Effectively leveraging patient outcomes data can unlock numerous insights that help standardize care and improve healthcare delivery, but many organizations lack the tools and best practices for accessing and acting on that data.
In partnership with FOTO, we recently sat down with Daniel Lord, DC, CCSP, Clinical Program Director, and Matt DeBole, PT, DPT, Physical Medicine Program Manager from Crossover Health to discuss how they’ve begun to leverage outcomes data, clinical training, and patient engagement tools to improve patient care delivery within their organization.
Q: How did you first identify the need to collect patient outcomes data?
A: [In our experience,] the current model doesn’t work. Musculoskeletal care tends to involve overdone imaging and referrals to secondary care without enough physical therapy and chiropractic first. We set out to prove this, and FOTO and MedBridge have been instrumental in [this process, by] providing tools that allow us to deliver education and outcomes.
We want to fundamentally change the way we deliver healthcare through our value-based care model that aligns incentives and is patient-centered. Instead of finding which CPT code aligns with how we’re reimbursed, we have to go to new payors who use value-based payments—so we need to have outcomes that show our value versus the more insurance based fee-for-service model that we see in the community.
Do you find that the tools provided by FOTO and MedBridge allow you to standardize care while working with the patient?
Because our model is really driven by the value we create, it’s easier for us to standardize and make sure FOTO outcomes inform patient care and that we have processes in place to deliver patient education and home exercises. There are no barriers because we don’t need a CPT code, or to bill a certain way. We’re trying to solve the patient’s problem. FOTO will give guidelines on that and we can deliver any education we want with MedBridge, whether that’s during the visit or in between visits. So it allows us to standardize with ease.
[As we implement] standards around home exercise program delivery, MedBridge helps us deliver patient education and home exercise programs. We use MedBridge between visits as well to gather feedback on whether we need to progress or regress home program difficulty or exercise selection. It’s helpful to have our team aligned and using the same system, not just from an organizational standpoint but from a patient experience standpoint.
At MedBridge, once our clients begin measuring outcomes, they can take action by determining what they want to remediate and where they want to excel. We call that closing the loop. At Crossover, how have you as an organization taken outcomes data and the other tools in your tool belt and closed the loop?
Matt: Now that we have data to review, we can identify clinical skillsets that might allow providers to be successful with certain patients or across certain presentations. We can identify gaps and allocate resources like MedBridge continuing education to try to close those gaps, which is really powerful. Beyond just improving our clinicians’ approach, we advocate for musculoskeletal experts to be the ones who see musculoskeletal conditions first. So now we’re advocating for patients to see physical therapists and chiropractors first within our own model.
Dan: We’re super excited about how we’re able to deliver care in this new model. Directly contracting in a value-based way allows us to spend more time with patients and get paid differently so we can attract great providers. We’re deeply integrated with primary care so that creates leverage to be the first point of entry.
On average we’re able to end a patient episode and get them to their goals much faster with our model, allowing us to reduce costs and be more competitive with our payors, partners, and clients. And because we have an integrated team, we can collaborate, use different modalities, and solve problems in a different way.
With the opioid crisis still a big problem (editor’s note: 10.3 million people in the U.S. misused prescription opioids in 2018, according to the U.S. Department of Health and Human Services), we’re able to prescribe opioids at one-tenth the rate of the community by prioritizing physical therapy first.
We’re solving problems in the right way by not throwing the kitchen sink at them, which solves economic issues as well. Per patient episode we’re reducing the cost to the payor. We want to change how healthcare is delivered and hit the quadruple aim so it’s exciting to publish this type of research, and part of it is that we have great partners.
Q: You’ve embraced technology, but you also need to implement technology. So how did you go about translating that to the clinical team and getting that buy-in? What lessons did you learn throughout the process?
You really need to get the whole team involved. With a top-down implementation, a lot of times there’s not as much buy-in. But if you involve the team in determining how to use the data to measure performance and improve workflows at the point of care, you can create some big wins and get buy in and create a culture of measurement-based care.
When that’s part of your culture and people accept that, it’s different than making it a mandatory thing. So getting your team involved in the details of implementation, workflow, and standard of work is really key.
Just becoming a measurement-based culture and using outcomes is a big step. Take baby steps along the journey instead of trying to jump all the way into it. Getting providers involved at the ground level, getting engagement, getting buy-in early and often is more important than getting perfect data early and often. Start small with small wins, because over time it really starts to pay off when people buy in. Then your data follows, and your data is going to be more strong, more stable, and more accurate when people aren’t just going through the motions because it’s what they’re supposed to do but rather are really using it to drive the care model.
For the full conversation, including additional insights, tips, and audience questions, view the recorded presentation.
About Crossover Health
Crossover Health provides a Connected System of Health—powered by a virtual-first, national medical group. Combining onsite, nearsite, and virtual health centers, they deliver personalized care from a designated, collaborative care team and a curated network of specialist providers. Crossover takes the complexity out of healthcare by connecting every employee—in headquarters or in remote locations—to remarkable care. Powering this outcomes-focused model is a sophisticated enterprise data warehouse that aggregates a vast array of permissioned health data, and a suite of analytics to identify high-risk and high-cost employees to help companies take control of their healthcare spending. Care teams engage members directly through their proprietary software, better managing their conditions, and preventing costly complications. Headquartered in San Clemente, California, Crossover Health serves hundreds of thousands of employees and dependents of some of the largest companies across the nation. To learn more, visit www.crossoverhealth.com or follow on Twitter @crossoverhealth.