Guest post by Abhinav Shashank, CEO and c0-founder, Innovaccer.
Former US President Abraham Lincoln once said, “Give me six hours to chop down a tree and I’ll spend four hours sharpening the ax.” After having a look at the efficiency of the US healthcare system, one cannot help but notice the irony. A country spending $10,345 per person on healthcare shouldn’t be on the last spot of OECD rankings for life expectancy at birth!
A report from Commonwealth Fund points how massive is US healthcare budget. Various US governments have left no stone unturned in becoming the highest spender on healthcare, but have equally managed to see most of its money going down the drain!
Here are some highlights from the report:
The US is third when it comes to public spending on health care. The figure is $4,197 per capita, but it covers only 34 percent of its residents. On the other hand, the UK spends only $2,802 per capita and covers 100 percent of the population.
With $1,074, the US has the second highest private spending on healthcare.
In 2013, US allotted 17.1 percent of its GDP to healthcare, which was highest by any OECD country. In terms of money, this was almost 50 percent more than the country on the second spot.
In the year 2013, the number of practicing physicians in the US was 2.6 per 1000 persons, which is less than the OECD median (3.2).
The infant mortality rate in the US was also higher than other OECD nations.
Sixty-eight percent of the population above 65 in the US is suffering from two or more chronic conditions, which is again the highest among OECD nations.
The major cause of these problems is the lack of knowledge about the population trends. The strategies in place will vibrantly work with the law only if they are designed according to the needs of the people.
What is Population Health Management?
Population health management (PHM) might have been mentioned in ACA (2010), but the meaning of it is lost on many. I feel, the definition of population health, given by Richard J. Gilfillan, president and CEO of Trinity Health, is the most suitable one.
“Population health refers to addressing the health status of a defined population. A population can be defined in many different ways, including demographics, clinical diagnoses, geographic location, etc. Population health management is a clinical discipline that develops, implements and continually refines operational activities that improve the measures of health status for defined populations.”
The true realization of population health management (PHM) is to design a care delivery model that provides quality coordinated care in an efficient manner. Efforts in the right direction are being made, but the tools required for it are much more advanced and most providers lack the resources to own them.
If population health management is in place, technology can be leveraged to find out proactive solutions to acute episodes. Based on past episodes and outcomes, better decision could be made.
The concept of health coaches and care managers can actually be implemented. When a patient is being discharged, care managers can confirm the compliance of the health care plans. They can mitigate the possibility of readmission by keeping up with the needs and appointments of patients. Patients could be reminded about their medications. The linked health coaches could be intimated to further reduce the possibility of readmission.
Over the past few years, healthcare technology has seen many advances. We’ve achieved mass-market adoption of EHRs, many organizations are making meaningful progress on data aggregation and warehousing information from multiple diverse systems, and wearables and other sensors show much potential to unlock personal information about each patient. The pace of change in healthcare is quickening, with each new technology or initiative sending off a chain of reactions across the entire ecosystem, ultimately improving patient care.
I see three trends driving the industry toward change:
Analytics will help predict population heath management
One of the persistent industry challenges is the “datafication” of healthcare. We’re amassing more and more data now than ever before. And new sources (like wearable devices) and new health factors (like DNA) will contribute even more. This data explosion is putting increased pressure on healthcare organizations to effectively make this data useful by delivering efficiency gains, improve quality of care and reduce overall healthcare costs.
Navigating this digitized healthcare environment will require increasingly sophisticated tools to help handle the influx of data and make the overload of healthcare information useful. In 2016, the industry will begin to take concrete steps to transition to a world where every clinician will see a snapshot of each of their patients to help them synthesize the critical clinical information they need to make a care decision. Moreover, hyper-complex algorithms will allow providers not only to know their patients, but to accurately predict their healthcare trajectories. By giving providers insights into how each patient is trending, clinicians will be able to make better-informed, precise decisions in real-time.
Consolidation leads to new healthcare models, improved outcomes
New models for effective population health management continue to drive change across healthcare systems. These models incentivize stakeholders to optimize costs, identify organizational efficiencies and improve decision-making processes to deliver better care at a lower cost through an emphasis on care coordination and collaboration.
After years of underinvestment, CIO’s in healthcare may have something to cheer about this year. The biggest trend seems to be the increased focus and investment in IT in healthcare enterprises. With more than $30 billion invested in electronic health record (EHR) systems, and meaningful use (MU) requirements out of the way, we are seeing enterprises turn toward the more strategic aspects of IT in the ongoing transformation of the healthcare sector.
These investments, however, will follow the money. In other words, funding will focus on initiatives that have the biggest impact in terms of revenues, cost avoidance, and transformative potential. A recent survey by technology provider Healthedge suggests that investments among payers will be targeted at selective enhancements to the most critical systems that support business development, and not a wholesale upgrade of IT. Here are a few of the top investment areas across healthcare:
Population Health Management (PHM): Everybody is on board with the concept of PHM as the defining principle in an outcomes-based business model. However, PHM has eluded a consistent definition, other than that its desired impact is to reduce overall costs of patient populations, and improve clinical outcomes. Analytics has been an important aspect of this discussion, however standalone analytics solutions have struggled to demonstrate value, and progress on advanced analytics involving predictive models and cognitive sciences has been slow. This year may change all of that. Many standalone analytics companies are likely to be acquired, and IBM Watson will gain more traction. M & A in healthcare will drive PHM as well.
Information Security: With healthcare data breaches at over 112 million in 2015, including high-profile breaches at Anthem, Premera, and Excellus, IT security is now a CEO level issue. There is no doubt what this means – investments in data security technologies are going to increase. However, there is no guarantee that data breaches will not increase.
Healthcare Consumerism: Changing demographics and unexpected increases in the costs of health insurance are driving the consumerization of healthcare today. Silicon Valley startups, flush with VC money, are coming up with direct-to-consumer approaches that are making traditional healthcare firms sit up and take notice. At the same time, the newly awakened healthcare consumer is also demanding information and price transparency. New York Presbyterian has launched a patient-first marketing strategy aimed at improving engagement with patients through information sharing, and is revamping its website completely. BCBS of NC has already released the cat among the pigeons by publishing price data (and is facing pushback from its provider network). IT investments will now be focused on maximizing the reach and value of the information to empower consumers to make the right choices.
Guest post by Kirk Larson, national CIO, healthcare, NetApp Inc.
As we start a new year, let’s take a moment and take stock of the past 12 months. Like an annual physical, it gives us a chance to take a pulse check on the industry and see what the next year has in store – the opportunities and the obstacles.
During 2015, we had the opportunity to chat candidly with CIOs, healthcare technology partners and healthcare providers to discuss the big questions affecting the industry:
— What are the big topics the industry will be focused on?
— What changes do you see coming?
— What new challenges lay ahead and what new technologies will help us overcome them?
Based on these discussions, here are some of the key trends healthcare CIOs can expect in 2016:
Electronic Health Record (EHR) Optimization
As healthcare organizations move beyond implementation phase of EHRs, CIOs and IT are refocusing their efforts towards enhancing care workflow and benefits realization by way of optimizing the IT infrastructure. Basically, the status quo on overspending on legacy hardware is no longer being tolerated.
While the high availability, performance and security requirements for IT infrastructure certainly aren’t lessening anytime soon, IT is feeling greater cost pressures to run EHRs more efficiently. As a result, organizations are looking to simplify IT operations for running on-premises data centers with improved data management solutions, with the end-goal of moving toward building their own private clouds.
In addition to greater cost efficiency, we are seeing a growing demand for increased agility of IT services. As such, organizations are looking to advanced analytics capabilities as a means of achieving greater responsiveness. But before they can reap the benefits of employing a population health management system, IT needs to shift from tired legacy IT environments to highly agile IT infrastructure.
Population Health Management
Population health management programs have long been used by healthcare insurers to increase wellness and decrease claims cost. Organizations leverage multiple data sources such as EHRs, pharmaceutical data, insurance claims, etc.; to enhance and preserve wellness, as well as, programs that anticipatory and pre-emptive in design.
Guest post by Mohd Haque, vice president and global business head, healthcare, Wipro Technologies.
Population health management (PHM) isn’t just the latest buzzword. Or a new initiative mandated by the Affordable Care Act. Implementing a successful PHM program requires a complete shift in mindset from volume healthcare to value-based and outcome-based. PHM can’t be something that your healthcare facility “does,” but it must become the cornerstone of everything related to how your facility practices medicine.
Although the shift in perspective is the first step, it is essential to arm yourself with Population Health Management IT tools as well. According to 26th Annual HIMSS Study, half of the respondents (51 percent) have improved PHM through IT tools with only 38 percent saying that their organization was using specific Population Health Management tools.
By using big data analytics, EHR integration, IT infrastructure and security as part of a PHM program, providers can ensure patients that need high levels of care aren’t overlooked and the lower risk patients don’t get unnecessary care. This will in turn increase quality of care while saving money on interventions needed for low risk patients.
What are the Components of Effective PHM Program?
Since PHM is such a large shift, it is important to know exactly how to go about creating an environment that focuses on outcomes instead of volume. Population Health Alliance recommends the following four components to a PHM program:
Assessment – Evaluate each patient’s health and assign patients to a risk group (high to low)
Stratification – Provide the same interventions for everyone in the same risk group
Person-Centered Intervention – Provide interventions based on each specific patient’s needs, including community health research
Impact Evaluation – Determine the impact of interventions for each risk group as well as each individual patient
However, you can’t simply change the process without changing how each person on the team views healthcare and their patients. It must be a fundamental shift in your facility from the receptionist to the department chief.
Electronic health record (EHR) technology has become truly transformative for the healthcare industry; prepared or not, healthcare teams are increasingly relying on new information technologies to improve the delivery and management of care. EHRs have enabled faster and easier access to patient information, and hold the promises of improved workflows, efficient sharing of information across communities and reduced costs for many physicians and hospitals.
But now that nearly 80 percent of physician practices in the U.S. today have EHR systems in place and the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program is well underway, it is time to look to the next stage of health care technology and innovation. Health care teams must now move beyond the first step of digitizing patient records to transforming this valuable data into meaningful and actionable knowledge that will help care teams make more informed decisions at the point of care and ultimately, improve outcomes.
For this impact to take place at both the individual level and at the population level, care teams need to leverage clinical analytics that will provide visibility into important clinical trends across the entire population. For example, being able to review trends in diabetes care or readmission rates across a population represents an opportunity for specific, meaningful change to improve care delivery and outcomes.
For a practicing clinician, “population health management” means being able to see where an individual patient is within the clinician’s or clinic’s population (e.g., whether the individual’s chronic condition is above or below population benchmarks) and to take action at the point of care, as well as being able to refer to relevant population health metrics.
For a patient, clinical analytics presumes trust, not only in the competency and care of the physician, but also in the security of his or her information. Population health management and analytics tools must ensure that patient information can be gathered, stored, and used in a way that is demonstrably secure.
Care teams should consider four key elements when exploring clinical analytics tools for population health management:
Guest post by Diane D. Homan, MD and Adam Lokeh, MD.
As the healthcare industry unwraps the next phase of population health management (PHM), providers are increasingly embracing its promise to drive success with healthcare’s triple aim of improving population health, enhancing patient experiences and reducing costs. It’s a 180-degree shift in thinking for many providers who have been conditioned to long-standing fee-for-service models, one that will require a coordinated care effort and an advanced technological infrastructure to support decision-making based on the latest industry evidence.
As regulatory initiatives, such as meaningful use and value-based purchasing converge to up the ante on improved outcomes, the proactive premise of PHM will be critical to success. A foundational component to effective implementation of a PHM model is a clinical decision support (CDS) strategy that drives standardization of care based on best practices.
For Rush-Copley Medical Center, the first step in this process was deployment of evidence-based order sets and a complete clinical content management solution— ProVation Order Sets, powered by UpToDate Decision Support. The decision to leverage evidence-based order sets at the point of care has proven advantageous on many fronts, from supporting recent responses to public health crises to raising the bar on outcomes improvement and laying a foundation of accountability across the continuum.
Reducing Variation for Improved Response
Getting clinicians on the same page and helping them to adopt industry best practices in their day-to-day workflows is certainly a key element in bending the quality curve, but ensuring that variations are minimized in a public health crisis is absolutely critical to success.
A 210-bed hospital serving the greater Fox Valley region of Illinois, including the state’s second largest city, Aurora, Rush-Copley uncovered an outbreak of tuberculosis (TB) in late 2009 following two admissions over the course of two months. In cooperation with the Kane County Health Department, an investigation traced the outbreak back to a homeless shelter, which, in turn, presented a considerable challenge to containing the outbreak as the population was highly transient.
With evidence-based order sets and an advanced clinical content management solution already deployed to address standardization of care, the clinical team was able to quickly deploy a point-of-care strategy for identifying at-risk patients, apply isolation management tactics and develop collaborative efforts throughout the community to minimize exposure. The strategy was three-fold: 1) contain the epidemic, 2) provide highest quality treatment based on industry best practices and 3) avoid duplication of services.
Guest post by Brian O’Neill, president and CEO, Office Ally.
As healthcare reform rolls out nationwide, medical providers at all points across the care continuum are acknowledging the critical role that practice management systems play in population health management. Moving onto an electronic medical record is an important first step. Maximizing the digital capabilities these systems provide is a close second priority – and one that can yield big dividends in enhanced communications and better patient care.
One of the stars in the pantheon of indispensible functionality is real-time clinical messaging. Similar to texting but on a grander scale, real-time clinical messaging notifies medical providers before, during or after patient encounters of the recommended procedures that will improve patient outcomes. The two-way messaging can come directly from outside sources, such as third party administrators, IPAs, health plans or accountable care organizations, as well as other parties important to the care of patients. Studies have shown that such real-time digital communication significantly improves quality of care and allows for better outcomes in disease management patients. It can also result in fewer hospitalizations and a reduction in serious medical errors.
Clinical messaging can also facilitate direct communication between the medical provider’s office and a health plan’s case manager. This uninterrupted linkage improves the timeliness of the care provided, allowing case managers to contact the physician’s office prior to a member’s appointment to discuss procedures to be provided. Clinical messaging also enables the electronic two-way transfer of documents between the physician and the health plan, while allowing the case manager to communicate with the provider’s office while the patient is present in ways that maximize the efficacy and efficiency of that visit.
Most important of all clinical messaging helps to improve quality, which is the reason the healthcare exists in the first place. It can accurately capture all of the mandated HEDIS preventive care measures, demonstrating compliance with HEDIS and NCQA standards in a manner that can improve the “Star Ratings.” Both have become standard measures of quality throughout the healthcare industry and are increasingly becoming tools that employers and individuals use in selecting healthcare providers.