Record reform | A national grant puts Bangor health care providers in the fore of IT innovations

In May, the Bangor area became one of 15 communities poised to receive millions in federal dollars to invest in health care information technology and, ultimately, combat rising health care costs.

Eastern Maine Healthcare Systems, the lead player in the three-year grant, will receive $12.75 million to speed the adoption of electronic medical records at local health care organizations — not just those under the EMHS umbrella — and to connect them all to HealthInfoNet, Maine’s statewide health information exchange. The money will fund technology upgrades, but its ultimate goal is to improve the quality and efficiency of health care services, which in turn will hopefully help slow the growth of ever-increasing health care costs for individuals and businesses.

The Bangor Beacon Community, the name given to the collaboration, is comprised of 12 area partners, including organizations under the umbrella of EMHS like Eastern Maine Medical Center, but also independent organizations, such as St. Joseph Hospital and Penobscot Community Healthcare.

Traditionally, each primary care doctor’s office, hospital, nursing home or specialist’s office was a “data silo,” according to Mac Hilton, the Beacon Community program manager at EMHS. Each organization had its own patient records. If a patient floated among a primary care doctor, a hospital and a specialist, their medical records, including test results and allergies, would have to be shared through paperwork and phone calls. The goal of this Beacon Community grant, Hilton says, is to build a collaborative system so that a patient’s medical records follow them wherever they seek care.

The initiative is consistent with EMHS’ past efforts to build collaborative approaches with partners outside the system, including a competing hospital like St. Joseph, with the goal of improving the delivery of health care in the Bangor-Brewer region, says Michelle Hood, CEO of EMHS. “I think from the system’s perspective, it provides us an opportunity to accelerate what we’ve already been working on, which is building an integrated delivery system that provides patients with a great health care partnership experience, regardless of what health care needs they have.”

The grant is intended to improve how health care services are delivered and measure the impact on clinical performance, says Devore Culver, the executive director of HealthInfoNet. On a national level, each Beacon Community identified specific health care goals relevant to their local communities. In some areas, it could be addressing obesity or smoking. In Bangor, the focus is on managing the care of patients with one of four chronic illnesses — diabetes, congestive heart failure, asthma and chronic obstructive pulmonary disease. These high-risk, high-cost patients place a large demand on the local health care industry, which drives up costs across the board. “Most of the money is being spent building out technology, but the real objective is to demonstrate real impact in classes of patients with chronic disease in Bangor,” Culver says.

For example, partners within the Bangor Beacon Community will adopt a collaborative approach to the care of a diabetes patient, who visits multiple health care providers in the area. That collaboration, the partners hope to demonstrate, will result in fewer duplicated tests, more preventive care and lower cost demand on the health care system as a whole. Along the way, the partners will work on developing an efficient system that yields the best clinical results. In other words, the grant offers an opportunity “to incubate some ideas” when it comes to care management, says Hilton.

Of course, to do this, traditional competitors — like EMMC and St. Joseph — are working together for the greater good, not something that happens in every industry. (An analogy would be forcing banks to invest in IT systems that would allow other banks to access their clients’ financial data.) The collaboration is a departure from the past, says Donald Krause, medical director for quality improvement at St. Joseph Healthcare, the parent corporation of St. Joseph Hospital. The idea of different health care providers sharing patient information four or five years ago “would have been heresy,” Krause says. “But now it’s absolutely the essential thing to do.”

Financial incentives

The federal funding for the Beacon Community Cooperative Agreement Program comes from the HITECH Act, part of the federal health care reform bill that became law in March. While several of the reform bill’s provisions don’t kick in for several years, the HITECH Act is already changing the makeup of the health care industry. Besides providing funding for the Beacon Community program, the HITECH Act also includes incentives for health care providers to adopt “meaningful use” of electronic medical records

EMHS’ nearly $13 million comes from a pot of $265 million, which the Office of the National Coordinator for Health Information Technology set aside for the Beacon Community Cooperative Agreement Program. Physicians are eligible to receive up to $44,000 in total incentives each from Medicare for “meaningful use” of electronic medical records starting in 2011, according to athenaHealth, the Massachusetts-based health care services provider, which also has an office in Belfast.

Though the health care industry has recognized that electronic medical records and health information exchanges are the future, the necessary investment for a primary care doctor’s office or a small independent hospital to incorporate these into their businesses can be daunting. For instance, while an organization like EMHS has been investing in health care IT for decades (the system has spent roughly $40 million on health care IT in the past seven years alone), St. Joseph Hospital in Bangor began incorporating electronic medical records only three or four years ago, and then just in certain departments, says Krause. Implementing electronic medical records can be “exceedingly complex, time-dependent and an expensive program to do,” he says.

That being said, Mac Hilton at EMHS says one of the reasons Bangor was chosen to receive this grant was that so many health care organizations have already invested in electronic medical records, which “is somewhat unusual in the country,” he says. “That’s a big head start for us.”

Indeed, Eastern Maine Medical Center has for the past three years been named one of the “Most Wired Hospitals” in the country by Hospitals & Health Networks magazine.

For HealthInfoNet, the grant offers a unique opportunity to demonstrate how its health information exchange can work in a local area. Currently, six organizations throughout the state are connected to the exchange, which represent a little more than 50% of inpatients and outpatients in the state, Culver says. But the Bangor Beacon Community offers a unique opportunity because it will offer the first glimpse of what it could be like if all health care organizations in a region were connected electronically. “We don’t have a comprehensive community investment anywhere in the state,” Culver says.

As part of the Beacon Community, Eastern Maine Community College will develop a program to train health information professionals to sustain the IT infrastructure in the future. “I think that we will continue to see the need for health IT professionals,” Hood says. “Once these complex systems are put in place, they need maintenance. That need will not lessen in the years ahead.”

Just how many jobs the burgeoning health care IT industry could create is unclear. “Obviously if you’re going to greatly expand information technology infrastructure in health care, then you’re going to need to feed and maintain that infrastructure. That clearly indicates a need for more people engaged in that side of the profession,” says Culver. “What is really not clear is how big the opportunity really is. Is it 100 jobs? 1,000? 10,000?”

Revolutionizing payments

What Bangor gains from this three-year grant will benefit the entire state, as well. As part of the Bangor Beacon Community, EMHS will form a state advisory group to evaluate the project, “so that what we learn through this effort can be transferred to other hospital and health care systems in the state,” says Hood.

EMHS will also be part of a national discussion with the other 16 Beacon communities (the federal government recently announced two more grants) around the country to share what worked and what didn’t.

Behind this talk of information technology and collaboration among health care providers, there is a larger discussion focused on payment reform, according to several people interviewed for this story. The lack of a proper model for managing payments is holding up progress in how health care is delivered in this country, says Krause at St. Joseph Healthcare.

Currently, commercial insurers tend to pay based on incidents. This means health care providers are paid based on the volume of patients they see, not on the quality and outcome of a patient’s care. This system fosters the habit of health care organizations working independently — in those “data silos” — and does not offer incentives to work collaboratively.

“This grant introduces something that generally doesn’t happen in health care today,” Culver says. “This is very different, you now have clinical people from different organizations sitting around a table together determining goals and how to target impacts and how to measure those impacts. That’s a very, very different model than what we’re traditionally used to.”

So, how could this impact payment reform? The goal of the Bangor Beacon Community is to demonstrate that within a local population of high-risk, high-cost patients, a collaborative approach can lead to improved care and cost savings. “The assumption is if the Beacon grant succeeds and demonstrates real value, then that can translate to payment reform,” says Culver. “Today, the incentive is the grant. Tomorrow, that incentive may very well be how people get paid for treatment.”

Of course, if all this can be accomplished, the benefit to the business community would be lower health care costs. “Certainly, from my perspective, that would be the goal,” says Krause. “It would not improve the profit margin of an insurance company. If I were the employer and saw the outcome of this grant as successful, then I would as an employer demand reduced insurance costs, so that the cost of providing insurance for employees would be less.”

Payment reform and inexpensive health insurance aside, the Beacon grant does offer some tangible short-term benefits. “From my perspective, the Beacon grant has been a great stimulus for finding ways institutions can work better together,” says Krause. “There’s communication between St. Joe’s and Eastern Maine Medical Center that has been strengthened. And it’s opened up a conversation between disparate health care providers in finding better ways to work together, and that, for the community, is a huge success.”

Whit Richardson, a writer based in Yarmouth, can be reached at editorial@mainebiz.biz.