Understanding Data Means Better Health Care Decisions

Community Health’s Managed Care and Data

As the first Director of Population Health in the state of Vermont, Andrea Wicher is breaking new ground in the world of health care at Community Health. She’s a social worker, an advocate and a data analyst. The job she holds at Community Health was created last year by area hospital and primary care executives in Rutland County who collaborated to help them understand, administer and broadcast the benefits of the accountable care organization (ACO) OneCare Vermont of which Rutland Regional Medical Center and Community Health are members.

“I have started to lay the groundwork as an advocate and the more people get familiar and understand data, the more people will make better informed decisions,” she said recently as she explained that there is much confusion about the ACO and its purpose. “OneCare is meant to create awareness,” Wicher said.

That’s where Wicher comes in. Rutland is the first service area in the state to hire one person to focus on population health analysis for the Rutland community.

“My role now is getting buy in and promoting change,” she said, using her skills as a data analyst and social worker to listen to what’s going on in the community and to apply what’s learned from information collected from the patients and health care providers.

Wicher said her focus on the community will range from observing and identifying what health care issues need to be implemented organically, to validating those needs with the data and advocating for the changes that are vital to the health of the community.

So, what is population health? Population health looks at the health status and outcomes within a group of people in a geographic region as opposed to looking only at the health of single individuals. Understanding and improving the health of a group, or population within a geographic area, is the goal of population health.

What is an Accountable Care Organization (ACO)? In Vermont, the all-payer ACO is a group of doctors, hospitals and health care providers who join together to focus on how best to deliver high quality, coordinated care to all patients in the most cost-effective way with the most productive health outcomes. The ACO gathers data and payments from Medicaid, Medicare and other insurers and distributes the claims to the organization’s members. Under guidance from the ACO model developed by the federal government, OneCare staff developed ways to distribute health care service payments to member organizations, incentivizing prevention and positive health outcomes.

By using the data that OneCare collects from what patients provide for their medical coverage (Medicaid, Medicare, private insurers), health care organizations can see how much a patient spends on a specific service for a specific month in a particular part of the state, Wicher said. She plans to mine the data and use it to help the Rutland community be more urgent and contemplative about the direction of quality health care coverage to promote a healthier community.

Does more volume mean better care she asks, or does less volume mean better care?

What determines the quality of care? The future of health care will depend on how health care is managed, and that is where Wicher is starting her journey.

She’s focusing on Community Health’s care management program, looking to evaluate the current procedures and adding new elements of evaluation such as creating risk stratification, patient prioritization and documenting health outcomes for the patients who are care managed.

“Do we see improvements in their health with care management?” she asked.  She’ll look to see how often, if at all, these patients are taken to the emergency department and if there is a change in the number of patient admissions to the hospital for managed care patients.

“Standard definitions help us to measure how well we are doing with data,” she said, “and I will educate people I work with and teach them the benefits of using data. A lot of what I do is think big picture while thinking at a granular level at the same time.”

While the scrutiny of the ACO concept continues, Wicher said how the organization disseminates the information it gathers and the formulas it creates to compensate member health organizations will evolve.  She’s the first in the state to be working full time to make the best use of the ACO information and she’ll combine it with on the ground observation of what a population needs from its health care networks.

“OneCare is a conduit. Instead of payers paying the organizations directly, they pay OneCare and OneCare pays us,” she said. The ACO helps manage the flow of the funds in an effort to transition to value-based care. An important part of the ACO’s function is that they receive data from the payers that allows them to analyze it and look for trends. “We need to do this not just for reducing spend, but because it’s the right thing to do. We need to make improvements with how we treat health care,” Wicher said.

“People forget that I am a social worker. My role in the community has been a leader but not just a leader with clinical outcomes for patients and health outcomes, but driving the change from a data perspective,” she said.

Wicher found a niche combining social work and data analysis helping to support community-wide collaboratives, facilitating and creating structure around organizations to work together in the community to make changes for patients. She recognized the true power of understanding data and taking that data to help other people understand the data to make decisions.

For 2021, Wicher has set aggressive goals for her work at Community Health. They include:

• creating a care management model for the community
• reducing special care referrals
• increasing Medicare annual wellness visits

Her role will be to drive these initiatives and change across the health system to improve health outcomes with a more robust care management program.

For more information about Community Health, Community Health Care Management, or other Community Health programs, check our website at https://www.chcrr.org/.

More information about OneCare Vermont can be found at https://www.onecarevt.org/.

Andrea Wicher, Community Health Director of Population Health, joined Community Health in January 2021 from Rutland Regional Medical Center where, as part of the quality and safety team, she developed an interest in population-based work, project management and data analytics. She moved to Vermont in 2013 and has worked with early childhood, substance abuse, case management and psychotherapy programs in the state. She earned a bachelor’s degree in social work from Bloomsburg University and master’s degree in social work from Marywood University.

Community Health is Vermont’s largest Federally Qualified Health Center (FQHC), a network of primary care, pediatric, behavioral health, dental and pharmacy services with offices in Rutland, Brandon, Castleton, West Pawlet and Shoreham. Community Dental offices are located in Rutland and Shoreham, Community Health Pediatrics is in Rutland and Behavioral Health services are available at all of our locations. Community Health Express Care Centers, open 7 days a week, are located at the Rutland and Castleton Community Health Centers.