How Small- and Medium-Sized Practices Can Use Big Data

Is big data the right fit for your practice? It could be if you're part of an accountable care organization (ACO) or a Patient-Centered Medical Home (PCMH) and your practice is now directly accountable for keeping your patients healthy.

Dan O'Connor, vice president of client relations at Bethel Park, Penn.-based Stoltenberg Consulting, likes to talk about the TV show "House" when describing how big data works in healthcare. On "House," which ran on Fox for eight seasons and finished up in 2012, patients presented with two or three symptoms of a particularly exotic disease and Dr. House spent the entire episode wracking his brain - and the brains of his clinical team - to diagnose and then treat these patients.

When it comes to big data in healthcare, you take that idea about focusing on one patient and you apply it to searching vast amounts of data based on key words to bring back relevant information to your practice. O'Connor said that practices that are trying to embrace the PCMH and ACO models need to be able to utilize all the data they have access to within their EHR and claims data from payers.

When Amarillo Medical Specialists joined an ACO - along with nine other physician practices - in January 2013, it became immediately apparent that the entire ACO needed to figure out whether the services it was providing were actually serving their patients' needs. Each of the practices in the ACO needed to find out how their costs fit into the overall cost of care, according to William Biggs, an endocrinologist and internal medical physician at the Amarillo, Texas-based practice and medical director of the ACO.

For example, before the practices had access to information about the medications and home health and skilled nursing services prescribed by doctors, they didn't know how much any of these services cost - nor did they know the  quality of the care they were providing to patients.

"When we became accountable as an ACO and saw how much we were spending in those categories and how much was being wasted and not used in a constructive way, that was a big eye opener for the doctors," said Biggs. By analyzing data gleaned from the practices' EHRs, its health information exchange, and claims data from insurance companies and Medicare, the practice was able to determine, for example, the appropriateness of patients' emergency room visits and how medically necessary they were.

This meant that the practices involved in the ACO have had to grapple with how accessible they are to patients, according to Biggs. "Are patients able to [be seen] in a timely fashion when they are ill? Or is the front desk just telling them to go to the emergency room? Or are they put on hold and the message tells them to go to the emergency room if this is an emergency - without talking to anybody?"

Fixing a practice's accessibility problem is left up to the individual practice. Biggs said that typically starts with reviewing urgent calls from patients. One solution can be to provide a usable script to the front desk staff that walks them through helping a patient decide if an emergency room visit is required. Having a nurse available to triage patients is also helpful, as is leaving enough slack in the schedule to work in urgent patients rather than sending them to the emergency room.

In its first year, the ACO was able to save Medicare about $4.85 million. About half of that amount was shared among the practices, and a large portion of that amount was shared with the doctors in bonuses. The ACO also saw a 23 percent reduction in hospitalizations in the first 18 months.