Electronic Health Reporter

David Caldwell is the vice president of sales and marketing at Transcend Insights, a wholly owned subsidiary of Humana Inc., dedicated to simplifying population health. Transcend Insights helps manage the complexities of population health through community-wide interoperability, real-time healthcare analytics and intuitive care tools. The company’s HealthLogix platform provides healthcare systems, physicians and care teams with valuable clinical insights that enable more informed decisions at the point of care, enhance the patient experience and reduce costs.

Here, Caldwell discusses how the firm serves its clients; the benefits of analytics and its impact on ACOs; population health initiatives; and the future of the company.

Tell us a bit about your product offerings and the role that they play in the health care technology space.

Transcend Insights is a population health management company that provides health care systems, physicians and care teams with advanced community-wide interoperability, real-time health care analytics and intuitive care tools designed to simplify the complexities of population health. The new company represents the merging of three leading health care technology businesses—Certify Data Systems, Anvita Health and nliven systems. We integrated Anvita’s health care analytics into Certify’s HealthLogix™ platform to provide physicians and care teams with the real-time insights necessary to improve health outcomes and reduce costs. In addition, we made these insights accessible at the fingertips of physicians and care teams through a mobile point of care solution, a technology we gained from nliven.

Today, Transcend Insights works with more than 130 health systems, serving at least 600 hospitals and over 20,000 physicians. Through community-wide interoperability, we help large health care systems gain access to both acute care and ambulatory data that reside in various silos across the care continuum.

We analyze 2.3 billion clinical data points on 10.8 million patients every day. Our analytics engine offers more than 33,000 evidence-based clinical rules and last year identified over 36 million opportunities to improve care and helped our clients close 4.3 million gaps in care.

Lastly, we leveraged nliven’s expertise in mobile health technology to develop a mobile point of care solution that allows physicians and care teams to not only visualize data but also gather and assimilate patient data in real-time.

Who are your customers and what level of clinician typically accesses your product on a day-to-day basis?

The vast majority of our customers are multi-hospital, integrated health care delivery networks that have purchased our product to help them move from a fee-for-service to a value-based care delivery model. Our customers utilize the HealthLogix platform to reach both contracted and affiliated physicians, and to piece together disparate electronic health record (EHR) system data across the care continuum.

Clinicians who are closely involved in the patient’s care, including physicians, nurses and nurse practitioners, access our product on a daily basis. Our day-to-day customers also include administrators involved with practice management, as well as those at the accountable care level who are referencing population-wide statistics to better manage the overall performance of contractual arrangements.

How does Transcend Insights work with EHR vendors to reach top standards of interoperability?

Transcend Insights has been on the leading edge of interoperability with EHR companies across the nation for the past decade. Our HealthLogix platform is vendor-neutral and can integrate with any Office of the National Coordinator–Authorized Testing and Certifications Body-certified EHR product designed for inpatient and ambulatory settings. Through our EHR partnerships, we have simplified the integration process and connected over 90 different EHR systems to establish seamless interoperability across the entire care continuum. I believe true interoperability will continue to evolve to meet the needs of health care systems, physicians and care teams.

How is Transcend Insights working with its customers on population health management efforts?

We continuously evaluate the needs and challenges of our customers to ensure they are able to effectively manage a population from both a clinical and financial risk basis. In addition to offering community-wide interoperability capabilities, real-time health care analytics and intuitive care tools, we continue to evolve our technology to meet the current and future requirements of our customers. Our immediate product development focus is integrating back office analytics and front office point of care tools to enable Accountable Care Organization (ACO) managers and care givers alike to deliver better health outcomes, lower costs and help their patients achieve their best health.

How do you see analytics tools impacting the existing ACO model in the future?

I believe the vast majority of analytics tools today are utilized by those on the administrative side of accountable care organizations, to look broadly across their patient population. This allows them to identify populations most at risk, and focus on areas where better care can be provided. Most of this analysis pertains to areas of patient stratification and segmentation to identify disease categories where health improvement may be needed.

In addition, most health care data and analysis today is based on claims data. This has proven to be somewhat limited in value in the long-term due to the lag in relevant claims data available at the point of care. We really need to tap into real-time clinical data to provide physicians and care teams with a patient’s most relevant information at the moment of influence.

Most importantly, combining claims data with real-time clinical data will allow physicians and care teams to refer to a complete view of a patient’s medical history, while they are with their patient, to enable a more meaningful discussion. This will also help with enabling a more proactive approach to patient care for improved health outcomes.

Tell me more about the impact of the ACO. Where will its benefits land? Its drawbacks?

ACOs are affecting health care services nationwide. When the ACO model first began as a demonstration project to pioneer health care systems, we were still learning about the impact it would have on care. However, as the health care industry continues to transition from a fee-for-service to a value-based model, I believe ACOs will greatly impact the benefits of the triple aim: improving population health, enhancing the patient experience and reducing costs.

In addition, ACOs have the potential to help Americans better afford health care going forward. It is critical that we leverage the various technologies that are available today as well as those that will emerge over the next few years. This includes managing both financial and clinical risk, and the care of a patient population. Therefore, I believe the benefits of ACOs will clearly result in better care for our nation that we can all afford.

The drawback to an ACO is that it is such a new model of care delivery. Some health care systems across the country have effectively used this new model to manage both care and financial risk on a broad basis. However, our nation’s history of incentivized fee-for-service care is still deeply rooted in our workflows, making it difficult to transition to this new way of delivering care. Another major drawback is the time required to evolve into an ACO that will allow for the achievement of the triple aim.

ACOs are presenting a real cultural challenge alongside the obstacles of an emerging population health management market. There is a lot of noise in this market, which will require health care systems nationwide to make some tough choices on how they will transition to this new way of delivering care.

What do you think needs to be done to improve payer-provider collaboration?

From my perspective, payer-provider collaboration is already taking place. Where we are seeing this most predominantly is in the sharing of financial risk for a defined population. These contracts have been going on for a number of years and are now being elevated to a higher level.

We need to move away from the transaction–based relationships that have traditionally transpired between insurers and providers. Both sides need to recognize that they are in this business for the same reasons: to take better care of people and improve a population’s health. As soon as we can recognize that, collaboration will accelerate.

What is the most pressing issue facing hospital leaders today? How is Transcend Insights helping ease leaders’ concerns?

The main concern of health leaders today is how to successfully move from a fee-for-service to a value-based reimbursement model. High occupancy rates have traditionally allowed hospitals to prosper financially. In the new model, however, health care systems are increasingly focused on improving patient care at the primary care level in order to prevent hospital admissions.

Transcend Insights helps ease these financial concerns by providing the tools clients need to evolve from a fee-for-service acute care model to a community care model. Our technology allows them to reach beyond the four walls of an acute care hospital and into the ambulatory care settings in a way that is impactful both clinically and financially.

What lies ahead for Transcend Insights? How do you plan to make an impact on the population health market?

We plan to continue to build on the trust and relationships that we have established with many of the leading integrated health care delivery systems across the country. We currently have more than 130 of those relationships serving at least 600 hospitals and over 20,000 physicians and we look forward to continuing to serve them and be their trusted partner. We have had very little attrition, with a 99 percent client retention rate. In fact, many of our clients have been with Transcend Insights since its beginnings. We plan to continue to maintain and cultivate those relationships and bring additional technologies to market that give clients capabilities to better care for their patients.

We will continue to impact population health management by helping physicians and care teams improve individual health outcomes, reduce costs and take care of patients in a meaningful way.

What’s next for your clients?

The most important requirement that is next for our clients is providing them with the tools and technology necessary to help them succeed as an ACO. Many of our clients are putting infrastructure in place to manage both financial risk and the risk of care across a wide population.

During this process, our clients are recognizing interoperability as an important facet to their success. Most health systems and hospitals realize that many of their community-based care sites can’t all be on one platform, so interoperability capabilities are a key priority.

Anything else you’d like to say?

Transcend Insights is keeping a keen eye on how we can help our health system clients move towards population health in an elegant and simple way. Our mission and vision are centered on helping health care systems move from a fee-for-service to a pay-for-performance model and learn how to take on risk in a way that allows them to continue to be high-quality providers of care.