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We Can’t Afford To Be Vague About Population Health Challenges

Posted on June 19, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, I looked over a recent press release from Black Book Research touting its conclusions on the role of EMR vendors in the population health technology market. Buried in the release were some observations by Alan Hutchison, vice president of Connect & Population Health at Epic.

As part of the text, the release observes that “the shift from quantity-based healthcare to quality-based patient-centric care is clearly the impetus” for population health technology demand. This sets up some thoughts from Hutchison.

The Epic exec’s quote rambles a bit, but in summary, he argues that existing systems are geared to tracking units of care under fee-for-service reimbursement schemes, which makes them dinosaurs.

And what’s the solution to this problem? Why, health systems need to invest in new (Epic) technology geared to tracking patients across their path of care. “Single-solution systems and systems built through acquisition [are] less able to effectively understand the total cost of care and where the greatest opportunities are to reduce variation, improve outcomes and lower costs,” Hutchison says.

Yes, I know that press releases generally summarize things in broad terms, but these words are particularly self-serving and empty, mashing together hot air and jargon into an unappetizing patty. Not only that, I see a little bit too much of stating as fact things which are clearly up for grabs.

Let’s break some of these issues down, shall we?

  • First, I call shenanigans on the notion that the shift to “value-based care” means that providers will deliver quality care over quantity. If nothing else, the shifts in our system can’t be described so easily. Yeah, I know, don’t expect much from a press release, but words matter.
  • Second, though I’m not surprised Hutchison made the argument, I challenge the notion that you must invest in entirely new systems to manage population health.
  • Also, nobody is mentioning that while buying a new system to manage pop health data may be cleaner in some respects, it could make it more difficult to integrate existing data. Having to do that undercuts the value of the new system, and may even overshadow those benefits.

I don’t know about you, but I’m pretty tired of reading low-calorie vendor quotes about the misty future of population health technology, particularly when a vendor rep claims to have The Answer.  And I’m done with seeing clichéd generalizations about value-based care pass for insight.

Actually, I get a lot more out of analyses that break down what we *don’t* know about the future of population health management.

I want to know what hasn’t worked in transitioning to value-based reimbursement. I hope to see stories describing how health systems identified their care management weaknesses. And I definitely want to find out what worries senior executives about supporting necessary changes to their care delivery models.

It’s time to admit that we don’t yet know how this population health management thing is going to work and abandon the use of terminally vague generalizations. After all, once we do, we can focus on the answering our toughest questions — and that’s when we’ll begin to make real progress.

Diving Into Population Health

Posted on April 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Population Health is a nebulous term that seems to be applied a lot of different directions. To get a better understanding of what’s happening with Population Health, Healthcare Scene sat down with Arthur Kapoor, President and CEO of HealthEC. HealthEC has been working in healthcare and the population health space for more than 24 years, so they have an interesting perspective on how that space has evolved over the years and where we are today.

You can watch the full video embedded below, or skip to any of the following population health topics we discussed with Arthur:

Utilizing data to understand and better serve populations is only going to become more important in healthcare. A big thanks to Arthur for sharing his insights with us.

If you liked this video, be sure to subscribe to Healthcare Scene on YouTube and watch other Healthcare Scene interviews.

Population Health 101: The One Where It All Starts

Posted on December 7, 2016 I Written By

The following is a guest blog post by Abhinav Shashank, CEO & Co-founder of Innovaccer.
population-health-101
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!

Increasing Troubles
report from Commonwealth Fund points out how massive the US health care budget is. 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:

  1. The US is 3rd when it comes to public spending on health care. The figure is $4197 per capita, but it covers only 34% of its residents. On the other hand, the UK spends only $2,802 per capita and covers 100% of the population!
  2. With $1,074, US has the 2nd highest private spending on healthcare.
  3. In 2013, US allotted 17.1% of its GDP to healthcare, which was the highest of any OECD country.   In terms of money, this was almost 50% more than the country in the 2nd spot.
  4. 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).
  5. The infant mortality rate in the US was also higher than other OECD nations.
  6. 68 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.

population-health-trends

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 which 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.

Countless Possibilities
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, a 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 with 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.

Let us consider Diabetes for instance. Many times Diabetes is hereditary and preventive measures like patient engagement would play an important role in mitigating risks. Remote Glucometers, could be useful in keeping a check on patient sugar levels at home. It could also send an alert to health coaches and at-risk population could be engaged in near real-time.

Population Health Management not only keeps track of population trends but also reduces the cost of quality care. The timely engagement of at-risk population reduces the possibility of extra expenditure in the future. It also reduces the readmission rates. The whole point of population health management is to be able to offer cost effective quality-care.

The best thing to do with the past is to learn from it. If providers implement in the way Population Health Management is meant to be, then the healthcare system would be far better and patient-centric.

Success Story
A Virginia based collaborative started a health information based project in mid-2010. Since then, 11 practices have been successful in earning recognition from NCQA (National Committee for Quality Assurance). The implemented technologies have had a profound impact on organization’s performance.

  1. For the medical home patients, the 30-day readmission rate is below 2%.
  2. The patient engagement scores are at 97th percentile.
  3. With the help of the patient outreach program almost 40,000 patients have been visited as a part of preventive measures.

All this has increased the revenue by $7 million.

Barriers in the journey of Population Health Management
Currently, population health management faces a lot of challenges. The internal management and leadership quality has to be top notch so that interests remain aligned. Afterall, Population Health Management is all about team effort.

The current reimbursement model is also a concern. It has been brought forward from the 50s and now it is obsolete. Fee-for-service is anything, but cost-effective.

Patient-centric care is the heart of Population Health Management. The transition to this brings us to the biggest challenge and opportunity. Data! There is a lot of unstructured Data. True HIE can be achieved only if data are made available in a proper format. A format which doesn’t require tiring efforts from providers to get patient information. Providers should be able to gain access to health data in seconds.

The Road Ahead
We believe, the basic requirement for Population Health Management is the patient data. Everything related to a patient, such as, the outcome reports, the conditions in which the patient was born, lives, works, age and others is golden. To accurately determine the cost, activity-based costing could come in handy.

Today, the EMRs aren’t capable enough to address population health. The most basic model of population health management demands engagement on a ‘per member basis’ which can track and inform the cost of care at any point. The EMRs haven’t been designed in such a way. They just focus on the fee-for-service model.

In recent years, there has been an increased focus on population health management. Advances in the software field have been prominent and they account for the lion’s share of the expenditure on population health. I think, this could be credited to Affordable Care Act of 2010, which mandated the use of population health management solutions.

Today, the Population Health Management market is worth $14 billion and according to a report by Tractica, in five years, this value will be $31.8 billion. This is a good sign because it shows that the focus is on value-based care. There is no doubt we have miles to go, but at least now we are on the right path!

Longitudinal Patient Record Needed To Advance Care?

Posted on November 23, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In most day to day settings, a clinician only needs a small (if precisely focused) amount of data to make clinical decisions. Both in ambulatory and acute settings, they rely on immediate and near-term information, some collected during the visit, and a handful of historical factors likely to influence or even govern what plan of care is appropriate.

That may be changing, though, according to Cheryl McKay of Orion Health. In a recent blog item, McKay argues that as the industry shifts from fee-for-service payment models to value-based reimbursement, we’ll need new types of medical records to support this model. Today, the longitudinal patient record and community care plan are emerging as substitutes to old EMR models, McKay says. These new entities will be built from varied data sources including payer claims, provider EMRs, patient health devices and the patients themselves.

As these new forms of patient medical record emerge, effective population health management is becoming more feasible, she argues. Longitudinal patient records and community care plans are “essential as we steer away from FFS…The way records are delivered to healthcare providers– with an utter lack of visibility and a lot of noise from various data sources– creates unnecessary risks for everyone involved.”

She contends that putting these types of documentation in place, which summarize patient-based clinical experiences versus episodic clinical experiences, close big gaps in patient history which would otherwise generate mistakes. Longitudinal record-keeping also makes it easier for physicians to aggragate information, do predictive modeling and intervene proactively in patient care at both the patient and population level.

She also predicts that with both a longitudinal patient record and community care plan in place, getting from the providers of all stripes a “panoramic” look at patients, costs will fall as providers stop performing needless tests and procedures. Not only that, these new entities would ideally offer real-time information as well, including event notifications, keeping all the providers involved in sync in providing the patient’s care.

To be sure, this blog item is a pitch for Orion’s technology. While the notion of a community-care plan isn’t owned by anyone in particular, Orion is pitching a specific model which rides upon its population health technology. That being said, I’m betting most of us would agree that the idea (regardless of which vendor you work with) of establishing a community-wide care plan does make sense. And certainly, putting a rich longitudinal patient record in place could be valuable too.

However, given the sad state of interoperability today, I doubt it’s possible to build this model today unless you choose a single vendor-centric solution. At present think it’s more of a dream than a reality for most of us.

Population Health Tech Will Lag Until Standards Emerge

Posted on June 22, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

There’s little doubt that healthcare organizations will continue to partner up with peers and acquire physician practices. The forces that drive healthcare network development are only intensifying as time goes by, particularly as the drive toward value-based payment moves ahead. But there’s a lot more to making such deals work than a handshake and a check. To make these deals work, it’s critical that networks become experts at population health management — and unfortunately, that’s going to be tough.

While merging health systems into ACOs or acquiring referring physicians has merit, this strategy won’t grow the steadily dropping pace of hospital admissions, notes William Faber, M.D., senior vice president of the GE Healthcare Camden Group. “Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base,” making it unlikely that the networks will grow admissions, he points out.

To make a clinically integrated network successful, it certainly helps to take the initiative – to get to market more quickly than competitors – and to do a better job of controlling costs of care and demonstrating higher quality and service. Where things get stickier, however, is in managing that care across a large group. “The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management,” he writes.

And this, I’d argue, is where things get very tricky. Well, judge for yourself, but I’d argue that the HIT industry is ill-equipped to support these goals. Despite many years of paper-chart experimentation with population health, and several with population health technology, my sense is that the tech is far behind what it needs to be. Health IT vendors won’t get far until providers do a better job of defining what they need.

A different mindset

The truth is, this generation of EMRs is designed to track individual patients across an experience of care. While CIOs can add a layer of analytics technology to the mix, that is a far cry from creating tools that natively track population health trends. Looking at populations is simply a different mindset.

Admittedly, vendors will tell you that they’ve got the problem licked, but if they were completely candid many would have to admit that their products aren’t mature yet. Until someone creates an EMR or other basic tool which is designed, at its core, to track group health trends, I foresee more half-baked hacks than results.

What’s more, I doubt the health IT business will be able to help until it has at least an informal standard to which such products must adhere. Should such tools measure costs of care by diagnosis code? Compare such costs to national standards? Highlight patients in outpatient settings whose tests or exams suggest a crisis is about to happen? If so, which settings, and what cutoffs should be tracked for test scores? Does such a system need natural language processing to scour physician notes for trigger words, and if so which ones?

Without a doubt, medical and business executives leading integrated networks will come together and develop more answers to these questions. But until they do, health IT vendors won’t be able to help much with the population health challenge.

Value-Based Lawn Care – Life Imitating Healthcare

Posted on March 28, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Ah, spring. Warmer weather, budding trees and the return of that big ball of light in the sky. The clearest sign of spring? The arrival of lawn-care flyers in my neighborhood. It’s only been a week of spring and already I have received over 15 flyers.

Normally I just throw these flyers out – taking care of my lawn is a responsibility I prefer not to outsource – but this year one company’s flyer caught my eye. Instead of the pay-as-you-mow or weekly visit programs offered by their competitors, this particular company was offering a program that guaranteed a green lawn until the start of fall. For a set price they would aerate, weed, spray, fertilize, cut and trim your lawn as needed.

“Have a healthy, weed-free lawn all summer. Let us do all the preventative and maintenance work. You just enjoy your weekends.”

Here was a company that was eschewing the industry’s volume-based standard practice and opting for a value-based offering instead. This company smartly recognized that homeowners do not want someone to come and care for their lawn on a regular basis but rather a healthy green lawn. The process to get that healthy lawn makes no difference, just the outcome. Funny how no government penalty system or legislation was need to pressure lawn-care providers into adopting a value-based model.

I must admit I never thought that the lawn care industry in my neighborhood would be going through the same volume-vs-value challenge as we are in healthcare.

I wouldn’t have made this connection had it not been for the excellent post by Sarah Bennight, Director of Marketing at eMedApps. She wrote about the four key requirements she believes are necessary for transitioning to value-based care:

  1. Strong quality measures
  2. Comprehensive population health
  3. Predictive analytics and trending in the clinical setting
  4. Breaking down silos

The lawn-care industry doesn’t have any comparable challenges (or consequences) like those mentioned by Bennight. I can’t imagine that competing landscaping companies are all that interested in sharing data or breaking down industry silos. However, I do think that healthcare can look to other industries for inspiration and ideas to address our own transition to a value-based world.

Better go seed my lawn now.

Hospitals Should Give Smartphones To Sick Patients

Posted on June 1, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As I see it, hospitals have developed a new and rapidly emerging problem when it comes to managing mobile health services. Not only do they face major obstacles in controlling staff use of tablets and smartphones, they’re right in the center of the growing use of these devices for health by consumer. It’s BYOD writ even larger.

Admittedly, most of the consumers who use mobile devices don’t rely that heavily on them to guard and guide their health. The healthiest of consumers may make a lot of use of wearable fitness bands, and a growing subset of consumers may occasionally leverage their phone’s video capabilities to do telemedicine consults, but few consumers base their medical lives around a mobile device.

The chronically-ill patients that do, however, are very important to the future of not only hospitals — which need to keep needless care and readmits to a minimum if they want to meet ACO goals — but also the insurance companies who finance the care.

After all, the more we dig into mHealth, the more it appears that mobile services and software can impact the cost of care for chronic conditions. Even experiments using text messages, the lightest-weight mobile technology available, have been successful at, for example, helping young women lose weight, change their diets, and slash their risk of cardiac problems. Just imagine the impact more-sophisticated technologies offering medication management, care coordination, blood glucose and pulse ox tracking could have on patients needing support.

But there’s a catch here. A long as mHealth services are delivered via the patient’s own device, the odds of successfully rolling out apps or connected health monitoring services are minimal. I’d argue that such mHealth services will only have a major impact on sick patients if the technology and apps are bolted to the hospital or clinic’s IT infrastructure.  And the operating system used by patients, be it Android or iOS, should be the same one the hospital supports among its employees, or maintaining apps, OS upgrades and patches and even firmware upgrades will be a nightmare to maintain.

Given the security and maintenance issues involved in fostering a connection between provider and patient, I’d argue that providers who are serious about advanced mHealth services absolutely must give targeted chronically-ill patients a locked-down, remote controlled smartphone or tablet (probably a smartphone for mobility) and lock out their networks from those trying to use connected apps on a rogue device.

Will this be expensive?  Sure, but it depends on how you look at costs.  For one thing, don’t you think the IT staff costs of managing access by various random devices on your network — or heaven forbid, addressing security holes they may open in your EMR — far exceed even the $700-odd retail price for such devices?

This might be a good time to get ahead of this issue. If you’re forced to play catch up later, it could cost a lot more.

Healthcare Analytics is a Big Privacy Issue

Posted on March 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Coming out of HIMSS, everyone said that healthcare analytics was a major discussion. I talked to someone from Allscripts today and they quoted me that something like 42% of their business is coming from population health (analytics, patient portal, and HIE) functionality. Today someone else told me that the future of healthcare IT is going to really be around analytics and how we use the data. When you think about future revenue streams, the data is likely going to be the center of most business models.

Analytics is going to play a major role in the future of health IT and I believe will lead to really important improves in the care patients receive. My guess is that one day we’ll look back on the EHR of today and wonder how we saw patients with such limited data and intelligence built into the EHR.

However, Sheri Stoltenberg from Stoltenberg Consulting made a great comment to me at HIMSS which is the title of this blog post: Healthcare Analytics is a Big Privacy Issue.

While we love to talk about the benefits of big healthcare data and the value of healthcare analytics, it’s also got a lot of big privacy issues that I think we’re going to need to address. Many will argue that we already have HIPAA and that should be enough. Certainly it will provide the framework for privacy and security of healthcare data and analytics. However, that’s likely going to need to evolve as the healthcare analytics involves. I’m not sure we even know the issues that healthcare analytics will pose to privacy in 5 years. Unfortunately, I don’t see HIPAA being able to keep up with it.

If the healthcare IT industry were smart, it would start working together and appropriate privacy and security within healthcare analytics. If they don’t, be ready for the government to step in and impose it on them. We know how that usually works out.

Hopefully this blog post will be inspiration for every organization to consider the privacy and security issues associated with their healthcare analytics.