As value-based care takes hold in healthcare, a variety of care delivery organizations are showing results in managing risk through the use of population health management tools and techniques.
Over time, these provider organizations are getting better at augmenting population health tools and practices with other information technologies, particularly analytics, to segment patient populations and direct appropriate care more effectively.
For example, the use of population health management and analytics have provided benefits for Innovation Care Partners, a large multispecialty physician-led clinical integration network and accountable care organization in Phoenix. It’s one of only a few ACOs participating in the Medicare Shared Savings Program that’s both met quality performance standards and generating savings in excess of goals set by the program.
Overall, the ACO saved about $9.5 million on a population of 18,000 Medicare beneficiaries, and it received a shared savings payment of $4.7 million from the program. For most ACOs participating in the MSSP program, the biggest challenges involve the complex data gathering and analytics necessary to meet compliance and reporting requirements, says Faron Thompson, chief operating officer of Innovation Care.
The ACO is unconventional in that 75 percent of about 1,600 participating physicians are independent and not owned by a central health system, operating practices that use different electronic health records systems. The ACO copes by engaging physicians by making data available to clinicians and helping them to act upon findings that the larger organization derives through analytics. Innovation Care uses software from OrionHealth.
“The care team is good at understanding the data,” Thompson says. Care managers help engage clinicians by supporting their access to data and improving coordination of care overall. Innovation Care’s physician leaders also serve as champions of emerging population health approaches—they realize the doctors are very pragmatic and realistic, and they are able to effectively bring about change because they realize how physicians practice.
Population health approaches and other technology is also helping Community Care of North Carolina (CCNC), a case management program for the state of North Carolina that provides interventions for high-risk patients among its 1.7 million Medicaid members and Medicare Advantage beneficiaries.
CCNC uses VirtualHealth as a care management platform, selecting it as a technology this past Novbember, says Jamie Philyaw, the organization’s vice president of care management. The new technology will better enable it to improve care coordination and advance proactive care management strategies by equipping providers with actionable insights into both clinical and behavioral risk factors, as well as address the unique social needs of its highly complex populations, she says.
Care management teams that currently reach out to members/enrollees draw on a “whole-person” view of patients to identify care gaps and circumvent the need for high-cost interventions. Through continuous monitoring of patient data, care teams are alerted to changes in conditions or behaviors, empowering them with the data needed to reduce costs and improve the health of the populations they serve. The VirtualHealth platform will provide a user-friendly foundation for caregivers as they intervene—the across the state is expected to be completed by the end of the year, Philyaw says.
Analytics also are providing a bedrock of data support for improvements in population health management and care delivery at Presbyterian Healthcare Services, an integrated delivery system based on Albuquerque, N.M.
The system operates eight hospitals and has about 1,000 physicians, says Soyal Momin, its vice president for data and analytics. The organization has developed an enterprise data warehouse, and then adopted an analytics platform from MedeAnalytics to harness data to create a data-driven culture that promoted clinical excellence and enabled the health system to save over $11 million.
Benefits of the analytics effort went beyond improved care delivery by physicians, Momin says. The platform also enables better operational and financial performance by components of the organization, which leads to better results overall.
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