Information Technology Reference
In-Depth Information
Wellcentive
was founded in 2005 by a former employee of mine, Mason Beard, and
his brother-in-law, Paul Taylor, a practicing physician in Michigan. Paul's organiza-
tion, a Physician Hospital Organization (PHO) was under a pay-for-performance
contract with Blue Cross. A contract like this places demands on the physician
group to produce superior clinical outcomes. A PHO by law must be clinically inte-
grated to provide coordinated care, but Paul's organization was attempting to achieve
this essentially using spreadsheets. There were a variety of EHRs in use but many
practices were documenting on paper.
Mason was working and going to graduate school when they got into a discus-
sion of the problem. Paul felt that their payers, who were only able to look at retro-
spective claims data, had an inferior view of care to the more timely view that could
be assembled from the practices in the PHO if clinical data were aggregated in “real
time”. Providers also had more detail. For example, the payer might know that a
hemoglobin A1c (HbA1c), an important test to follow the clinical status of diabet-
ics, was done but they wouldn't know the value, so it was very hard for them to see
if the test was being followed up appropriately. Also, each payer saw their claims
but not the claims paid by other payers while the patient's physician could, in the-
ory, have a much more comprehensive view of the care, particularly if data was
aggregated from all the practices caring for a patient.
Together they decided to develop a solution. The data they needed was in the
systems that supported each practice. The key challenge was getting it and putting
it into a useable, more standardized and structured, form. The original proof of con-
cept was web-based and was integrated with a few systems, mainly in clinical labo-
ratories. It also had a generic tool for loading data from other systems. Despite the
fact that the tool was primitive by today's standards, the PHO rose significantly in
the Blue Cross Physician Group Incentive Program (PGIP) quality rankings. [
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Today, Wellcentive's data collection and aggregation is most commonly from
ANSI 837 claims data, the same data that is sent to the payer, via a direct feed from
the practice management system that does billing for the provider office; transfer of
LOINC codes from the major lab companies; and HL7 feeds from the local health
systems for information about hospitalizations and discharges. Where an HIE is
present it is possible to get much of the needed data via an interface to it. The com-
pany can accept data in a CCD format via a DIRECT connection but, as of this
writing, they say this is just starting to happen.
The Wellcentive Advance suite of products is comprised of four key capabilities
called Data Manager, Analytics Manager, Outcomes Manager, and Community
Quality Manager and is used by providers in all 50 states. The company says their
customers include some of the nation's best known health systems. Data Manager
helps these customers map data from their systems to Wellcentive in order to bridge
any differences in terminology. The tool takes advantage of the web so customers
can collaborate with their business partners to build these maps. For example, a
provider network might allow a lab technician in the local hospital to help build a
map between the terms used in that laboratory and those used in Wellcentive. The
tool also logs and tracks data errors. A common example is a patient not found in
one of the systems in the network because of a naming or other difference in key
