The 3 Ms of pop health platforms
Sometimes, ideas in healthcare have a way of starting small but quickly getting much bigger.
Take Care Team Connect, an Evanston, Ill.-based IT firm that provides software platforms for population healthcare management while also offering provider coaching services on how to manage population-based workflows effectively.
According to Carrie Kozlowski, Care Team’s senior vice president of client services and marketing, the company got its start five years ago after the founder, Benjamin Albert, became frustrated trying to manage care for his sick grandfather from a distance.
Thus Care Team was founded, Kozlowski said, “to enable care coordination with the idea that family members and private caregivers would be the management team.”
But then healthcare reform came along, and the company decided that the real scope and scale of coordination responsibilities were going to fall to larger organizations and collaboratives such as ACOs. And almost as affirmation of that decision, the company was recently tapped by BlueCross/BlueShield of Tennessee to provide the platform for BC/BS’s statewide Patient Centered Medical Home program.
According to Kozlowski, IT platforms base population health management around a three-piece loop.
- Measure. The first step in managing any population, of course, is determining who that population consists of, and an effective IT platform can enable providers to analyze their patient loads in myriad ways – by payer, condition, risk or care setting – then determine how active or passive the care should be for any specific group.
- Manage. You might say the measurement part of population management, not surprisingly, amounts to a multi-faceted exercise in crunching numbers. The trickier part comes with figuring out how to best serve a population once it’s been identified. According to Kozlowski, an effective IT platform can facilitate that process by auto assigning care managers and guiding those managers toward best practice protocols and guidelines that are determined by judging what is working across an entire community of patients.
- Monitor. Developing those protocols and guidelines consists of monitoring programs once they’re put in place. What works, what didn’t work? What happens when protocols were or weren’t followed? And what is the true cost of a program of care?
As Kozlowski sees it, there are a lot of systems that can integrate data, but that’s only the beginning. To truly help providers, population management systems need to be able to determine the data that care managers must have to drive improvements, then determine on an ongoing basis how best to share that data with their clients.
And given the different types and sizes organizations of puzzling their way through population management – from ACOs. to employer-based systems aiming to lower costs through workplace health improvements, to hospitals seeking to lower readmissions – from an IT perspective, Kozlowski said, population management is now about responding to organizational scale and integrating the right data into any provider’s workflow.