Medical group builds EHR to improve care

Dr. Christopher Chen, CEO of Miami Gardens, Fla.-based ChenMed, knew his physician-led primary-care group would have to optimize its performance to successfully expand from its home base. One factor giving him confidence was its custom-built electronic health-record system, which includes patient scheduling and clinical-data analytics.

The group's health information technology system works differently from commercial systems, he said. A ChenMed doctor navigates fewer screens to find information. That's partly because ChenMed works mostly on capitated contracts with Medicare Advantage plans rather than with fee-for-service payments. So its EHR's focus is on producing efficient results for patients rather than on maximizing volume of services. “Our technology is designed to get a particular outcome in the patients,” Chen said.

ChenMed is a family-owned company founded in the 1980s by Chen's father, Dr. James Chen, a Taiwanese immigrant. The elder Chen was diagnosed with cancer nearly a decade ago, and experienced the fragmented nature of the U.S. healthcare system. After his recovery, he sought to build a high-quality, coordinated-care system led by physicians.

ChenMed is “doing a lot more in terms of analytics, risk scoring, triggering reminders and tracking steps in the care process,” said Dr. Bob Kocher, a partner at venture capital firm Venrock, who formerly served as special healthcare assistant to President Barack Obama on the National Economic Council. “They're doing a ton more analytics than anyone,” he said.

That means ChenMed doctors are better able to track and take care of their patients. Relying on their homegrown health IT system, ChenMed doctors and staff have a tightly organized care model. ChenMed vans transport patients to and from its clinics, where patients show their card and are automatically checked in. The clinics are laid out so that doctors can readily confer with other staff and specialists. Providers use a mobile app to check patients' records and protocols. Physicians have patient panels of 350 to 450 patients, which allows them to see each patient about once a month and spend more time with them.

Patients also can pick up their prescriptions from their doctor at the time of their visit. That's because the group's technology has the capability to send the prescription order, get it authorized and have it delivered from the clinic's on-site pharmacy within the space of the patient's appointment. And 95% of their on-site medicines have no copay, Chen said.

Delivering prescriptions that quickly is important given the problems providers face in ensuring medication adherence. “The data shows that high-risk seniors are taking less than one out of two (prescribed) pills, and that's a huge barrier to improvement in health,” said Dr. Craig Tanio, the group's chief medical officer. Removing the obstacles to filling prescriptions quickly and cheaply leads to better patient outcomes, he said.

Because medications are delivered immediately, doctors can talk to patients about those medications. That makes it more likely the doctor and patient together will catch medication errors. Tanio contends that it's also more therapeutically and psychologically effective to have doctors personally deliver medications to patients.

A June 2013 Health Affairs article by Chen and Tanio noted that the group's Medicare patients had 1,058 bed days per 1,000 patients in 2011, compared with 1,712 bed days per 1,000 patients nationally. That's even though 73% of ChenMed's patients had five or more chronic conditions.

Chen said that because of its health IT system and recruiting the right physicians, since 2011 ChenMed has successfully expanded through a partnership with Humana. ChenMed now has 11 centers in South Florida, with a 12th scheduled to open soon. Outside Florida, it has 25 clinics in Georgia, Illinois, Kentucky, Louisiana and Virginia. Chen said he hopes to expand fourfold by 2020.