In 2011, Intermountain Healthcare made a deliberate decision to move assertively toward value-based care. The Salt Lake City-based health system believed that in order to drive greater affordability and quality for the communities it served it would need to engage in steadily increasing numbers of value-based care contracts.
Since that 2011 decision was made, Intermountain has seen solid performance and big momentum in its value-based care arrangements.
Uncovering disproportionate gains
"But we started to notice that although overall our performance was good, we saw there were tools and services that were available to providers who were employed by Intermountain Healthcare that were driving disproportionate gains," said Andrew Sorenson, chief analytics officer at Castell, Intermountain's analytics platform subsidiary.
Castell was launched in 2019 to help providers, payers, ACOs and others make better use of their data and manage the demands of value-based reimbursement.
"The gains were in the affordability and the quality of care being delivered," said Sorenson.
But only about half of the patients in the Intermountain's value-based care arrangements were treated by these employed providers.
High-performance value-based care
"So in order to drive better affordability and quality across all of the communities, we realized we would need to help clinics and others increase their capacity to deliver value-based care efficiently and in a high-performance way," he said.
"We needed an organization that could go in and partner both with our Intermountain providers and these independent providers, who could select our wholly owned payer partner, as well as CMS or other insurance companies."
"We have lots of technology, focused data, experts who partner with people who work for Castell, or work for Intermountain, or work with one of the companies that we partner with, to ensure the data is showing up the way that is needed at the time when it's needed, and in a way that is actually usable to improve the decision-making processes."
Andrew Sorenson, Castell
So Intermountain needed an end-to-end data set across its network.
"That helps providers and care teams understand the needs of their patients using data from across the full continuum," Sorenson explained. "And so Castell established a set of products and services that leverage that full continuum of data. Castell partners really deeply with a number of vendors, including Arcadia, to help us amass data about the members we serve.
"Then Castell delivers technology products that leverage that data, as well as a number of more human-based traditional services that help clinics with delivering high-quality, low-cost care."
A scalable analytics capability
Castell used Arcadia Analytics to build a scalable analytics capability across more than 800,000 lives managed under risk, more than 1,600 providers and hundreds of clinics. The analysts at Castell were early adopters of Arcadia's new platform called "Vista," using it to build polypharmacy dashboards in support of a pharmacy strategy for patients with multiple expensive drugs.
Basically, Arcadia helps amplify (through aggregation and in-depth analytics and analysis) the Castell data platform. Castell's data scientists use that data to manage risk contracts and value-based care, and to develop strategic population health initiatives.
Castell made significant investments in its data infrastructure and then partnered with vendors like Arcadia, which helped efficiently bring on data from many different sources.
"So the first step is that we ingested and normalized and processed all of this data so it can be ready for us to deliver into people's workflows," Sorenson said.
"Step one, again, was acquire the data and clean it, and then the next step was to deliver products and services, both to people employed by Castell, as well as people who are employed by primary care practices and elsewhere along the care continuum to leverage these data sets."
Castell has services like care coordination, where a Castell employee helps ease transitions of care and performs other care tasks along those lines.
A team sport
"So it really is a team sport," he said. "We have lots of technology, focused data, experts who partner with people who work for Castell, or work for Intermountain, or work with one of the companies that we partner with, to ensure the data is showing up the way that is needed at the time when it's needed, and in a way that is actually usable to improve the decision-making processes."
The year 2020 was interesting year for Intermountain and Castell to try and clearly delineate the cause of improved performance.
"The early results we've seen include looking at the clinics that have partnered really deeply with Castell and clinics that we haven't been able to engage yet," Sorenson observed. "And if we look at the clinics where we are more deeply partnered, we've seen that the cost of care for those clinics' patients has decreased in a meaningful way."
As Castell looks at a type of delivery system that has been deployed within Intermountain Healthcare called "reimagining primary care," it has seen, not only improvements in quality, but also improvements in engagement scores, he said.
Hitting the Quadruple Aim
"We're achieving the quadruple aim," he added. "We're improving costs, improving quality. We're improving patient experience, and, critically, we're seeing improvements in provider engagement," he stated.
"In hindsight, as we've looked to create partnerships with vendors and as we've become a bit of a vendor ourselves, I think that one of the things that's critical is to find partners who have a similar view of the world," Sorenson advised.
"They have a similar mission, a drive where they're trying to accomplish similar things for similar reasons."
If one has that type of alignment, it makes nearly every other component of the partnership much easier, he said.
"And then one of the other things I would advise people to do is to always check references," he concluded. "I know it seems a little bit obvious, but we learned a lot as we've done our due diligence with partners. To understand how their clients feel about their offerings, that helped us arrive at the partnerships we're in now."
Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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