Innovation Pulse: Population health's 4-letter word
The notion of gleaning insights from mountains of health information, then applying those precisely to individual patients hinges on the confluence of various factors.
Indeed, against the backdrop of emerging accountable care organizations, health information exchanges, entities serving as both payer and provider, new models for care delivery and payment, as well as the requisite technological underpinnings, resides what is currently being called population health management.
"The most advanced organizations have already begun deploying analytics and care coordination," said David Bennett, executive vice president of healthier populations at Orion Health. "Some are also starting to offer patient engagement capabilities to support enhanced care coordination."
Count Cal INDEX and Covenant Health among those. Cal INDEX, a non-profit statewide HIE in California is embarking on the goal to "construct longitudinal records" for all patients that, in turn, can help doctors better coordinate and manage care. And Covenant, for its part, has already used population health tools to streamline operations and save both finances and less-tangible resources.
Those models needn't all work perfectly for population health to gain widespread purchase, of course, but reality dictates that it will come down to four letters: data. Data liquidity, specifically.
"Some level of liquid data is required to shift to population health," said Cal INDEX CEO David Watson.
EHRs and other data threats
Among the harsh realities in today's healthcare system is that many providers are essentially flying blind, piecing together fragments of patient information one by one, all the while knowing they do not comprise the entire picture.
EHRs are not yet making it any easier. By optimistic accounts electronic health records systems house approximately half of all available patient data, according to Bill Bunting, director of healthcare solutions at storage vendor EMC.
"This incomplete view of the patient record, with unstructured and fragmented data across multiple systems, and even paper records, will continue to block even the most committed institutions from population health success until they are able to retrieve all forms of information, and assemble that data in a form that is clinically actionable," Bunting added.
EHRs are not the only threat Bunting sees, either. Providers and technology vendors must accelerate integration, optimization and innovation around big data to capture that complete patient view, for starters, and also enable analysis to uncover answers in those records. On top of that integration and analysis, the industry will have to provide access to those insights.
"From that global viewpoint, we must understand the progress of patient groups with the same conditions, just as we must understand the prevalent health needs of our patient base," Bunting said. "Technology alone is merely a tool, and without proper analysis and workflow, cannot itself improve patient health outcomes or lower costs."
Put simply: Organizations of any size will need some manner of access to large data sets, and the ability to put that information to use.
But exactly how much information is enough? Where's that inflection point?
"The number of patients related to the value contracts is the important factor in determining if the provider is ready to pursue true population health initiatives," Cal INDEX's Watson explained.
Establishing a population health program, almost by nature, benefits more than just patients. Take Covenant Health, for instance. The not-for-profit system in New England needed a change, according to CEO Richard Boehler, MD.
"Costs for the Covenant employee health plan were rising and we were not receiving timely, meaningful performance data," Boehler said. So Covenant implemented MedeAnalytics' population health solution as part of its transformation. "The data did all the talking and uncovered insights – both on the clinical use side and financially – that we would have never been able to obtain."
In addition to the tangible $1.8 million in savings thus far, Boehler said that clinical insights helped to foster a cultural shift wherein care coordinators and other employees have become more responsible when it comes to healthcare utilization.
Best is yet to come
Even though they are already achieving measurable returns on the clinical and financial sides, both Boehler and Watson see the bigger benefits as still to come.
"Our goal," Boehler said, "is to have 50 percent of our payments based on alternative models by 2018."
To build its longitudinal records, Cal INDEX turned to Orion's platform.
Acknowledging that "ubiquitous population health is not imminent," and even though Cal INDEX is still experimenting on a number of fronts, Watson waxed a bit prophetic: "Having longitudinal information on a specific population allows any number of analyses that can yield health insights," Watson said. "You can identify chronic disease populations, characterize their risk, and apply resources to keep them well, thus improving outcomes and reducing cost of care in the process."
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