Data is key to population health management

Managing populations – whether an aggregation of patients or a physical community – is a burgeoning field in healthcare as a way to improve care while containing costs. Many of the IT initiatives currently underway are related to population health in one way or another: electronic health records, meaningful use, interoperability, accountable care organizations, disease state management, pay-for-performance and patient-centered medical home all have elements that relate to managing patients in groups.

There are many ways to go about addressing the issue of population health management, but the starting point is with information technology and data, says Carol Cassell, client services executive with Buffalo, N.Y.-based CTG.

“Technology is the catalyst for the healthcare changes that need to occur to improve quality of care while lowering costs,” she said. “While technology is the foundation, it is the availability of data at the point of care that drives informed decision making.”

At the same time, as data is shared, it can be turned into information and knowledge, Cassell said, urging providers to examine how data gets used in understanding a population, variations within that population where care is provided and whether everything is “right” in terms of care.

“If you can’t measure it, you can’t manage it,” she said.

Populations take many forms – differing geographically, ethnically, and by age, gender and income. But the initial entry point into this science has been a focus on groups of patients with the same chronic diseases, including diabetes, asthma, congestive heart failure, hypertension, arthritis, sleep apnea, chronic obstructive pulmonary disease and certain cancers. Susan Merrill, epidemiologist with Wayne, Pa.-based ICW, is also studying how certain behaviors in society are leading to disease risk.

“It is essential to understand how certain risk factors cause disease, like obesity,” she said. “Obesity is an incredibly expensive disease factor and it is widespread. Addressing the public health portion of this is key to improving care while controlling costs.”

Eyeing care ‘gaps’

Ever since Steve Schelhammer joined Dallas-based Phytel in 2008, the company’s direction has been focused on population health – specifically identifying “gaps” in care across populations. When the founder of Accordant Health Services came over to Phytel, he brought chief medical officer Richard Hodach, MD, with him to give the program “meat and muscle.”

Together Schelhammer and Hodach have engineered a suite of health information products integrated to leverage data, analytics and multi-modal communications to enable providers to deliver on population health management. Specializing in large multi-specialty group practices, Phytel’s client base has grown to more than 12,000 physicians in 41 states.