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.
“We integrate the interface with the EMR, bring data into the environment and build registries,” Schelhammer said. “Our protocol engine is applied against that data to see gaps in care and then leverage an integrated multi-modal communication. The engine is designed for outreach to those patients under the brand of the health organization and physician, because people respond to that. These communications used to go out as brand of the company or insurance plan, but the response rate was not at the same level.”
Schelhammer’s interest in population health goes as far back as the 1980s, when he says he saw “so many situations where there was a lack of sharing information, which often created an environment where caregivers couldn’t coordinate the best care. I wanted to start a company that addressed that in order to preempt crisis events.”
Gaps of care are most prevalent in circumstances where standards of care are not followed, Hodach said, adding that “what we try to do with the population model is to find chronic care needs for disease categories and subgroups to unearth guidelines of care and figure out where care teams can be used to their maximum ability.”
Finding data ‘truth’
Initiating a population health management program requires that providers find “the first absolute truth” for the data, says Eric Mueller, president of Nashville, Tenn.-based WPC Services.
“That means knowing what data you have access to, how easy it is to access and what data points do you have throughout the continuum of healthcare – all have data points and require different expertise,” he said. “You need to know that all your transactions are there to provide a rich data set so that people can make informed decisions, that invoices and payments can be made and to provide information to make decisions on both sides of the fence. That is the absolute.”
Managing chronic conditions is one of the most important functions of population health, particularly when it comes to reducing costly hospital readmissions, says Gary Kolbeck, president of Sioux Falls, S.D.-based LodgeNet Healthcare.
“To us it’s about the patient engagement elements,” he said. “Patients and their family caregivers need to be motivated to get involved – become part of the care team. What we find is that they are starving for information and providers can point them in the right direction, toward motivational drivers. Patients won’t change their behaviors without it.”
LodgeNet produces an integrated IT solution that gives patients and caregivers more information to determine their behaviors as well as accessibility to practitioners. Automated reminders sent via phone, text and patient portal – including messages in languages other than English – can help patients better understand why their role is so important in preventing circumstances that lead to hospital readmissions, Kolbeck said.
Population health management can also include public health monitoring to help contain the spread of contagions and food-borne illnesses, says Matthew Holt, co-chair of San Francisco-based Health 2.0, which hosts annual conferences to showcase new technology.
“You’re seeing some cool stuff on this front, such as data visualization for public health,” he said. “If there is an outbreak of spinach salmonella in Indiana, the technology enables an analyst to ‘see’ the tracking of the outbreak and trace where it came from.”
Likewise, the Google Flu Trends search engine provides tracking information on where flu outbreaks are popping up across the country, he said.