Tina Esposito, VP, Center for HIS, Advocate Health Care, Chapter 1

As VP of the Center for Health Information Services, Tina Esposito knows very well the value of digging deep into analytics to find answers. But she has found that when it comes to learning what clinicians actually need, the best course is to simply ask them. By going “to the source” instead of making assumptions, leaders can help provide what those on the frontline need, says Esposito. In this interview, she talks about how the Center came about, the change in thinking that was needed to become an ACO, and the interoperability challenges that come with multiple EHRs. Esposito also discusses the concept of patient-centered care, why her team is focused less on HCAHPS and more on building loyalty, and why she’s excited for the future.

Chapter 1



* About Advocate

* CHIS’ origin in 2005

* “We are, first and foremost, a safe clinical enterprise.”

* Monthly scorecards with “drill-down analysis” on safety, quality & engagement

* Becoming an ACO — “Our data wasn’t structured that way.”

* Partnering with Cerner to create an analytics platform

* The “evolution” in how data is used

* Clinician input — “You need to ask them.”



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Bold Statements

We always knew we were doing good work. There was just a need to ensure that there was a level of objectivity in understanding the work that was going on, the outcomes that were being delivered, and the opportunities that may exist.

One of the first things we had to do was pull all of our data together. And not just inpatient-focused data using the traditional siloed approach, but rather, how do we pull all of our EMR source systems together? How do we pull and marry that with our claims data and our PBM data and truly create a platform that reflected all aspects of care, not just individual levels like we had in the past?

We’ve evolved as a team, becoming less focused on the technical aspects of bringing data together and more so on ensuring that we’re using it in the way that provides insight to the organization.

What we quickly understood from our clinicians was the need to ensure we were thinking about all readmissions — not just acute myocardial infarction, heart failure, pneumonia — but thinking about how we ensure that the tools we’re creating would help manage any potential readmission, not just one definition of one entity out there.

Gamble:  To start off, can you provide an overview of Advocate? I know you’re a large health system, but can you get a little bit more into the details in terms of number of hospitals, things like that?

Esposito:  Absolutely. We are, I believe, the largest, integrated health care system in the state of Illinois. In total, we have 11 hospitals and 6,000 physicians that are aligned with us, either formally employed (about 1,400 of those) or through a clinical integration program, which is our Advocate Physician Partners Program. The system itself does about 6.4 billion in annual revenue. We’re a pretty large accountable care organization — at one time, I know we were the largest. I think now we’re the second largest with about 865,000 attributed lives. We also have a very large post-acute presence with a large home health division that also includes hospice, a skilled nursing facility referral network, and a large palliative care program.

Gamble:  We’re certainly seeing the trend of more focus on that post-acute presence and bringing that into the fold in a way that hasn’t always been done. Now, in terms of your background, how long have you been with Advocate?

Esposito:  I’ve been with Advocate 18 years, so quite a long time.

Gamble:  How long has the Center for Health Information Services been in place?

Esposito:  Since 2005.