Monday, March 26, 2012
Cayman Collaborative Care Initiative
26 March 2012
To: Interested Vendors
The national health system of the Cayman Islands, also known as the Health Services Authority (HSA), is developing a physician compensation model that includes physician productivity and clinical quality as risk variables to total compensation. The project is known as the Collaborative Care Initiative (CCI). To these ends, the HSA is conducting an options assessment for vendors and products that can meet the reporting requirements to support the CCI metrics for productivity and clinical quality. HSA defines the overall value of healthcare as follows. Vendors must be capable of supporting this conceptual definition with their solution.
That is, the overall value of healthcare is greatest when the quality of care is delivered in a cost-effective manner. Cost and quality are inextricably linked. In this early iteration of CCI, physician productivity is being used as an inverse proxy for cost of care—highly productive clinicians reduce the overall cost per unit of high quality care produced.
Below are the high level requirements for CCI metrics and reporting. HSA encourages vendors to suggest additional requirements and functionality to ensure the best overall solution.
1. Timelines: HSA will schedule vendor meetings and product demonstrations immediately, on a first-come/first-served basis. The initial operational date for CCI reporting is July 1, 2012.
2. Contact Information: Interested vendors should contact Mr. Keith Higgins, Acting CIO, at firstname.lastname@example.org, to arrange demonstrations and discussions of their solutions.
3. Cerner-Centric: The HSA currently operates a full complement of Cerner Millennium products, operating in Cerner’s Remotely Hosted Option (RHO) in Kansas City. The vendor’s product must be capable of extracting data from Cerner for purposes of reporting and analysis.
4. HSA Hosted Data: The data extracts from Cerner must reside within the administrative and operational environments of HSA. Therefore, the data must be hosted in the Cayman Islands—either in HSA’s data center or a data center that is currently associated with HSA administration—or in Cerner’s RHO data center in Kansas City.
5. Adaptable Data Extracts, Model and Content: At present, Cerner is the primary source of data for clinical quality and physician productivity measures, however, HSA may, in the future, divest itself of the Cerner system. Therefore, the vendor’s solution must be capable of functioning with very little modification, and minimal additional cost and time if this divestiture occurs. HSA also utilizes a large number of standalone spreadsheets for tracking various aspects of the care process. These spreadsheets could be useful in the context of CCI. The vendor’s solution must be capable of including this spreadsheet content by either extracting and integrating the data, or by accommodating the data collection directly in the vendor’s solution.
6. Reporting Requirements: The vendor’s solution must support the following reporting environments:
a. JCAHO ORYX
d. Meaningful Use
e. Pioneer Accountable Care Organization reporting
f. Patient reported satisfaction with care
7. Physician Productivity: HSA believes that there are no perfect models for measuring physician productivity and therefore, compromises in this regard will be necessary. Vendors are encouraged to suggest new and innovative models. Traditional measures of physician productivity, especially revenue-based, are not appropriate in HSA’s context. HSA is a national health system, therefore revenue generated by HSA is realized as an expense to the Ministry of Health and the Cayman Islands National Insurance Company (CINICO). This tension between revenue vs. expense is the same in US-based direct contract agreements between self-insured employers and healthcare systems—a growing market trend in the US. RVU-based models are not appropriate within HSA’s environment because the RVU model is CPT-driven, thus rewarding volume of clinical procedures over quality of clinical outcomes. Furthermore, HSA and CINICO are migrating away from a fee-for-service/CPT-based reimbursement model towards a capitated, fee-for-quality/ICD-based reimbursement model. At present, HSA believes that the best overall measure of physician productivity is based upon patient access to care, as measured by clinical encounters per unit of physician time worked, including telephone and email encounters. Future models of productivity may emerge, therefore the vendor’s software solution must be adaptable and agile.
8. Inpatient and Outpatient Duties: The measures of quality and productivity must accommodate the physicians’ inpatient and outpatient duties.
9. Administrative Duties: The measures of productivity must accommodate the administrative duties associated with physicians’ roles, such as staff meetings and especially those meetings that are associated with care planning and clinical quality initiatives that impact broad issues of patient care, but are not specific to an individual patient.
10. DRGs: HSA does not currently utilize DRGs, therefore the vendor’s solution cannot be dependent on DRGs.
11. References: The vendor must provide at least three referenced accounts who are using the vendor’s solution in initiatives which are very similar to CCI.
12. Affordability: HSA is equivalent in size and scope of services to a rural health system in the US, with similarly modest access to operational and capital funds. The Total Cost of Ownership (hardware, software, labor services) for the vendor’s solution will be evaluated early in this options assessment. Vendors will be expected to engage in these discussions accordingly and will be quickly eliminated from the procurement, regardless of rich functionality, if their solutions are not affordable within the context of rural healthcare. If and when a contract is awarded, the contract will be firm-fixed price, with modest annual support fees. HSA’s total operating budget is $85M per year. The total bed count is 125. HSA employs approximately 750 people, of which 40 are physicians.
Thank you and please contact Mr. Higgins if you have any questions or interest in this procurement.
Senior Technology Advisor/CIO Mentor
This article in the Washington Post describes the increased presence of Russian nuclear-armed submarines off the coast of the US, reflectin...
The following comment was posted on the Mr HISTalk web site, in response to my earlier blog about interoperability: "Dale, why hasn’...
I was searching through some files today, looking for something else, when I came upon this. It's my "CIO Watch List" from Nov...
Population health isn’t as complex or novel an idea as some people make it out to be. We're wringing our hands and making it more comp...