The unprecedented information-sharing capabilities provided by Crouse Health Network empower primary care physicians, specialists and hospital providers to better manage patient care and costs.
Mitchell Brodey, MD, Carl Butch, MD, Seth Kronenberg, MD, and Maud White
According to the American Hospital Association, “clinical integration is needed to facilitate the coordination of patient care across conditions, providers, settings and time in order to achieve care that is safe, timely, effective, efficient, equitable and patient-focused.” Crouse Health began its process of clinical integration in the 1990s, developing a physician-hospital organization to better manage patient care by analyzing national and local data and forecasting likely needs for all providers involved, according to Seth Kronenberg, MD, Chief Medical Officer, Crouse Health, and President of Crouse Health Network. The Crouse Health Network today is a clinically integrated model that supports Crouse’s strategic focus of strengthening alignment with both employed and community-based providers and patients.
Maud White, Executive Director, Health Alliance PO and IPA, and Interim Director of Crouse Health Network
“Early on, we formed a partnership between local physicians and the hospital on the premise that direct medical care is based on those two pieces so we could provide better services through collaboration,” says Maud White, Executive Director, Health Alliance PO and IPA, and Interim Executive Director, Crouse Health Network. “When Crouse began looking at ways to meet the new challenges in health care, the leadership looked to the Health Alliance Physician Organization and the medical staff. The vast majority of physicians who work with Crouse are in private practice, so collaboration was built into the organization from the beginning.”
Crouse Medical Practice – Cardiology, part of Crouse Health’s clinically integrated network of care, continues to serve the interventional and diagnostic cardiac needs of patients from throughout Central New York. Pictured are cardiologist Fafa Xexemeku, MD (left), and Martin Obey, LPN.
Seth Kronenberg, MD, Chief Medical Officer, Crouse Hospital, and President of Crouse Health Network
It is the changing healthcare environment that led to the development of Crouse Health Network in 2015. The network is used to develop population health management tools by analyzing data from insurers, providers and Crouse, and produce actionable recommendations to help reduce expenses and improve quality across the care continuum.
“We’re changing the paradigm by trying to keep patients out of the hospital and focusing on compliance at home,” Dr. Kronenberg says. “We were able to set up a process in which physicians were incentivized to provide care activities that keep patients in the most appropriate place for care. This aligns well with the Crouse mission, which is to provide the best in patient care and promote community health.”
Digging into Data
Crouse Health Network benefits practicing physicians by improving communication between providers and bringing the many pieces of care management information together.
“Patients go through the care continuum and, particularly in cases when they need ongoing treatment, they see their physician, visit specialists, take medications, are treated by hospitalists and so on, and each provider has a different EHR system — there has to be better communication,” says Mitchell Brodey, MD, President and CEO of FamilyCare Medical Group and Medical Director of Crouse Health Network. “Having care managers and patient navigators helps, of course, but who’s going to pay for that? The burden tends to fall on individual physicians. As a health network, we have established a base of people and resources that reduce barriers to communication.”
“With Crouse Health Network, there’s good communication between Crouse Hospital and community physicians. They’re interested in improving quality, and their leadership is committed to that goal. I think we’re making progress toward improving the health of the region.”
— Mitchell Brodey, MD, President and CEO of FamilyCare Medical Group and Medical Director of Crouse Health Network
A 2010 study in The American Surgeon illustrates Dr. Brodey’s point. Physicians saved intraoperative images from 19 procedures and presented them to interdepartmental cancer conferences. According to the study’s authors, sharing these images ensured physicians “preserved pertinent intraoperative findings in the patients’ electronic medical record.” Another way of reducing costs and improving communication through successful clinical integration is identifying duplication in paperwork across offices. If such simple practices can improve referring physicians’ care for those patients, how much more can a thorough collaboration between all care providers affect population health?
“Crouse Health Network allows us to look at vast amounts of patient data — from physicians, payers, patients and quality scores — and put it all together to obtain a picture of how a patient moves through the system,” White explains. “We can then find places where quality could have been improved or costs could have been reduced. We look at EHR data, at insurance claims, hospital data, and unlike the old days of physician-hospital organizations, we now use the same measurements as mandated by the Centers for Medicare & Medicaid Services and other nationally set metrics, so the pool of information we have is now enough to parse while maintaining statistical significance.”
Further, the information gleaned through Crouse Health Network can be used to benefit individual patients, not merely to set standard practices.
“This data is accurate, and I can obtain it in real time to assist in closing care gaps during a patient visit,” says Carl Butch, MD, Medical Director, Crouse Medical Practice PLLC. “Working from this knowledge base allows us to focus on preventive care and reducing risk factors for many common disease states, making it likely that we can improve the overall health of the population.”
“One benefit of the clinically integrated network is the collaboration that occurs between different physician groups within it. For example, one group in our network has a credentialed sleep center with capacity to take on additional patients. We are more likely to refer patients rather than open another sleep lab. This allows another group to invest time and money in areas that will better serve the needs of the population.”
— Carl Butch, MD, Medical Director, Crouse Medical Practice PLLC
Carl Butch, MD, Medical Director of Crouse Medical Practice PLLC, with a team member
In its efforts to improve data sharing across the healthcare industry, The Office of the National Coordinator for Health Information Technology cited four implementation objectives found in medical communities that successfully communicate medical information: physician engagement, data element and measure reviews, plans for EHR data quality improvement, and data management plans for EHR quality issues. Crouse’s long history of collaborating with physicians in its PO and IPA put the organization in an ideal starting place for clinical integration. By providing the data management expertise for providers, Crouse Health Network relieves them of the burden of managing this data on their own.
Data Sharing Is Patient Caring
“Crouse Health Network is a large system that includes the hospital, specialists and primary care providers with multiple private groups engaged who are looking at metrics together, partnering with payers to develop information technology modalities that allow us to share our expertise and the cost of this additional work,” Dr. Kronenberg says. “Access to patient information used to be very episodic, very fragmented; now we look at patients across the continuum of care. We’re seeing improvements in blood pressure control, medication adherence and preventive care access.”
“We need community physicians to succeed, so we’re providing access to resources and consulting assistance to help primary care and specialty care practices understand and use the data they can access through Crouse Health Network. We work hard to provide that support.”
— Maud White, Executive Director, Health Alliance PO and IPA, and Interim Executive Director, Crouse Health Network
Physicians and groups who work with Crouse Health Network have the opportunity to go through a credentialing process to participate in information sharing without having to abandon the organizations they’ve worked hard to build and maintain. Rather than buying out physician groups to promote a top-down clinical integration, Crouse Health Network seeks to support Central New York practitioners where they are — without requiring a major investment.
“This is essentially a way of getting all affiliate providers to communicate with one another in an age when expenses are rising and people are getting sicker,” Dr. Brodey observes. “My group has about 75 physicians and 30 mid-level providers. While our size helps us communicate with insurance companies about contracts, we still need someone who can read the data we’re getting and turn it into quality improvement and cost savings. Crouse Health Network fosters that communication and provides those vital resources. Our patients are ultimately the ones who benefit from our collaboration.”
For more information about Crouse Health Network, visit crouse.org.