“If our beds are filled, it means we’ve failed.”
That was the intriguing headline of an ad recently run by Mt. Sinai Hospital in The New York Times. Readers of the newspaper may be forgiven for wondering why the hospital would want to have fewer patients filling beds? Has the hospital’s leadership gone mad?
Far from it. Mt. Sinai recognizes that value-based care and community-based population health management has arrived.
To thrive in an era of value-based reimbursement, health systems like Mt. Sinai must aim to treat patients in the most appropriate care setting, which may be an ambulatory care office or even the patient’s own home. They must do what was once unthinkable—keep patients out of hospital beds. Mt. Sinai is a national leader in reaching out to the public to communicate this new strategy.
But as anyone in the trenches of healthcare knows, shifting away from an acute-care-centric model isn’t easy. Keeping patients out of the hospital means understanding their health status and proactively preventing hospitalizations—and sacrificing revenues on which they currently depend. This effort requires new models for delivering care, a commitment to change that crosses organizational boundaries and, above all, unprecedented insight into each patient’s health.
It is clearly impossible for physicians to take into account every piece of information needed to proactively manage an entire panel of patients. Even the best human minds have a limited capacity to store and absorb information. This human limitation is why technology now plays such a critical role in healthcare. To support new approaches for delivering care and to maximize savings, health information technology applications need to evolve to monitor patients so clinicians can anticipate patients' care needs, rather than react to them.
That’s why health systems such as Orlando Health and Bon Secours Health System are retooling their IT systems, putting functionality in place to parse huge volumes of aggregated data, to proactively manage patient populations and succeed under value-based payment methods.
Orlando (Fla.) Health, an eight-hospital integrated delivery system, is using HIT to identify patients that are or will soon be sick but don’t know it yet. By using technology to identify patients at risk for serious illnesses and to intervene with early treatment, the health system has improved the quality of care, earned millions of dollars in value-based savings incentives, and is successfully participating in four accountable care organization (ACO) contracts.
Richmond, Va.-based Bon Secours Health System, with 19 hospitals in six states, has rolled out a combination of population health management, patient engagement and care management technologies and services to ensure that discharged patients get the care and attention they need to prevent hospital readmissions. Discharges trigger an automated communications system that contacts patients within 72 hours of leaving a hospital or emergency department; they’re asked to complete a basic health assessment, which helps confirm that they understand discharge instructions and medications. The system then automatically escalates those patients who have questions or health issues to nurses, social workers and care managers for one-on-one counseling.
Even though health systems are making promising progress, we must acknowledge that even with computing systems, physicians still don’t have all of the information they need or the capacity to parse it. One reason is the high volume of unstructured data that exists in the notes section of the digital chart; that’s the easiest place for most providers to record insights in free text about a patient’s condition. Because most systems are programmed to search for or sort data in structured fields, the unstructured notes get lost. Thus, the information in clinician notes often doesn’t influence care management.
New and unprecedented technological capabilities—called cognitive computing—solve this problem. Cognitive computing systems not only can “see” unstructured data but also interpret it the way a human would. They can evaluate what is important to the task at hand and what should be ignored in delivering a diagnosis and the best treatment recommendations. They can then make decisions on how information is presented to physicians – solutions with the highest probability of importance are listed first.
Just as important, cognitive computing systems can learn from their successes and their errors, just as people do, but they learn millions of times faster. With such powerful, data-driven insights at clinicians’ fingertips, we can look forward to a future where all patients receive the targeted care they need to keep them healthy and out of the hospital.
With its new ad campaign, Mt. Sinai is informing the public about its vision for population health. However, its strategy goes far beyond mere marketing. Like other leading health systems across the country, Mt. Sinai is betting its future on innovations that will help it profile its patient population, engage individuals and families in their health to prevent illness, empower physicians and care teams to support patients between and outside of face-to-face encounters, and deliver formerly high-cost services more efficiently in lower-cost settings -- all while raising quality and improving the patient experience.
It’s a bold vision, and one that is leading the way for true healthcare reform.
Karen Handmaker is vice president of population health strategies for Phytel, an IBM Company that is part of Watson Health.
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