Sequent Health Physician Partners has developed a number of strategic partnerships with health plans to provide higher quality, more cost-effective medical care to their membership.
Payers who partner with Sequent are likely to realize the following benefits:
Sequent has taken an inclusive approach to inviting providers from the medical community to participate in the clinically integrated network. Providers must meet the professional qualifications established by Credentialing Committee to participate in the network. They must subsequently maintain quality performance standards established by the Quality Committee to remain in the network.
Sequent’s physician network is comprised of both primary care and specialty care physicians. It is also comprised of physicians employed by Northside Hospital and physicians in independent, private practice.
Providers agree to actively participate in clinical initiatives to further Sequent Health's value-based mission. This participation includes sharing data and agreeing to work with Sequent staff on practice transformational activities and integrate evidence-based practices.
Sequent has made the necessary investment in infrastructure and support systems to ensure it can have a meaningful impact on clinical outcomes and the patient experience.
Sequent Health Physician Partner’s analytics at the core of its IT investment strategy. To maximize use of Sequent’s care management resources, it must prioritize where to focus within large groups of patients. Sequent must also have the ability to translate data into actionable insight for clinicians and care management staff. Therefore, Sequent has partnered with athenahealth to aggregate data across the large number of practices throughout the network.
Athena’s PMS is a cloud-based solution that helps address a broad spectrum of cost and quality challenges, from population assessment and provider profiling to performance and provider management:
Being a part of Northside Hospital allows Sequent’s Data Analytics team to work closely with the Northside’s Information Technology department. The group works together to ensure the data is protected, the proper data is used for reporting, and to validate all reports via a formal data governance process.
The Data Analytics team is continually mining data in the various reporting systems to find new opportunities for the Clinical team. This includes mapping providers to patients to determine gaps in coverage areas, analyzing monthly claims data to identify differences since the last quarterly reports, and to produce reports that are meaningful and easy to use for the providers in the network.
The Sequent Clinical Team is focused on building strong care teams, coordinating care across the continuum and leveraging information systems to ensure patients receive evidence-based care. The team is comprised of two distinct clinical roles: Registered Nurse (RN) Care Managers and Quality Specialists.
RN Care Managers have primary responsibility for coordinating the care of patients across the spectrum of medical providers and identifying / supporting patients that are at risk for an adverse event. RN Care Managers oversee two primary functions:
RN Care Managers help patients navigate the healthcare system and refer patients to community-based services as needed. These could include hospital care management, nursing facility care management, home health services, post-acute programs, community-based services, and payer-provided disease management/case management programs. This ensures the patient is aware of the resources available and that the resources are coordinated and efficiently deployed.
Quality Specialists are focused on identifying patients that have ‘gaps in care’ across the patient population regardless of the patient's level of risk. Quality Specialists contact patients to provide vital information about evidence-based screenings, medical services or reminders that will help them manage their health. Quality Specialists also assist RN Care Managers in coordinating post-acute services, specialty referrals and community-based services where appropriate.
Quality Specialists also play a fundamental role in supporting physician’s journey in value-based care. They work closely with physician offices to develop workflows to identify patients with gaps in care so physicians can address needs at the point-of-care. Quality Specialists often function as a conduit for transferring information and data between Sequent and the physician’s office.
The Sequent culture of continuous quality improvement is led by the Sequent Quality Committee, which is comprised of Sequent physician members that represent multiple specialties. The Quality Committee determines the quality improvement practices are performed consistently across the Sequent Network and leverages data on these evidenced-based practice guidelines to identify opportunities for improvement. This committee is also responsible for building care pathways to guide movement between settings and providers. These pathways ensure timely access to high quality specialty medicine where appropriate and map the flow of clinical information for integration.
Individual provider and practice performance on metrics identified by the Quality Committee are shared through performance dashboards. These dashboards include performance on quality and utilization measurers. Along with these dashboards, practices are provided guidance from the Sequent Clinical Team about potential opportunities for improvement given their current performance and patient population. Along with high-level metrics, the clinical team has tools to drill down to the patient-level in order to identify patients driving high and/or inappropriate utilization as well as the patients with identified gaps in care. The team works with the practice to determine appropriate changes to current workflows in order to improve in identified measurers. The overall goal of this process is to determine the system issues leading to gaps in care or barriers to care. Once potential barriers are identified, the team works with in the practice to determine new, evidence-based standard work or system changes that will help provide better care and improve practice efficiency.
Over time, impacts of these changes are measured by monitoring the dashboards to quantify the degree of improvement. The network tracks performance over time to determine if the change had the intended impact. When the expected impact does not occur (or does not occur to the degree to which was expected), the team will work to make small tests of change to the plan to determine which activities produce the largest impact. Thus, tracking quality and utilization metrics gives the practices a new tool to measure the impact of new workflows.
In addition to using metrics for quality improvement, it is also a tool used measure individual provider performance. Providers and practices are held accountable for their performance via oversight by the Quality Committee. The committee reviews performance to determine practices or physicians who are outliers within each measure. When high performers are identified, the team seeks to learn more about the drivers of their strong performance in order to spread their innovative tactics to others within the network. On the other hand, when low performers are identified, resources are provided to assist physicians with activities to improve their performance.
All of this quality improvement activity requires a high degree of engagement from the practices within the network. Engagement with the clinical team and the quality improvement process is paramount to success, thus engagement is tracked very closely. Groups identified as displaying low engagement are discussed at physician leadership meetings. Physician leaders perform peer-to-peer outreach to discuss the current issues and engagement requirements moving forward. This process allows an unengaged group to hear directly from a trusted colleague who is leveraging the data and resources well. Should provider continue to display poor levels of engagement, the provider will potentially be further educated, coached, penalized and/or terminated from the network.