For organizations seeking to improve their population health management capabilities, big data is a critical part of the journey.
Gathering information from different sources – such as claims, medical records, and lab systems – can help providers paint a picture of patients’ health, target resources to those who need them most, and measure health outcomes.
At Lee Health, leaders recognized the need for a solution that would help them build an infrastructure to unify data from these different sources, resulting in improved care management and population health management applications.
“We have been on a population health journey for about four years,” Robert Millette, executive director of population health at Lee Health, told HealthITAnalytics.
“Our goal is to be a clinically integrated network across our tri-county region. We want to have the ability to narrow networks to high-quality, appropriate costs, and get into unique relationships with payers, which present a pathway to long term quality and success.”
This type of investment and payer relationship can help offset stagnant revenues while allowing organizations to focus on quality, Millette noted.
“To do that, we not only have to bring our employee group into a value-based environment, but we also have to bring in community partners of standalone practices, including primary care and medical and surgical specialties,” he stated.
“So, we need a platform that connects us. We need a horizontal platform that connects all of these different verticals that we have across the healthcare landscape, with the express goal of improved outcomes in the populations that we're managing. This will lead to lower costs of care.”
Lee Health partnered with Innovaccer to implement a horizontal solution that would drive quality. The platform helps providers and care managers keep up with changes in patients’ health status, helping them stay ahead of poor outcomes.
“One of the things that differentiates us as a value-based organization is the relationships that our high-risk care managers have with the local physician population that truly owns these patients from a care perspective. One of their goals is to build a relationship with providers and staff so as to drive the focus on these high-risk patients,” said Millette.
“This unified platform helps us because we have the opportunity to connect what's going on with the patients when they are not in the physician's office. It allows us to unify claims data, EHR data, and other sources of information to help paint a picture of the patient’s needs. The platform also enables us to conduct predictive risk stratification of populations, which can help us prevent an event from occurring.”
With the platform, a primary care physician or a specialist can see what the high-risk care management team is doing with a patient, and they can agree or disagree with the changes a care manager might make.
“You can think of that team as an extension of the provider's office. The integration of this work – making it appear seamlessly to a provider in their native EMR workflow – is really the key,” said Millette.
“That's the benefit of being in a network that is building an infrastructure towards value. Providers are able to have that outreach and extension in the community outside of traditional channels. They have the ability to touch all of the vertical segments in healthcare and work toward better outcomes, through the platform and the team.”
While horizontal solutions like these can help connect key players and elements in healthcare delivery, Millette pointed out that implementation doesn’t always come without roadblocks.
“We've run into some project management barriers on both sides. The IT expertise is there – but the industry needs to develop clinical and data experts around value to help pave the road,” he explained.
Setting expectations is another barrier that the organization has had to overcome.
“Both clinical and operational leaders have to understand that this solution cannot be everything for us, nor can any of these solutions be everything for us. They are a part of the puzzle,” Millette said.
“We have to make sure that we're setting expectations appropriately. Anybody going on this journey should make sure the expectations are clear. Understand your top three or four deliverables in each phase, as well as the underlying measures that you're going to use to gauge your success.”
For health systems looking to enhance the use of big data, leaders should first understand what their goals are and how they plan to achieve them.
“Number one, you need to have a strategy. You need to know how you're going to differentiate yourself in whatever area you're looking to support with that tool,” Millette stated.
“You should also remember that the unified data platform is simply a tool – it’s a means to an end. It is by far not the only thing. You have to have network infrastructures, and you have to have the right contracts with payers to move and perform in value. There are a number of different levers you need to have, and they're all important.”
Leaders at Lee Health plan to use the lessons they’ve learned to refine and enhance their care management and population health management practices.
“Going forward, we want to continue to perfect what we're doing right now – bringing in the claims data, marrying it with some pertinent EHR data to develop action plans around patients, improving quality and outcomes, and ultimately lowering costs in our payer partnerships,” Millette said.
“And again, those are value propositions that certainly move away from volume, because it's not about volume of care. It's about actually connecting the dots across the continuum to create more value in that volume.”
In many organizations, the ongoing shift to value-based care can be challenging – but it’s a worthy journey to undertake.
“Giving a holistic view of a physician's performance in terms of value metrics instead of volume-based metrics is extremely important. It’s a learning experience for all,” Millette concluded.