landmark review of population health management

© 2013 Health Catalystwww.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.

© 2013 Health Catalystwww.healthcatalyst.com

Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

The 12-Criteria of Population Health ManagementBy Dale Sanders


Overview

• Evaluate healthcare IT vendors and their PHM offerings

• Develop internal strategies and roadmaps for Accountable Care Organizations (ACO)

Focus is on the data management of Population Health Management

Purpose

• Not necessarily the processes of PHM


CR

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RIA Precise Patient Registries

Evidence-based definitions of patients to include in population health registries

1

Beyond ICD-9 billing codes, which are likely to miss 30-40% of the population


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RIA Patient-Provider Attribution

Strategies and algorithms to assign patients to accountable physicians or clinicians

2

Generally accepted high-level options for assigning attribution

Patient selection of physician during open enrollment

“Most frequently visited” physician over the past two years

Random assignment of patients to primary care physicians in the same geographic area

Random assignment of patients in an employer group to primary care physicians in the PPO or HMO


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RIA Precise Numerators in Registries

Discrete, evidence-based methods for flagging the patients in the registries that are difficult to manage or should be excluded

3

Reasons why a patient may not be able to fully comply with clinical protocols

Language barriers

Cognitive inability to participate in a care protocol

Physical inability to participate in a care protocol

Economic inability to participate in a care protocol

Willing and informed refusal to participate in a care protocol, e.g. religious reasons

Medication contraindications to participating in a care protocol

Geographic inability to participate in a care protocol

Mortality (it can be surprisingly difficult to identify these patients)


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RIA Clinical and Cost Metrics

Monitoring clinical effectiveness and cost of care to the system and patient

4

Measure practice of medicine against these protocols

Measure the variability in care

Build dashboards around specific patients and population of patients

Must track the total cost of care for specific patients and a per-capital basis across the population

Provide quality, outcome, and cost variance feedback to physicians, risk adjusted, at the point of care

Ultimately this prepares an organization for fixed-fee contracting in a true value-based system


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RIA Basic Clinical Practice Guidelines

Evidence-based triage and clinical protocols for single disease states

5

Number of patientsIn the population

The Average Total MedicalExpenditure (TME) per CapitaX( ) ( )

Measure practice of medicine against these protocols

Current evidence-based medicine lacks applicability outside the specific clinical trial

In the future, clinical trials’ “evidence” will be displaced by derived evidence from the analysis of local data sourced by the EDW

In the meantime, the industry must make-do with existing evidence and guidelines

Many external commercial sources and commercial vendors

Health systems need to establish a “Clinical Practice Guidelines” governance body and select their source(s) and processes

Start by defining clinical practice guidelines for patient cohorts and process families that offer the highest opportunity for improvement and cost savings


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RIA Risk Management Outreach

Stratified work queues that feed care management teams and processes

6

First need to stratify and monitor the registry patients

Then develop strategies to identify and intervene with high-risk trajectory patients

Ultimately need to profile and proactively treat patients before becoming members of the registry

Risk stratification enables an organization to analyze and minimize the progression of a disease and the development of comorbidities


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RIA Acquiring External Data

Access to clinical encounter data, cost data, laboratory test results, and pharmacy data outside the core healthcare delivery organization

7

Contrary to current national strategy and focus, acquiring external data should be a secondary focus in today’s market

It is geometrically more complicated to manage a patient population beyond the core healthcare delivery organization

Start with in-house process and data quality first

Then, carefully and deliberately expand the data ecosystem

HIEs are the most visible technology associated with ACO external data exchanges, but only address a small portion of the data puzzles required for PHM

The “A” in M&A will shift from bricks-and-mortar acquisition to data acquisition


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RIA Communication with Patients

Engaging patients and establishing a communication system about their care

8

Current solutions are fragmented and immature but will improve dramatically in the next 3 years

Today’s typical patient engagement solution is through a personal health record (PHR) tightly associated with a healthcare delivery organization EMR

The future patient engagement solution will be completely patient owned, decoupled from an EMR or single healthcare organization

The PHR will evolve into a personal project management system, with a combination of project management, knowledge management and social support.

Take advantage of current PHRs, but be prepared to jettison current PHRs for something more informative, customized, collaborative and functionally rich


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RIA Educating and Engaging Patients

Patient education material and distribution system, tailored to the patient’s status and protocol

9

Our current patient education system is hampered by the lack of highly personalized materials and an effective distribution system

Often, today’s patients receive no education material about their condition

PHRs tend to present generic education information

No certified, widely available method of evaluating material quality

Widely used vehicles like Twitter, Facebook, Zite, and Amazon have yet to be fully embraced

• Low-income, preteen girl with type 1 diabetes likely to receive same education material as a middle-aged executive man

• Materials are not tailored to blend comorbid conditions together


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RIA Complex Clinical Practice Guidelines

Evidence-based triage and clinical protocols for comorbid patients

10

Establishing protocols for comorbid patients is complicated

Few industry sources for clinical protocols for comorbid patients

Physicians often left to build their own guidelines, or chain individual disease treatment protocols together

Medicare patients on average affected by at least chronic diseases at the same time

Organizations that optimize comorbid care will be in a strong position to differentiate themselves in the market, both financially and clinically


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RIA Care Team Coordination

Inter-clinician communication and project coordination

11

We need to treat every patient as if they are at the center of a project plan

All members of a patient’s care management team should be able to quickly and easily see the patient’s overall project plan, next milestones, and responsibilities

Acute encounters should show recovery milestones and assigned people

Chronic diseases should show a lifetime project plan for health

The ideal system would function like a project management tool (like Basecamp)


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RIA Tracking Specific Outcomes

Patient-reported outcomes measurement system, tailored to the patient’s status and protocol

12

Patient-reported outcomes data is one of the most important pieces of data missing from our ecosystem today

Our best efforts today is assessing patient satisfaction, but that data falls short as an aid for measuring actual clinical outcomes

This is also the most culturally and technically difficult criteria to implement

Currently, no reasonable options exist in our industry

A future patient-reported outcomes system must have a closed-loop data relationship with the EMR, and then exported to the EDW for analytic purposes


Vendor Evaluation and Scoring

No single vendor today offers an integrated and fully functional population health management solution that meets all 12 criteria

Vendor scoring criteriaPersonal experience as a customer of the vendors’ products

Personal experience as an executive in the company (i.e. Health Catalyst)

Conversations and interviews with current and past customers of the vendors’ products

Market reports from, and conversations with, industry analysts at KLAS, Chilmark, IDC, Gartner, and the Advisory Board

Publically available information on the vendors, including their own case studies, white papers, on-line product demos, and product information

Conversations with current and past employees of the vendors


Vendor Evaluation and ScoringTwo patterns emerge from the scores

1: The vendor market is very inconsistent in its approach to population health management

2: Not all criteria equally important now

The first six to eight criteria are the most important now

They should be weighted heavier in the decision making and deployment planning process



Crimson ExplorysHealth

CatalystLumeris

OptumHumedica

Phytel PremierAverageScore

Criteria #01:Precise Patient Registries

5 5 9 3 3 3 3 4.4

Criteria #02:Precise Patient Attribution

5 5 8 5 6 5 5 5.6

Criteria #03:Precise Numeratorsin the Patient Registries

0 0 5 0 0 0 0 .7

Criteria #04:Clinical andCost Metrics

7 7 9 6 5 4 5 6.1

Criteria #05:Basic ClinicalPractice Guidelines

0 0 0 3 5 5 0 1.9

Criteria #06:Risk ManagementOutreach

1 0 0 5 7 5 0 2.6

Sub-Total 18 17 31 22 26 22 13

First tier evaluation scores



Crimson ExplorysHealth

CatalystLumeris

OptumHumedica

Phytel PremierAverageScore

Criteria #07:Acquiring External Data

0 5 6 0 4 2 7 3.4

Criteria #08:Communication with Patients

0 0 0 4 5 6 0 2.1

Criteria #09:Educating and Engaging Patients

0 0 0 2 3 4 0 1.3

Criteria #10:Clinical andCost Metrics

0 0 0 0 0 0 0 0.0

Criteria #11:Complex ClinicalPractice Guidelines

0 0 0 0 0 2 0 0.3

Criteria #12:Tracking Specific Outcomes

0 0 0 0 0 0 0 0.0

Second tier evaluation scores


Asset Allocation and TimingRecommended asset allocation as the market and organization evolve and mature in population health management


Asset Allocation and TimingRecommendations

Build a population health management roadmap

Start as soon as possible with the first six criteria while the latter six

develop in the market


Conclusion

Follow the lead of the IDNs which have been practicing PHM for years

Reference this presentation and the CCHIT framework when developing an organizational strategy and evaluating vendors for PHM

There is no single vendor that can provide a complete PHM solution today

Sequencing is important. Focus on the first six criteria over the next three years while the context evolves

Key points to remember


Population Health Management The Ordered Checklist for Your 3-5 Year Journey

1. Registries: Evidence-based definitions of patients to include in the PHM registries

2. Attribution & Assignment: Clinician-patient attribution algorithms

3. Precise Numerators: Discrete, evidence based methods for flagging patients in the registries that are difficult to manage in the protocol, or should be excluded from the registry, altogether

4. Clinical & Cost Metrics: Monitoring clinical effectiveness and total cost of care (to the system and the patient)

5. Basic Protocols: Evidence based triage and clinical protocols for single disease states

6. Risk Outreach: Stratified work queues that feed care management teams and processes for outreach to patients

7. External Data: Access to test results and medication compliance data outside the core healthcare delivery organization

8. Communication: Patient engagement and communication system about their care, including coordination of benefits

9. Education: Patient education material and a distribution system, tailored to their status and protocol

10. Complex Protocols: Evidence based triage and clinical protocols for comorbid patients

11. Coordination: Inter-physician/clinician communication system about overlapping patients

12. Outcomes: Patient reported outcomes measurement system, tailored to their status and protocol


More about this topic

The Evolution of Care Management to Population Health Management This covers the evolution of the care management market to the population health management, the data needs for effective population health management, and population health business models

Why the Solution to Population Health Management Woes Isn’t an EMRHealthcare systems are struggling to figure out how to shift to a value-based model and remain competitive. This will require hospitals to identify and reduce waste in three categories: the variation in 1) the care that is ordered, 2) how efficiently that care is delivered, 3) in care delivery that causes preventable complications .Clearly, EHRs aren’t the answer.

The Best Way to Prioritize Your Population Health Management EffortsEffective population health management starts with clearly defining a subset or cohort of patients and determining on which clinical processes to focus improvement efforts. The Health Catalyst Key Process Analysis (KPA) application determines the highest variation and highest resource consumption by integrating and analyzing clinical and financial data.

Case Study: Using Data and Reporting in Population Health EffortsHow a healthcare system went from manually pulling together reports with varying data to having near real-time data that one executive says, "enables our care coordinators to drive preventive care and ultimately lower our population health costs"

Case Study: Using Advanced Analytics to Manage Primary Care Population Health Population health management is largely being driven by the 5 percent of the population accounts for 50 percent of healthcare costs. Being able to identify these patients, provide high-quality care and reduce their utilization is a pressing goal for many of today’s primary care providers (PCPs). Learn how one organization used health care analytics to meet this challenge.

Implementing a Successful Population Health Management Strategy A White Paper by Dr. David Burton

Based on 25 years of experience, first as a senior executive at Intermountain Healthcare and later as the Chairman of the Board of Health Catalyst, Dr. Burton shares his in-depth learnings about how to systematically implement population health management in a long-term, sustainable way.

Link to original article for a more in-depth discussion.

A 12-Point Review of Population Health Management Companies (Webinar)

http://www.healthcatalyst.com/From-Care-Management-to-Population-Health-Management

http://www.healthcatalyst.com/solution-population-health-management

http://www.healthcatalyst.com/improve-population-health-management

http://www.healthcatalyst.com/success_stories/population-health-enabling-patient-engagement

http://www.healthcatalyst.com/success_stories/using-advanced-analytics-to-manage-population-health-in-primary-care-clinics

http://www.healthcatalyst.com/success_stories/using-advanced-analytics-to-manage-population-health-in-primary-care-clinics

http://www.healthcatalyst.com/WhitePaper_PopulationHealthManagement.html

https://www.healthcatalyst.com/webinar/a-landmark-12-point-review-of-population-health-management-companies

https://www.healthcatalyst.com/webinar/a-landmark-12-point-review-of-population-health-management-companies

landmark review of population health management

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cost data

total cost of care

specific patients

clinical encounter data

clinical trials evidence

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