During our in-depth interview with the Heritage Provider Network (HPN) qHMO team, we discovered the many ways this technology and application are helping to bring automation and uniformity to enhance and deliver quality care utilization among physicians and healthcare professionals across the healthcare spectrum. The dedicated team responsible for this innovation development and design speaks to its features and functionality to highlight the many benefits of qHMO and its goal to streamline processes across HPN and its affiliates, thus creating improved and expedited information sharing and capturing to bring patient experience to a completely new level.
Q: When did you first realize there was a need to develop an in-house population health technological solution?
A: In 2003, the purpose was to manage CMS risk adjustment for the Medicare Advantage population, as there were no other products available in the marketplace. Since then, the Heritage team has been developing in-house applications to streamline processes, such as Quality Measures, Care Management, and standardized financial reporting. As Heritage’s membership grew substantially, and on-boarded additional lines of business in the wake of the Accountable Care Act in 2012, the organization faced new challenges and regulatory requirements in the realm of population health management. The healthcare industry has long focused on event-based care, which reflects a lack of patient-centered, coordinated care approach among the popular EMR systems. The existing products in the marketplace did not meet the requirements for population health and holistic care management, and therefore, we expanded and enhanced our existing in-house applications. The application meets all regulatory and health plan requirements, and is NCQA certified.
Q: How did you approach building what is now called “qHMO”?
A: Our goal was to improve our ability to serve our patients by using technology to increase our healthcare team's efficiency. We enabled the organization to direct resources toward actual delivery of care. This includes empowering all stakeholders with aggregated and meaningful information about the patients, in an intuitive and easily accessible manner, enabling them to provide care in a coordinated and collaborative manner.
Q: How does your team determine which enhancements to launch, and when?
A: The q. development and enhancement cycle is unique and more frequent compared to any application of its size. The application is typically updated with new releases twice a week to ensure that new features are made available to the users as soon as it becomes available. The end-users play an integral part in requesting enhancements that help automate their processes, and/or assist in meeting regulatory requirements. The Heritage team conducts and attends meetings both at the Heritage level, and in individual group settings to understand users’ requirements. The requirements are then evaluated and optimized workflows are created to finalize the enhancement. Based on overall clinical, financial and regulatory impact, a priority is assigned to each enhancement.
Q: What are the key features of qHMO that help to streamline population health?
A: q. has comprehensive disease registries, which are created, using data from claims, lab and pharmacy that is fully integrated into the application. The registries are “transparent” as they provide detailed criteria, which qualify a member to be part of the registry. When managing a member in a particular registry, all the comorbidities are made available so they are addressed at the same time to provide holistic care.
For each disease registry, the application has national clinical guidelines (detailed and summarized) and treatment algorithms to educate clinical staff in setting goals and managing the disease conditions. The application also provides disease specific patient education and dietary education materials from nationally recognized vendors.
In addition to population health management registries, the application uses a comprehensive algorithm for risk stratification to identify members who have the highest acuity and therefore qualify for complex case management.
Q: What is the team’s structure and responsibilities?
A: In addition to the regular functions handled by the Heritage team, the team also manages the software development lifecycle. We follow the industry practices for obtaining user requirements, planning, designing, developing the code, testing and releasing the update. Different team members are involved at different stages of the development cycle. There is always a senior team member who oversees the development and deployment of an enhancement. In addition, all enhancements are reviewed and approved by Jaya Kurian, CFO, Heritage Provider Network, along with other senior team members.
Q: How do you maintain the servers in the back end?
A: The q. application is offered as a hybrid Software as a Service (SaaS), where the physical servers (hardware) are maintained by the groups’ IT teams, and the remaining aspects of the servers such as the databases, web applications, documents, etc. are managed by the Heritage team. There is a high level of automation on the servers to ensure that integrated processes, interfaces, and jobs run smoothly.
Q: What is the most innovative feature of qHMO?
A: One of the most innovative features is learning through gamification (q.Jack). In addition to improving user engagement, it provides educational training to the users. Based on our users’ feedback, the best feature of the application is the aggregation of member’s healthcare data, meaningfully organized and presented concisely.
Q: What does the future hold for qHMO?
A: We are currently working toward implementing e-prescribing and building an HR portal for Employee Management.
Q: What is the mobile app and how does it fit within qHMO?
A: q. mobile app allows members to connect and communicate with their assigned Interdisciplinary Care Team (ICT). The ICT members can view and respond to messages from members using q.HMO or the mobile app.
Mobile app utilizes data from q.HMO to display the member’s health history, care plan goals, view medications and make appointments with their ICT.
Q: What is the goal of the mobile app?
A: The primary goal for the mobile app is to improve member experience and outcomes by:
Q: What are the features of the mobile app?
A: Some of the features of the mobile app:
Q: What is the future of the mobile app?
A: We are currently working on implementing Televisit via video conference.
Scott Bae, VP, Corporate Information Systems, adds, “Each member of the qHMO team performs many other responsibilities within the department. The q application is just a fraction of their daily tasks. We work very closely and cohesively so that anything that is requested of a team member, no matter how large or small, is performed willingly to achieve a single goal, which plays a pivotal role in its success.”
The success of qHMO and the mobile app will inspire greater collaboration and improved healthcare delivery as it becomes more widely utilized. It will transcend all levels of healthcare management, setting the bar for quality and efficiency, influencing daily operations across all medical groups and affiliates.