Delivering better obstetrics results
Any obstetrician knows that every second counts in the delivery room, as does access to all of the medical records for women in labor. But for Women’s Health Connecticut (WHC), frequent changes made by their previous electronic health records vendor meant that for every upgrade the practice had to shut everything down, complete the updates, and then test them — losing crucial time. “It was a good 18 to 24 hours to do that,” explains Medical Director Dr. Daniel Welling. Having an effective cloud-based solution like athenaOne, he says, has made upgrades “basically seamless,” and enables the 250-provider network to easily activate and share data with Marketplace partners like Dorsata. Their ACOG Prenatal Record, designed in partnership with the American College of Obstetricians and Gynecologists, is native within athenaClinicals for practices that use Dorsata. It includes decision support prompts and advanced reporting capabilities. The result is hours of time saved for physicians who don’t have to track down the latest ACOG guideline updates, and for medical assistants who no longer have to perform manual chart extractions for state Medicaid reimbursements.
Reducing inefficiencies with better reporting, workflows and prompts
The transition to athenaOne was an easy choice, says Welling, because it’s not only easy to learn but easy to train new associates on—he estimates it takes just a day to get employees up to speed. athenaOne also helped streamline workflows and templates across WHC, which has more than 80 locations. “The customization has been critical to us,” he explained. “We built multiple templates right from the beginning and that was nice because then we could have some standardization across the organization.” Dr. Welling said he jumped at the chance to become one of the earliest adopters of Dorsata when it entered the marketplace as an athenaOne partner in 2017, because it combined the feel of ACOG paper charts of the past with care guidance reminders that are unique to each patient’s stage of pregnancy and clinical conditions.
“There are all of these things that are built in that help you be a better physician in that busy, crazy day. If you get interrupted to look at lab results or get on a phone call with another provider, you have to interrupt what you’re talking about with a patient. So with a prenatal patient you can easily forget things that should be done,” Welling said, citing flags for flu prompts or gestational hypertension. “With Dorsata, you’re sitting there [with a prompt] that says, ‘Order the flu vaccine.’ I’ll be honest—if someone took Dorsata away, I’d probably retire.”
There are efficiencies outside of exam rooms, too, as four WHC medical assistants previously dedicated to manual patient chart abstractions were able to refocus their efforts, and practices also reduced the amount of time to complete data submissions. “Using Dorsata’s configuration services and reporting capabilities, we were able to streamline reporting, and perform well in our state’s Medicaid Pay for Performance Program,” said Dr. Welling. The more efficient process resulted in a reduction in staff required to generate and complete the data for an estimated cost savings of $75,000 annually.
The value of the partnership between Dorsata and athenaOne also proved valuable for Dr. Welling and his colleagues when an insurance company alleged WHC did not screen appropriately for chlamydia in women younger than 25. Not only were reports quick to generate in order for WHC to be awarded the performance initiatives, they saved a lot of headaches since all of the data was at hand with no manual extraction required. “We were able to use athenaOne as well as Dorsata to gather information and go back several years. We were able to go back to this insurance company and say, ‘You’re wrong.’ Because in a sexually inactive woman, you don’t have to do a chlamydia screen,” explained Dr. Welling. “We could prove that of the women that we should have screened, we were well above what they used as a cutoff and so we were able to get the pay for performance dollars that we wouldn’t have gotten without those reports.”
Tools promote better patient experience, provider profitability
In addition to clinical efficiencies, Dr. Welling says using both athenaOne and Dorsata have proven financial value when it comes to meeting challenging reimbursement landscapes. “Certainly as the insurance companies come up with more and more risk-based contracting, we want to have the data where we can go to them and properly negotiate. We’ve been able to leverage Dorsata to make our reporting to the state easier,” he said. In 2020, there’s $1.2 million in Connecticut Medicaid reimbursements that he predicts getting a “significant piece of”; 2019 resulted in a 27% Medicaid revenue increase thanks to Dorsata’s accurate and timely reporting capabilities. Last year, projected bonus payments were $840,000, versus an average of $660,000 in past years without using Dorsata.
Besides pay for performance initiatives, having a better crosssection of data has also helped WHC decrease the reported rates of incidents related to the management of high-risk conditions (like Cesarean sections and NICU admissions) that typically lead to legal claims. WHC pays for its own malpractice insurance, so a reduction in these claims equates to monetary savings. Having ACOG inform Welling’s decisions complements years in delivery and exam rooms. “I think a lot of the C-section rate reduction is because it’s being concentrated on, and it’s education. But again, following the guidelines carved out by experts instead of ones carved out by my experience” – like the expertise proffered by Dorsata prompts — also likely leads to a reduction, credits Welling.
WHC also used athenaOne metrics to leverage existing but underutilized capabilities, including depression screenings conducted during annual exams. Insurance companies pay for PHQ-2 and PHQ-9 tests, as well as the Edinburgh test for postpartum, but Welling said these were not performed consistently. Using an athenaOne marketplace partner, the Connecticut network now uses digital check-in forms and online questionnaires to complete screenings and tests, and increase annual insurance revenue. WHC is also able to leverage athenaCommunicator to align with new Connecticut Medicaid mandates requiring two post-partum visits. Welling said he sees a correlation in the increase in the number of reimbursed appointments—approximately 80 percent of patients scheduled to meet the requirement of a visit between 14 and 21 days post-partum—to the technology that helps encouraging booking those follow-ups.
Measures that enable better profitability have not only resulted in better patient health routines, but enhanced gratification among providers and those they care for. Satisfaction scores consistently average between 92.5 and 93.5 across WHC, higher than the national average. Welling credits that, in part, to both athenaOne and Dorsata. “Instead of the MA walking in with a computer and having to ask question after question, it’s more automated—they can go in and be personable,” he said. “I can stand looking at a patient eye-to-eye.”
Better ecosystem models help connect the dots
Like the joy of nurturing a baby, Welling and his colleagues are happy nurturing athena’s growing ecosystem. He sees even more opportunities for interconnectedness, especially when it comes to patients who require extra time and attention. Currently, most high-risk patients are eligible for six prenatal ultrasounds instead of the standard three, but insurance companies need to be notified by WHC of the high-risk determination. That requires phone calls and staff members’ time. “The more automated the insurance company is to the EMR, to the hospital, that whole pathway becomes more multidirectional, the better off we’re going to be,” he said. “It would be nice to get everybody talking. … It should be more of an automated path in every direction.”
Instead of the MA walking in with a computer and having to ask question after question, it’s more automated—they can go in and be personable. I can stand looking at a patient eye-to-eye.
— Dr. Dan Welling, Women’s Health Connecticut Medical Director