH and claims data

Over the last decade, healthcare – and more specifically, primary care – has been at an inflection point. As the industry continues to transform with the evolution of digital records, alternative payment models, and challenges of staffing and burnout, primary care practices have faced specific challenges keeping up with these demands.

As a result, the industry has seen small, independent practices consolidate with larger hospitals and health systems through acquisitions, ultimately losing their independence.

THE PROBLEM

Alaska Provider Network, a clinically integrated network, works to help these primary care providers remain independent and autonomous while transitioning to more complex payment and care delivery models, including value-based care.

“We are specific about meeting their needs by considering their unique market attributes – from geography to cost structures to personal relationships,” said Jason Haugen, president of Alaska Provider Network. “As a former technology startup founder – both inside and outside the healthcare space – a CPA and holding an MBA in finance, I knew data and technology had to be at the heart of Alaska Provider Network’s mission.

“As such, we also saw the need to evolve from a clinically integrated network into a more robust ‘connectionist network’ offering that works with more practices needing support to increase revenue and improve operations – so we turned to athenahealth’s electronic health record as well as to predictive analytics with artificial intelligence and machine learning,” he continued.

These technologies help Alaska Provider Network glean deep and valuable insights into high-risk, high-cost patients, measuring cost and quality of care, to meet practice-specific and broader industry needs to remain autonomous, he added.

PROPOSAL

After connecting with athenahealth, Alaska Provider Network realized it needed a vendor that was as much a service organization as a software company, and athenahealth proved to be just that, Haugen said.

“Athenahealth specializes in serving the needs of independent practices, and at Alaska Provider Network’s core, we particularly believe primary care should be the center of care,” he explained. “The industry often hears physicians saying it feels like they have two jobs – both clinical and administrative. To make it easier for providers to focus on what they really want to – patients – we adopted the technology to make high-quality care easier through patient record sharing across the network, real-time patient insights, and specialty dashboards for each of the practices.

“As mentioned previously, we were looking for avenues to assist primary care providers with the next evolution of healthcare, which not only includes value-based care but the interconnectivity of the parties that touch and impact care as well as the deep learning that comes from making sense of Big Data,” he continued.

A critical component to value-based care is the ability to understand the metrics of the practice and the impact on the patients and clinicians. The technology provides these insights, which may have otherwise not been possible for these practices, he added.

“With that said, value-based contracts are a part of it for sure, but it’s also broadly about taking patient and practice information and sharing it,” Haugen said. “Using athenahealth allows us to do this in ways the providers can exchange clinical data across systems and quicky and easily access clinical and financial data optimized for extraction and analytics.

“Ultimately, to make more timely and informative decisions to improve care, patient outcomes and practice performance,” he added.

MEETING THE CHALLENGE

Alaska Provider Network is harnessing real-time insights through electronic health records, social determinants of health and claims data to make providing high-quality care easier.

“Our entity has been on the cutting edge of using technology for quite some time,” Haugen stated. “While AI has recently become the most talked about term in healthcare, we have been using AI and ML for six or seven years.

“By combining clinical data, social determinant of health data and payer claims data with AI and EHR expertise, we’re able to create and improve models of care, including those for predictive analysis and care management,” he continued. “The marrying of these elements allows us to provide unique insights most valuable to payers.”

Athenahealth aided in implementation and provides support. The provider organization has its own data scientists who are experts in knowing how to take the information and data exported from the platform and pair it with AI to bring clinical and claims data together for optimal care decision making and delivery.

RESULTS

The data the EHR vendor has helped surface has allowed Alaska Provider Network and its practices to succeed in new payment and care delivery models by uncovering key metrics of success.

“We measure success through the cost component and the quality component of reducing the cost for patients and the system overall to improve care quality,” Haugen explained. “As mentioned, for each of the practices, metrics vary. By having the ability to create customized dashboards, we create and identify metrics critical for value-based care success so we can support all providers with a tailored approach.

“Harnessing clinical care data, among other data sources such as SDOH and claims data, with AI, we have created and improved models of care across the network, including those for predictive analysis and care management,” he continued. “These models allow us to understand patient outcomes models with a degree of accuracy up to about 70-80% at any given time.”

Understanding which patients are most likely to end up in a hospital or emergency room allows for more preventative care touchpoints between patients and providers, and ultimately, saves money and improves care outcomes, he added.

“In the last three years, we have experienced 200% growth within the groups we serve in and out of the network,” Haugen reported. “While we were once solely located in Anchorage, we’ve since expanded to other parts of the state and into the lower 48 because we have scalable technology available to meet the needs of additional practices.

“Our growth strategy is completely organic with the philosophy if we provide the right partnership, it sells itself,” he added.

ADVICE FOR OTHERS

For smaller primary care practices who may be wondering how they can meet the demands of value-based care models in healthcare or provide exceptional care while staying financially healthy without giving into consolidation, ‘connectionist networks’ like Alaska Provider Network’s are here, Haugen contended.

“Being able to leverage the EHR technology across a network can allow for practice independence, while keeping your own unique culture,” he said. “Each primary care practice can choose the technology that is right for them. Sharing resources and big system data for cost and value of care is necessary in the evolving healthcare landscape and allows providers to stay financially and culturally independent – this is where the autonomy lies.

“With each of the providers on the network able to create their own dashboard of metrics specific to their practice – for example, referral management, clinical care, revenue cycle – EHR, SDOH and claims data is an invaluable asset,” he concluded. “While data doesn’t treat patients, it’s a tool to arm clinicians with the information needed for high-quality patient care efforts. My advice is to see what the options are that fit your practice best and trust the data for the benefit of your practice and patients.”

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