{"id":388,"date":"2014-09-17T07:50:06","date_gmt":"2014-09-17T14:50:06","guid":{"rendered":"http:\/\/intercase.org\/?p=388"},"modified":"2014-09-18T07:57:48","modified_gmt":"2014-09-18T14:57:48","slug":"framework-for-discussion-of-population-health-management-it-tools","status":"publish","type":"post","link":"http:\/\/intercase.org\/?p=388","title":{"rendered":"Framework for Discussion of Population Health Management IT Tools"},"content":{"rendered":"<p>I am pleased by the frenzy of investment in tools that support the various elements of accountable care\/population health.\u00a0 I am a little surprised how rarely the advertised tools are detailed by the\u00a0 business functions that the tools support.\u00a0 I would suggest there are three broad categories of tools in support of accountable care:<\/p>\n<ol>\n<li>Provider performance measurement<\/li>\n<li>Predictive analytics<\/li>\n<li>Care coordination<\/li>\n<\/ol>\n<p>Each of these categories has one or more key subcategories.\u00a0 I think it would be useful to detail the subcategories to assist in IT tool selection.<\/p>\n<p><strong>Provider Performance Measurement Tools<\/strong><\/p>\n<p>This is the category that has been around the longest, and hence is the most mature.\u00a0 Typically, these tools aggregate claims and group the claims by care episode.\u00a0 Grouping of claims by episode gives an organization two fundamental capabilities:<\/p>\n<ul>\n<li>If the organization is going to contract for care, the tools give information on how to craft the contract, or indeed whether to contract at all<\/li>\n<li>If the tools are used during referral of an active patient, the tools can direct a clinician to select a referral target based on previous cost and quality performance<\/li>\n<\/ul>\n<p>There are literally dozens of tools in this category.\u00a0 The problem for most provider organizations is gaining access to a significant fraction of claims history to run the tools.\u00a0 This is somewhat easier for a health plan (because they have the claims for their members) but a provider organization might need claims from multiple payers about many other providers to make this tool perform successfully.<\/p>\n<p><strong>Predictive analytics<\/strong><\/p>\n<p>Predictive analytics tools are used for two broad purposes as well:<\/p>\n<ul>\n<li>Prospective assessment of costs for a defined population to support actuarial assessment\/pricing<\/li>\n<li>Identification of individuals likely to be utilizers to target treatment to mitigate the risk of adverse cost or quality events<\/li>\n<\/ul>\n<p>The claims-based predictive analytics tools are quite good at supporting the first bullet above.\u00a0 Unfortunately, claims-based analytics tools are poor at the second.\u00a0 The two problems with claims-based tools are 1) the predictive value is low for individual patients (R-squared is often under 50%) and 2) the claims arrive too late to be of any use (60 days post discharge does not give a lot of insight).<\/p>\n<p>Non-claims-based predictive tools are much more reliable if the objective is to direct active patient care.\u00a0 Non-claims-based tools would include:<\/p>\n<ul>\n<li>Tools to assess probability of readmission of a patient at discharge: This assessment is based on current clinical data (from the chart) and knowledge of the patient&#8217;s social circumstances (from interview or home assessment).\u00a0 This data, although harder to accrue and generally available only to the provider directly, is vastly more useful for predicting utilization.<\/li>\n<li>Tools to stratify populations based on global risk:\u00a0 Nearly any primary care physician can identify the top 3-4% of risky patients in his\/her practice.\u00a0 Risk, in this context is a combination of overall disease burden and weakness of social support mechanisms (primarily family) for the patient.\u00a0 Patients with high disease burden could be targeted for a deeper home assessment to identify preventable risks or potential family support mechanisms to mitigate the risk of utilization.<\/li>\n<\/ul>\n<p>It is worth noting that disease burden alone is often not a particularly strong indicator of future utilization, hence inclusion of data about a patient&#8217;s home environment is critical.\u00a0 The non-claims-based tools are often much more manual, but far more effective at identifying the high-utilization patients in advance.<\/p>\n<p>There are many tools to assist in the prediction of population costs, and they work well.\u00a0 There are very few tools to assist a provider organization in identification of high-risk patients.<\/p>\n<p><strong>Care Coordination Tools<\/strong><\/p>\n<p>As with the other tools, there are two very different objectives in care coordination:<\/p>\n<ul>\n<li>Disease management tools:\u00a0 These tools establish clinical objectives by disease state for each patient to assist in filling in gaps in care and to support reporting of compliance standards to external entities (payers, CMS).\u00a0 Disease management tools support compliance reporting and quality management.\u00a0 They do <em>not<\/em> drive cost reduction (indeed, they often raise utilization).<\/li>\n<li>Case management tools:\u00a0 These tools focus on specific patients in high-risk categories to manage the risk of excessive utilization or risk of treatment failure in complex conditions.<\/li>\n<\/ul>\n<p>There are many tools that support disease management functions.\u00a0\u00a0 These may be a component of the EMR specific to the clinical setting, or an add-on application to the EMR.\u00a0 In contrast, case management tools are somewhat more rare in the marketplace.\u00a0 The problem, as often as not, is that the critical issues in case management are often inter-clinical-setting.\u00a0 The implementation problem may be large enough that the provider organization is not well situated to &#8220;connect&#8221; to all of the key clinical settings to enable effective case management.<\/p>\n<p><strong>A Note on HIEs<\/strong><\/p>\n<p>Some might consider HIEs as an element in care coordination.\u00a0 In my view, HIEs alone do not &#8220;count&#8221; as care coordination tools.\u00a0 They may (or may not) be supportive, but if a tool cannot instantiate an intervention and report on completion of an intervention, it is tough to label it as a care coordination tool.\u00a0 Most HIEs would fail in this regard.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I am pleased by the frenzy of investment in tools that support the various elements of accountable care\/population health.\u00a0 I am a little surprised how rarely the advertised tools are &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5,3],"tags":[],"_links":{"self":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/posts\/388"}],"collection":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=388"}],"version-history":[{"count":5,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/posts\/388\/revisions"}],"predecessor-version":[{"id":394,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/posts\/388\/revisions\/394"}],"wp:attachment":[{"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=388"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=388"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=388"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}