By Abhinav Shashank, co-founder and president, Innovaccer.
Consider a situation where healthcare is not just an industry term — a situation where EHRs are not an integral part of physicians schedule but just a support to providing care. All considered, imagine a situation where patient-centric care actually involves the patient, and patient engagement is not just a buzzword but a reality. Unfortunately, all these imaginations were supposed to be a reality, but still, healthcare managers and organizations are struggling with the problems such as the lack of patients’ adherence to medication, varying trends in the population health, and a lot more. Patient population, nowadays, expect the same on-demand delivery convenience from the healthcare organizations as they get from the other companies, like Netflix.
Why is Patient Engagement the Core of Providing Patient-centric Care?
To understand the value of the patient in the entire care continuum, let us take an example. Consider a patient, Marcus, who works at an IT firm and is affiliated to a Commercial ACO in his county. Marcus is a 65-year-old male suffering from comorbidities like Type 1 Diabetes, and diabetic retinopathy. He is at constant risk of sporadic elevated blood pressure.
In the year 2016, Marcus visited the ED approximately five times. Considering the situation, his primary care physician referred him to a specialist and prepared a schedule comprising at least two monthly visits.
The year 2017 started with a lot of workload for him at his firm, and he was unable to keep up with the prescribed schedule. Because of improper communication between his PCP and him, his physician was not able to keep track of Marcus’s health. As a result, the ED utilization rate for Marcus increased from five times to nine times. Because of enhanced stress and improper quality of care, the sporadic episodes of elevated blood pressure turned into a constant problem of hypertension. Also, the overall cost of care for Marcus increased drastically.
Challenges in Achieving True Patient Engagement
Patient engagement, in itself, is not as simple as ABC. It is not just bringing patients in the cycle of care continuum but enhancing the patient’s skills, ability, knowledge, and most importantly, willingness to participate in the task of managing his own care. The concept of providing care with “engaged patients” sounds great theoretically, but it is not that smooth sailing. According to a survey, nearly 87 percent of the patient population believes that communication with their doctor apart from their scheduled appointments is really important.
The major flaw is the lack of awareness among the patients regarding their care procedures. Many patients are ignorant of the clinical processes which a physician follows, and they might miss out on major health details. With no actual knowledge of the disease symptoms, patients might not report to their physicians which might lead to reduced patient engagement, not to mention the increased risk of developing a chronic disease.
Care teams play a vital role in engaging the patients through regular follow-ups. Irregular and fragmented workflows of care managers and lack of personalization might lead to the generation of ineffective care plans for the patients. Reduction in patient engagement could also be the result of under utilization of technologies to analyze the massive amount of patient data that care managers have at their disposal. Through building more personalized care plans, patients can be engaged at a more grass-roots level.
Driving Effective Engagements through Value-based Care
Predictive population health analytics is the answer to nearly every problem linked with patient engagement. Advanced predictive analytics tools will help in dealing with the problems of disparate data systems and can pinpoint the exact area on which healthcare organizations can focus. Leveraging the insights obtained by data analytics, care teams can prepare the statistical models to prioritize each patient and can take necessary measures to engage patients in the process of decision-making. Understanding the patients’ habits by the care teams increases the chances of preparing personalized care plans for them and enhancing the level of patient satisfaction.
In January 2015, the Department of Health and Human Services set a goal to tie 50 percent of the Medicare payments to value or quality by 2018. This transition has put physicians on the frontlines of healthcare, as they play a major role in the value-based roadmap of an organization.
However, on the downside, this shift is causing substantial physician burnout — PCPs are spending more than 50 percent of their workday in the EHR doing documentation, order entry, billing, and coding, instead of spending time with their patients. There is a need to reduce physician’s IT usage by giving them easy and quick access to actionable information such as care-, and coding- gaps, thereby allowing physicians to focus on things that matter most – delivery and improvement of care.
Regardless of how many patients physicians see per day, they have to put in an equal, if not more number of hours in front of the EHRs for logging in every single detail. Physicians are likely very interested in quality care and making the care processes efficient; it is important to understand the implications that would be created on their reimbursements with a solution that mitigates IT usage burnout. Physicians should automatically be updated instead of having to inquire about information they need at any given moment as it might be disengaging. It is possible to engage physicians so that they can take forward the quality improvement efforts.
Alternative Physician engagement methodologies and their adoption
Making improvements to the healthcare system are the top of the agenda but how does the current scenario of physician engagement compare to this? Addressing the problem of physician burnout, several methods for engaging physicians have surfaced over the past few years:
Print / Fax PVP
Push data back in EMR
Medium in young physicians Low in older physicians
Another Web Portal
All of these methods are sub-optimal – either they are labor-intensive, or costly to implement, or require physicians to leave the EHR and go to another portal, thus decreasing the physician adoption rates. It is critical to engage physicians in a timely and effective manner to bring information transparency across the network and allow for prompt identification of low-quality care outcomes and unnecessarily high-cost events.
The solution: Engaging physicians with point of support for smarter and holistic care
Addressing above limitations, there is a dire need for a smart point-of-care support for physicians that is automated, easy to implement, and user-friendly. A support system that operates right besides EHR, pinpoints and surfaces only relevant insights, including care gaps and risk factors, which will help physicians right at the point of care without being overloaded with too much information.
Providing precise insights
Physicians require a solution that pops up just the precise insights like care gaps and risk factors to assist them in working with the patient within the EHR at the point of care. Moreover, creating a holistic picture of patients remains highly essential for physicians, however, it is still a challenge because of siloed data storage platforms in healthcare. This lack of a 360-degree view for every patient is a major barrier to collaborative and coordinated care efforts. These challenges can be addressed by integrating various patient-specific datasets, including clinical and claims and surfacing key insights on the physician’s screen in nearly real-time.
Personalizing patient interactions
Almost 80 percent of healthcare data is unstructured, and thus, to create impact at scale, physicians need pioneering analytic capabilities. For example, if a patient has visited the ED three times in the past two months, he needs to be tagged as a ‘frequent ED visitor.’ Giving physicians access to this information will guide them to revisit and optimize their care-programs for this patient such that the patient’s ED visits go down, which would further translate into decreased overall spend for the network.
With 2017 in the rear-view mirror, it is time to look forward to 2018 and how healthcare will evolve in this year. The last year has been an eventful one for healthcare, from the uproar in healthcare regulations to potential mega-mergers. Needless to say, it’s a time of transition, and healthcare is in a very fluid state- evolving and expanding. There are certainly going to be new ways to keep healthcare providers and health IT pros stay engaged and excited, and here are our top 10 picks:
The future of the GOP Healthcare bill
The Republican healthcare reform bill gained immense traction this year. In their third attempt at putting a healthcare bill forward, the senators and the White House officials have been working round the clock to gather up votes, but somehow, the reservations persist. The lawmakers have insisted that Americans would not lose their vital insurance protections under their bill, including the guarantee that the plan would protect those with preexisting conditions. However, as it so happens, even these plans have been put to rest. Perhaps sometime in 2018, the GOP may pass a budget setting up reconciliation for tax reform, and then pass tax reform. Then, they would pass a budget setting up reconciliation for Obamacare repeal, and then pass that- it all remains to be seen.
The ongoing shift to value from volume
Despite speculations, healthcare providers, as well as CMS have pushed for more value-based care and payments tied to quality, but it’s been going slow. Although providers have been slightly resistant to take on risk, they do recognize the potential to contain costs and improve quality of care over value-based contracts. And perhaps as data assumes a central role in healthcare, the increasing availability of data and smarter integration of disconnected data systems will make the transition easier and scalable. Notably, with a $3.3 trillion healthcare expenditure this year, there has been slow down the cost growth. 2018 is expected to be much more impactful as it builds on the strong foundation.
Big data and analytics translating data into real health outcomes
Big data and analytics have always brought significant advancements in making healthcare technology-driven. With the help of big data and smart analytics, we are at a point in healthcare we can make a near-certain prediction about possible complications a patient can face, their possible readmission, and the outcomes of a care plan devised for them. Not only it could translate to better health outcomes for the patients, it could also make a difference in improving reimbursements and regulatory compliance.
Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare’s longstanding challenge of interoperability and data exchange. Bringing blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of by innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security.
AI and IoT taking on a central role
2018 can witness a good amount of investment from healthcare leaders in the fields of Artificial Intelligence and Internet of Things. There is going to be a considerable advancement in technology, making the use of technology crucial in healthcare and assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care.
Digital health interventions and virtual care to improve access and treatment
In December 2016, many were suggesting that wearables were dead. Today, wearables are becoming one of the most sought-after innovation when it comes to digital health. And, the market is quickly diversifying as clinical wearables gain importance and as several renowned organizations integrate with each other. Not only wearables- there are several apps and biosensors that can assist providers with remotely tracking patient health, engage patients, interact with them, and streamline care operations. As technology becomes central to healthcare, 2018 will be the year when these apps and wearables boost the patient-physician interaction.
Have you ever thought how giant enterprises like Facebook, Google and Microsoft have harnessed big data technology so spectacularly well? These consumer-centric industries are continuing to succeed at a global level. Do you know what they all have in common? APIs.
Short for “application programming interfaces,” APIs are like connectors that allow you to access information on your application or software. It’s basically how two softwares talk. APIs are the not-so new big thing in the tech sphere and to make a headway into delivering top-notch quality care, it’s high time we embraced them for a better tomorrow.
Constraints in healthcare today
Given the complex nature of modern day healthcare data exchange, providers are themselves held back from tapping the full potential of the available data and utilizing it to drive the best possible outcomes.
Problems arise in the very initial steps of care delivery. Accessing or exchanging the medical information of any patient who reaches a facility is a most basic requirement that should be fulfilled at the very outset of care. But, the slow and long-drawn fragmented process of data exchange, siloed nature of data sets and lack of interoperability hinders a smooth transfer of information from one provider to another.
How then is it possible to carry out comprehensive care for a patient with only partial information about the patient? How about if, the traditional and complex process of data exchange were to be replaced with a simpler, easier and faster technology.
In a world where API is a reality, sluggish data integration and exchange ought to be passé.
Simple, modular and interactive
These efficient little elves (techie companies prefer to call them APIs) make things way simpler on the surface — quite literally! While using a low-maintenance infrastructure and only a few lines of code, these elves will open that door for you to be able to engage and interact with your patients at large.
Why should healthcare take to APIs?
Sweeping changes and new data sources are continually making their way into healthcare and with that there is an ever-growing need among healthcare organizations to share information. Patients, as they become aware of their health status, too are demanding greater access to their health information. Below are some pointers laying out why APIs are a better alternative than existing means like static databases for exchanging health data:
It saves time and resources.
Data is exchanged in real-time at faster pace.
Its processing is autonomous and easy to manage.
It makes information readily available on all devices, mobile or immobile.
It allows for very little delay in receiving or extracting information.
It facilitates seamless and secure data sharing.
Keeping technicalities aside, let me tell you that standardization is simpler with APIs and that is a huge plus point because it’s easier to process information when everyone speaks the same language. True, EMRs also work through APIs, however, open APIs can enable you to use whatever type of data on whichever device. Wouldn’t it be great if you could have your lab results and prescriptions appear on your phone, your vitals clear on the screen and your appointments listed on your calendar? APIs enable this and a lot more.
All that’s great. But what’s in it for the providers?
By bringing APIs into the fold, providers can make use of interfaces that are uniquely designed for their systems, helping them attain better clinical decision making.
They can use APIs to build their own custom apps and can have vital information about health conditions, medications, surgeries, and other details for use in their own applications or platforms.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
A personal health record of any patient, whether it is an aging parent, a spouse or a child with a chronic illness, contains a summary of medications, lab results, visit notes, billing information and more, and interoperability makes it easy to manage all these files and documents with just a few clicks.
Every form of health data makes an entry in an EHR today thanks to the shift towards a digitized healthcare in U.S. Although this has made data entry, storage, retrieval and exchange easier, it has brought with it certain challenges. Integrating and utilizing EHRs is the first baby step; however, if we are to overcome all the hurdles then achieving 100 percent EHR interoperability is the summit where we are yet to reach.
Physicians want to optimize the full potential and promise of EHRs for the simple reason that improved communication between systems will lead to a better and enhanced care. Once all the systems in use nationwide are connected and interacting with each other, patients will find it easier to seek a second opinion as their health information will reach the physician in a matter of seconds.
How interoperability exists today
Today, various interoperability standards have developed for the sake of continuous improvement in this realm. Health Level Seven (HL7) has produced the likes of HL7v2, HL7v3, and the latest FHIR as competent standards that exist in the industry for better streamlining of documentation and care coordination. With the help of FHIR, physicians can access health data on their mobile phones through various API (Application Programming Interface) functions that FHIR supports. This ease of access to complete and accurate patient data, in due course, helps in many ways. As providers and health coaches work together on improving the health of people, it also significant for them to be able to access accurate data from sources other than EHRs. Apart from EHRs, HIEs have popped up in various places that allow for the smooth flow of data across the health care network.
Ways in which interoperability facilitates healthcare
Physicians can easily access and share medical information with their patients and perform their tasks with greater efficiency. This could be done by increasing the efficiency of monitoring chronic diseases. Besides saving time and labor cost, physicians and patients with access to interoperable health information can benefit from higher-quality patient outcomes. Interoperable EHRs carry the potential of giving easy and ongoing access to patient’s health records to the physician. For a doctor to have an updated and detailed medical history of his patient cannot just be live-saving, it will mainly help those people who are always on the move. This will empower an individual to move across the continuum of care seamlessly with their clinical record.
Doing more with less
As value-based care and reimbursements stepped into healthcare, the US managed to turn the tide towards a more qualitative and equitable delivery of care. This has made physicians more responsible for better patient health outcomes than ever before. To manage hospital readmission and managed care plans, physicians need to have as much patient information as possible at hand at all times. This is where interoperability comes into play by aggregating and relaying data from disparate regions and bringing it onto a single platform.
For a secure data exchange to take place amongst healthcare organizations and patients, it’s important that both parties are willing and equally involved in the sharing process. This will inevitably lead to shared decision making apart from the fact that the physician will be able to make quick and informed decisions. The ultimate aim is to have a complete understanding of the health status of patients and helping them navigate effectively in their health journey for a better patient experience.
Patient-centric interoperability is the direction in which healthcare is slowly moving. There’s so much that we can do with the availability of data. Ongoing monitoring of patient data can better facilitate the ongoing management of that patient’s health and the physician can intervene where necessary. With this, patients too can track their progress and work towards improving their health hand-in-hand with the physicians.
Challenges that interoperability is yet to solve
One of the issues that interoperability is dealing with today is the vast and disjointed patient data that exists in regional HIEs and independent, transactional databases like EHRs. Along with this, patient privacy concerns and consent are other risk factors that need to be considered when diving through protected health information data. Lack of a common standard, state policy rules, workflow and policy difference and the need for incentives are some barriers in the way of achieving 100 percent interoperability.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
For a long time, healthcare insurance companies used to overlook people who were likely to be high-cost. As the landscape changed with new regulations, insurance providers have started offering new policies in the individual market without identifying any pre-existing conditions while enquiring about their health status. Even so, there have been many loopholes, and every administration has and continues to aim at minimizing these gaps. The one good answer thus far: risk adjustment.
What is risk adjustment?
Risk adjustment over the years has become a key mechanism used in healthcare to predict the costs incurred and ensure appropriate payments for Medicare Advantage plans, Part D plans, and health plans. Historically, it was only used in Medicaid and Medicare but lately has been an actuarial tool to ensure that health insurance plans have adequate funding and no financial hindrance in providing care to high-risk, high-need patients. Insurance companies and their plans are compared on the basis of quality and services they offer, providing a strong foundation to value-based purchasing.
Why is risk adjustment so important?
Risk adjustment advocates fair payments to health insurance plans by judging them on their efficiency and encouraging the provision of high-quality care. Beyond that, here’s why risk adjustment is important:
Provides a neutral field where providers and payers can be compared to their peers on the basis of their quality and efficiency.
Combining risk scores and evidence-based models with risk adjustment helps providers and care teams design post-discharge plans with intense follow-ups.
With predictive analytics, risk adjustment models may be used to capture all the dimensions of relevant patient risk.
How is risk adjustment used in healthcare?
Healthcare risk adjustment methodologies can be used to account for changes in severity and case mixes for patients over time. Risk adjustment has been critical in reducing “cherry picking” among health plans. Dimensions of risk in care can broadly be categorized into three categories:
Patient health-related behavior
It’s important to ensure that by providing incentives to enroll high-cost individuals, there are necessary resources available to provide efficient and effective treatment to the relatively healthy population without overcompensation. The methodology used to risk-adjust premiums varies on the following:
Patient population and their breakdown
Source of payment
Healthcare market regulation
On the macro level, unless the state combines its individual and small group markets, separate risk adjustment systems operate in each market. The Department of Health and Human Services (HHS), developed a risk adjustment methodology, where individual risk scores are assigned to each enrollee. The diagnoses are grouped into a Hierarchical Condition Category (HCC) and are assigned a numerical value which is averaged to calculate the plan’s average risk score. Payments and charges are calculated by comparing each plan’s average risk score to a baseline premium.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Time is money, an adage the world follows. When providers realized paper medical records were time-consuming, Electronic Health Records were developed to make things streamlined. Early EHRs were only meant to capture basic clinical information, and over the time EHRs have taken the form of a digital version of paper medical records. In an industry as dynamic and as focused on value as healthcare, it’s not feasible to have physicians spend almost half their time on EHRs.
Challenges physicians face with EHRs
EHRs, in their current state, not only consume a lot of physicians’ time, but they also draw their attention away from their direct interactions with patients. Some of the several significant challenges physicians face are:
Data entry and administrative tasks take up a lot of physicians’ time, according to a study, during the office day, physicians spend as much as 49.2 percent of their time on EHRs.
The demands of desk work and administrative work are not being reconciled with patient priorities and clinical workflows; creating huge gaps between patients and providers. For example, during patient examinations, physicians spend 37 percent of their time on data entry and desk work, compromising on their direct interaction with patients.
Physicians are only reimbursed for face-to-face visits, lab work, and medical procedures and not for EHR tasks. This increases the misalignment in fee-for-service payments and compounds the risk of physician burnout.
Why can’t we do away with EHRs?
While EHRs are not without their own set of challenges, their implementation was necessary, and that still holds true. Only recently, under the Merit-Based Incentive Payment System (MIPS), providers have started to make an effort to enhance value in the care they deliver and the meaningful use of EHRs has been included in MIPS with other substantial quality reporting initiatives. Besides that, there are many offerings of EHRs:
A quick and real-time access to patient records.
Reliable drugs and test prescriptions.
Complete clinical documentation, inclusive of patient medical history.
Accurate and streamlined coding and billing operations.
Reduced cost of operation.
EHR Optimization: Boosting your EHRs
EHR optimization is the process of enhancing and refining the operations of an already installed EHR, to enhance clinical productivity and efficiency. As more and more practices have begun the push for value-based reimbursement, they are demanding more integrated and efficient EHRs.
Opportunities for EHR optimization vary for every practice and range from simple to complex. However, the primary objective of every optimization is reducing the time consumed. Here are some ways healthcare IT platforms can optimize time spent on EHRs for improved patient outcomes:
Establish key performance indicators: Once a healthcare organization has examined its baseline performance, it can decide on goals and target a benchmark for future. Organizations can leverage advanced analytics to determine their progress across each key performance indicator which in turn, helps with quality reporting.
Comprehensive and complete clinical records: It’s important that a patient record is complete- right from their past medical history to their last lab test results. Along with that, if providers are able to look at all vital signs at once, the entire process of designing and implementing a care plan would become efficient.
Implementing clinical decision support: By combining clinical decision support with EHR data, providers can ensure safer and efficient care delivery by documenting every interaction and eliminating redundancies. With every information documented, providers can address the gaps in care well in time.
Sharing vital information across the network: More often than not, the delay in accessing information is the major reason behind improper or delayed care. It’s important that clinical data, lab test results, referrals, etc. are shared across all providers to ensure seamless treatment and population health management.
Monitor, evaluate and maintain results: To ensure the success of optimization isn’t short-lived, providers should continuously monitor their process improvement. Organizations should evaluate their growth and shortfalls and make their efforts to sustain and improve the results they achieve.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
The world of healthcare analytics is vast and can encompass a wide range of data that has the incredible potential to tell stories about health and healthcare delivery: right from individual patients to entire populations. Having numbers and an easy-to-use visualization at hand gives providers and caregivers the power to not only look into the lives of individual patients but also track the ongoing activities in their organizations. Simply showing visualizations are not enough and to fully understand their value, healthcare organizations have to take a few steps beyond basic graphs.
The Case for Data Visualization
In the words of Edward O. Wilson, the father or social biology:
“You teach me, I forget. You show me, I remember. You involve me, I understand.”
There are many disparate data sources healthcare providers have to deal with: EHRs, departmental data, claims data, resource utilization, administrative data, etc. Consolidating the data and spreading it out in a visually adaptive manner offers a more agile approach to managing complex population health data.
Data visualization was developed with the aim to make it easier to gain actionable insights from volumes of information and work on improving health programs, clinical healthcare delivery, and post-episode care management. Visualization provides real value in learning from disparate data sources, finding outliers, bringing out hidden trends out on the front, and delivering better health outcomes.
Streamlining Different Data Sources into a Single Source of Truth
Since the data pertaining to a patient’s health comes in from various sources, it is vital to pool all the data sets and obtain an aggregated, standard format of data every authorized person can view and manipulate.
Data in the healthcare industry can broadly be categorized into two sources:
Claims data: that comes from payers and contains extremely uniform and updated data about the care patients receive and how they are billed for it. This data is usually structured and has all the meaningful data required for provider reimbursement.
Clinical data: this data comes in from the providers’ end and contains valuable information about their diagnoses, claims, and medical history. While this data isn’t often structured, incorporates data elements critical to analyze a patient’s health in every time frame.
Fine-tuning Real-Time Visualization
The amount of data healthcare institutions aggregate is enormous: by 2012, it was estimated to be a whopping 150 exabytes (150 million * million * million) and is growing at a rate of 48 percent per year. As the volume grows, healthcare organizations need state-of-the-art, real-time analytical capabilities to improve the care quality and its effectiveness. Real-time analytics can turn the tables in ways more than one:
Monitoring end-to-end care delivery across a wide range of facilities.
Observing the progress of clinical decision support systems.
Identifying overhead cost drivers and detect care or documentation gaps.
Since data visualization holds great advantage to understand the going-ons in the organization in real-time, here are some key elements that count as best practices for data visualization:
Customized reports: Each set of users in healthcare requires different metrics and different orders. Offering customized reports with specific visualization provides actionable insights and can answer specific questions about risks, rewards, and success of the organization.
Visually adaptive: Data presented on the dashboards has to be complete with functional and visual features that aim to improve cognition and quick interpretation. Data listed in a color coded-manner will provide physicians with functional features and real-time alerts.
Create actionable insights: A dashboard or any other visualization tool will provide clinicians with the data, but unless someone looks at it, it will go unnoticed and may have potentially critical outcomes. Users should be made aware of how to review the dashboard, drill down to every immediate level, and initiate corrective actions.
The end user’s ultimate need: It’s paramount that end users can communicate their needs and demands and what is even more important is that their demands and performance indicators are incorporated well in advance of structuring the report.
Wrap-up with Healthcare IT
By leveraging healthcare IT, organizations can have their hands on simple but effective visualization and take a look at additional, important information that might have been difficult to notice in tabular format. Here are some ways healthcare IT can drive real-time data visualization to success:
Immediate access and sharing: Putting bidirectional interoperability to use, providers can access and share relevant data across the network, despite technological barriers.
Clear data visualization: Graphic, color-coded cues help physicians swiftly learn about the areas that need performance improvement or track the growth their organization is making.
Drilling down: To learn more about the reason behind certain shortfall, physicians can always drill down and narrow their area of focus to pinpoint the anomaly, and take quick remedial actions.
Driving Value with Visualization
With healthcare IT now an integral part of the value-based care system, there is little doubt that convenient, real-time data visualization will be heavily used to achieve positive health outcomes. Combining real-time data with advanced analytics will completely reshape how healthcare IT can improve clinical and operational outcomes. Once physicians move away from long, incomprehensible data flows, and find an alternative that helps them instinctively read, isolate, and act upon the insights, only then can we be one step closer to a data-driven value-based care.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
The way we see healthcare today is very different from what it was a couple of decades ago. Back then, we did not have the technology to capture the best practices. But, today we have the capability to use medical data as a source of innovation and create impact at scale. But the question is are we capitalizing on it? Have we made the lives easier for both patients and care teams? Are we close to the goals we started chasing ten years ago?
When we talk about innovation in healthcare, we stumble across intuition. The intuition of care teams enhanced by data-driven approaches. It is not just limited providing connectivity to healthcare organizations; it is also about providing advanced analytics and reducing the cumbersome, tedious work! Like deep diving for hours on Excel or making quality tracking and reporting easier.
The concept of population health management is a new one. It has evolved from an idea to become a clinical discipline that works on developing and continually refining measures to improve the health status of populations. A successful population health management program thrives on the vision to deliver robust and coordinated care through a well-managed partnership network. This said, there is no one definition of Population Health Management, fifty different CIOs in an interview gave different definitions to this term. It is a broad concept and covers a lot under its umbrella.
What does an ordinary health IT setup lack?
True, the healthcare systems are working on building the skills to interact and develop well-planned health intervention strategies to move away from the traditional fee-for-service model to value-based reimbursements and incorporating value, but they are falling short in many areas:
Limited EHR capability: EHRs played a pivotal role in digitizing health care, but with EHR technology many restrictions came along. Today, only a few are equipped to support the necessary interoperable standards. To deliver better clinical outcomes, it is of paramount importance that we have the data and right analytics to ensure improvements; something healthcare organizations lack even today.
Integrating data sources: A patient who is being relocated to a new state and will have a new PCP and Care Coordinator. Can we say with confidence that the patient’s information will be available to the new PCP? In a large healthcare network, there is labs, pharmacy, clinical, claims, and operational data, but the capability to integrate it into a single source of truth is still a challenge for many! This has limited the potential of care teams and made them communicate in a disconnected ecosystem.
Risk Stratification: 50 percent of expenditure in healthcare is on 5 percent patient population. Wouldn’t it be great if we could find these patients and cure them before any acute episode? Back in 2012, about 117 million Americans had one or more chronic conditions, and account for 86 percent of the entire healthcare spending. The road to population health management will require care teams to recognize at-risk population timely to reduce cost and improve outcomes!
Guest post by Abhinav Shashank, CEO & Co-founder, Innovaccer.
Whatever we do in the healthcare space, it is eventually meant for the greater good of patients, which is why today the aim of modern healthcare is shifting towards value-based reimbursement and with that the process is getting modified accordingly. Gradually, patient-centric care is becoming prevalent. The current standards require enhanced patient experience, and that comes with improved quality, coordinated care at a reduced cost.
CMS when releasing the fact sheet for Hospital Value-Based Purchasing Program for the year 2016, said in a statement, “We now pay hospitals for inpatient acute care services based on the quality of care, not just the quantity of services provided.” Backing this statement was the fact that out of the four quality domains, patient experience of care bore 25 percent of the weight. This led to hospitals working earnestly towards enhancing the patient experience and utilizing the massive potential to qualify for the bonus and improve on current standards.
Why does Patient Experience Matter?
Patient experience is an essential component of the IHI Triple Aim, a schema for elevating the standards of providers’ performance:
Improving the patient experience of care.
Improving population health.
Reducing the per capita cost of healthcare.
Fortunately, health systems know that patient satisfaction isn’t just a tool for a performance bonus. Improving patient satisfaction is a way to identify gaps in care delivery and develop quality services. Also, according to a survey conducted by a health system found that out of 1,019 adults interviewed, 85 percent were dissatisfied with at least one aspect of their providers. Creating a patient-centric industry where experience and satisfaction of patients are overlooked is almost impossible!
Improving Patient Experience
A lot of researches have established that improving patient experience directly results in higher quality of care. Healthcare systems have realized the importance of the Triple Aim, and here’s how they can start working in this order on improving one of the fundamental aspects:
Patient Engagement a Priority
Patient engagement has been one of the most talked-about aspects of healthcare and unquestionably a way to improve the care experience. What we need to ensure is that the patient is willing to participate in the decision-making and the provider advocating this intervention. Even though healthcare providers are making efforts to improve patient engagement at their end, a survey revealed that only 34 percent of the patients are highly encouraged. Some effective methods patients found useful are:
59 percent of the surveyed people found increased physician-patient time vital.
54 percent of the patients favored being part of the decision-making.
36 percent promoted the growth of patient access to services.
Using Data Analytics
Data analytics have proven their worth in healthcare, and we have only scratched the surface of the immense sea of possibilities that can be realized using data analytics. When it comes to advancing patient experience, data analytics can be used in several ways:
Gathering data and creating actionable follow-up plans for patients.
Leveraging data analytics for accurate analysis of patients and reducing readmission rate.
Data analysis can zero in on inefficiencies and medical errors and help reduce avoidable expenses.