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Landmark Review of Population Health Management

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Population health management (PHM) is in its early stages of maturity, suffering from inconsistent definitions and understanding, overhyped by vendors and ill-defined by the industry. Healthcare IT vendors are labeling themselves with this new and popular term, quite often simply re-branding their old-school, fee-for-service, and encounter-based analytic solutions. Even the analysts —KLAS, Chilmark, IDC, and others—are also having a difficult time classifying the market. In this paper, I identify and define 12 criteria that any health system will want to consider in evaluating population health management companies. The reality of the market is that there is no single vendor that can provide a complete PHM solution today. However there are a group of vendors that provide a subset of capabilities that are certainly useful for the next three years. In this paper, I discuss the criteria and try my best to share an unbiased evaluation of sample of the PHM companies in this space.

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Landmark Review of Population Health Management

  1. 1. © 2013 Health Catalyst www.healthcatalyst.com The 12-Criteria of Population Health Management By Dale Sanders Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  2. 2. Overview Focus is on the data management of Population Health Management • Not necessarily the processes of PHM Purpose • Evaluate healthcare IT vendors and their PHM offerings • Develop internal strategies and roadmaps for Accountable Care Organizations (ACO) © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  3. 3. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Precise Patient Registries 1 Evidence-based definitions of patients to include in population health registries Beyond ICD-9 billing codes, which are likely to miss 30-40% of the population
  4. 4. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Patient-Provider Attribution 2 Strategies and algorithms to assign patients to accountable physicians or clinicians Generally accepted high-level options for assigning attribution Patient selection of physician during open enrollment “Most frequently visited” physician over the past two years Random assignment of patients to primary care physicians in the same geographic area Random assignment of patients in an employer group to primary care physicians in the PPO or HMO
  5. 5. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Precise Numerators in Registries 3 Discrete, evidence-based methods for flagging the patients in the registries that are difficult to manage or should be excluded Reasons why a patient may not be able to fully comply with clinical protocols Language barriers Cognitive inability to participate in a care protocol Physical inability to participate in a care protocol Economic inability to participate in a care protocol Willing and informed refusal to participate in a care protocol, e.g. religious reasons Medication contraindications to participating in a care protocol Geographic inability to participate in a care protocol Mortality (it can be surprisingly difficult to identify these patients)
  6. 6. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Clinical and Cost Metrics 4 Monitoring clinical effectiveness and cost of care to the system and patient Measure practice of medicine against these protocols Measure the variability in care Build dashboards around specific patients and population of patients Must track the total cost of care for specific patients and a per-capital basis across the population Provide quality, outcome, and cost variance feedback to physicians, risk adjusted, at the point of care Ultimately this prepares an organization for fixed-fee contracting in a true value-based system
  7. 7. Measure practice of medicine against these protocols Current evidence-based medicine lacks applicability outside the specific clinical trial In the future, clinical trials’ “evidence” will be displaced by derived evidence from the analysis of local data sourced by the EDW In the meantime, the industry must make-do with existing evidence and guidelines Many external commercial sources and commercial vendors Health systems need to establish a “Clinical Practice Guidelines” governance body and select their source(s) and processes Start by defining clinical practice guidelines for patient cohorts and process families that offer the highest opportunity for improvement and cost savings © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Basic Clinical Practice Guidelines 5 Evidence-based triage and clinical protocols for single disease states Number of patients In the population The Average Total Medical ( ) X ( E xp e n d it u re ( T M E ) p e r C a p it a)
  8. 8. Risk stratification enables an organization to analyze and minimize the progression of a disease and the development of comorbidities © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Risk Management Outreach 6 Stratified work queues that feed care management teams and processes First need to stratify and monitor the registry patients Then develop strategies to identify and intervene with high-risk trajectory patients Ultimately need to profile and proactively treat patients before becoming members of the registry
  9. 9. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Acquiring External Data 7 Access to clinical encounter data, cost data, laboratory test results, and pharmacy data outside the core healthcare delivery organization Contrary to current national strategy and focus, acquiring external data should be a secondary focus in today’s market It is geometrically more complicated to manage a patient population beyond the core healthcare delivery organization Start with in-house process and data quality first Then, carefully and deliberately expand the data ecosystem HIEs are the most visible technology associated with ACO external data exchanges, but only address a small portion of the data puzzles required for PHM The “A” in M&A will shift from bricks-and-mortar acquisition to data acquisition
  10. 10. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Communication with Patients 8 Engaging patients and establishing a communication system about their care Current solutions are fragmented and immature but will improve dramatically in the next 3 years Today’s typical patient engagement solution is through a personal health record (PHR) tightly associated with a healthcare delivery organization EMR The future patient engagement solution will be completely patient owned, decoupled from an EMR or single healthcare organization The PHR will evolve into a personal project management system, with a combination of project management, knowledge management and social support. Take advantage of current PHRs, but be prepared to jettison current PHRs for something more informative, customized, collaborative and functionally rich
  11. 11. • Low-income, preteen girl with type 1 diabetes likely to receive same education material as a middle-aged executive man • Materials are not tailored to blend comorbid conditions together © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Educating and Engaging Patients 9 Patient education material and distribution system, tailored to the patient’s status and protocol Our current patient education system is hampered by the lack of highly personalized materials and an effective distribution system Often, today’s patients receive no education material about their condition PHRs tend to present generic education information No certified, widely available method of evaluating material quality Widely used vehicles like Twitter, Facebook, Zite, and Amazon have yet to be fully embraced
  12. 12. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Complex Clinical Practice Guidelines 10 Evidence-based triage and clinical protocols for comorbid patients Establishing protocols for comorbid patients is complicated Few industry sources for clinical protocols for comorbid patients Physicians often left to build their own guidelines, or chain individual disease treatment protocols together Medicare patients on average affected by at least chronic diseases at the same time Organizations that optimize comorbid care will be in a strong position to differentiate themselves in the market, both financially and clinically
  13. 13. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Care Team Coordination 11 Inter-clinician communication and project coordination We need to treat every patient as if they are at the center of a project plan All members of a patient’s care management team should be able to quickly and easily see the patient’s overall project plan, next milestones, and responsibilities Acute encounters should show recovery milestones and assigned people Chronic diseases should show a lifetime project plan for health The ideal system would function like a project management tool (like Basecamp)
  14. 14. This is also the most culturally and technically difficult criteria to implement © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CRITERIA Tracking Specific Outcomes 12 Patient-reported outcomes measurement system, tailored to the patient’s status and protocol Patient-reported outcomes data is one of the most important pieces of data missing from our ecosystem today Our best efforts today is assessing patient satisfaction, but that data falls short as an aid for measuring actual clinical outcomes Currently, no reasonable options exist in our industry A future patient-reported outcomes system must have a closed-loop data relationship with the EMR, and then exported to the EDW for analytic purposes
  15. 15. Vendor Evaluation and Scoring No single vendor today offers an integrated and fully functional population health management solution that meets all 12 criteria Vendor scoring criteria Personal experience as a customer of the vendors’ products Personal experience as an executive in the company (i.e. Health Catalyst) Conversations and interviews with current and past customers of the vendors’ products Market reports from, and conversations with, industry analysts at KLAS, Chilmark, IDC, Gartner, and the Advisory Board Publically available information on the vendors, including their own case studies, white papers, on-line product demos, and product information Conversations with current and past employees of the vendors © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  16. 16. Vendor Evaluation and Scoring Two patterns emerge from the scores 1: The vendor market is very inconsistent in its approach to population health management 2: Not all criteria equally important now The first six to eight criteria are the most important now They should be weighted heavier in the decision making and deployment planning process © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  17. 17. Vendor Evaluation and Scoring First tier evaluation scores Crimson Explorys Health Catalyst Lumeris Optum Humedica Phytel Premier Average Score © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Criteria #01: Precise Patient Registries 5 5 9 3 3 3 3 4.4 Criteria #02: Precise Patient Attribution 5 5 8 5 6 5 5 5.6 Criteria #03: Precise Numerators in the Patient Registries 0 0 5 0 0 0 0 .7 Criteria #04: Clinical and Cost Metrics 7 7 9 6 5 4 5 6.1 Criteria #05: Basic Clinical Practice Guidelines 0 0 0 3 5 5 0 1.9 Criteria #06: Risk Management Outreach 1 0 0 5 7 5 0 2.6 Sub-Total 18 17 31 22 26 22 13
  18. 18. Vendor Evaluation and Scoring Second tier evaluation scores Crimson Explorys Health Catalyst Lumeris Optum Humedica Phytel Premier Average Score © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Criteria #07: Acquiring External Data 0 5 6 0 4 2 7 3.4 Criteria #08: Communication with Patients 0 0 0 4 5 6 0 2.1 Criteria #09: Educating and Engaging Patients 0 0 0 2 3 4 0 1.3 Criteria #10: Clinical and Cost Metrics 0 0 0 0 0 0 0 0.0 Criteria #11: Complex Clinical Practice Guidelines 0 0 0 0 0 2 0 0.3 Criteria #12: Tracking Specific Outcomes 0 0 0 0 0 0 0 0.0
  19. 19. Asset Allocation and Timing Recommended asset allocation as the market and organization evolve and mature in population health management © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  20. 20. Asset Allocation and Timing Recommendations Build a population health management roadmap Start as soon as possible with the first six criteria while the latter six develop in the market © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  21. 21. Conclusion Key points to remember Follow the lead of the IDNs which have been practicing PHM for years Reference this presentation and the CCHIT framework when developing an organizational strategy and evaluating vendors for PHM There is no single vendor that can provide a complete PHM solution today Sequencing is important. Focus on the first six criteria over the next three years while the context evolves © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  22. 22. Population Health Management The Ordered Checklist for Your 3-5 Year Journey 1. Registries: Evidence-based definitions of patients to include in the PHM registries 2. Attribution & Assignment: Clinician-patient attribution algorithms 3. Precise Numerators: Discrete, evidence based methods for flagging patients in the registries that are difficult to manage in the protocol, or should be excluded from the registry, altogether 4. Clinical & Cost Metrics: Monitoring clinical effectiveness and total cost of care (to the system and the patient) 5. Basic Protocols: Evidence based triage and clinical protocols for single disease states 6. Risk Outreach: Stratified work queues that feed care management teams and processes for outreach to patients 7. External Data: Access to test results and medication compliance data outside the core healthcare delivery organization 8. Communication: Patient engagement and communication system about their care, including coordination of benefits 9. Education: Patient education material and a distribution system, tailored to their status and protocol 10. Complex Protocols: Evidence based triage and clinical protocols for comorbid patients 11. Coordination: Inter-physician/clinician communication system about overlapping patients 12. Outcomes: Patient reported outcomes measurement system, tailored to their status and protocol © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  23. 23. Link to original article for a more in-depth discussion. A 12-Point Review of Population Health Management Companies (Webinar) More about this topic The Evolution of Care Management to Population Health Management This covers the evolution of the care management market to the population health management, the data needs for effective population health management, and population health business models Why the Solution to Population Health Management Woes Isn’t an EMR Healthcare systems are struggling to figure out how to shift to a value-based model and remain competitive. This will require hospitals to identify and reduce waste in three categories: the variation in 1) the care that is ordered, 2) how efficiently that care is delivered, 3) in care delivery that causes preventable complications .Clearly, EHRs aren’t the answer. The Best Way to Prioritize Your Population Health Management Efforts Effective population health management starts with clearly defining a subset or cohort of patients and determining on which clinical processes to focus improvement efforts. The Health Catalyst Key Process Analysis (KPA) application determines the highest variation and highest resource consumption by integrating and analyzing clinical and financial data. Case Study: Using Data and Reporting in Population Health Efforts How a healthcare system went from manually pulling together reports with varying data to having near real-time data that one executive says, "enables our care coordinators to drive preventive care and ultimately lower our population health costs" Case Study: Using Advanced Analytics to Manage Primary Care Population Health Population health management is largely being driven by the 5 percent of the population accounts for 50 percent of healthcare costs. Being able to identify these patients, provide high-quality care and reduce their utilization is a pressing goal for many of today’s primary care providers (PCPs). Learn how one organization used health care analytics to meet this challenge. Implementing a Successful Population Health Management Strategy A White Paper by Dr. David Burton Based on 25 years of experience, first as a senior executive at Intermountain Healthcare and later as the Chairman of the Board of Health Catalyst, Dr. Burton shares his in-depth learnings about how to systematically implement population health management in a long-term, sustainable way. © 2013 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

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