The educational sessions at HIMSS16 serve as a barometer of the progress of population health management as a priority for healthcare organizations.

This year, after three days of attending sessions, I note four key themes—

1) Current economic realities are driving new strategies

The changing market is not just a distant-future consideration. Payment reform from CMS and private payers is already occurring and will accelerate. Local markets—in which healthcare organizations must compete—face shifting roles and demands of employers and consumers. In one local market, a reported 75% of payments are tied to risk contract. Facing the fact that maintaining the status quo is not sustainable in the long term, organizations are setting new strategic directions that balance external forces and internal capabilities to achieve success under commercial and Medicare programs.

2) Collaboration is key

Healthcare organizations must work with others to realize the revenue under value-based reimbursement. This includes building relationships with non-contracted physicians and other (often competing) organizations to form accountable care organizations, clinically integrated networks or performing provider systems to provide the geographic coverage required for an assigned population. In addition, organizations are changing their relationships with employers and payers to seek win-win contractual arrangements that improve the quality of care for patients served and manage the costs for all stakeholders.

For example, Inova Health System and Aetna launched a joint venture to form a new health plan, Innovation Health, working together for improved care, cost and quality. Care coordinators steer members to appropriate programs and provide coaching. High-risk patients are enrolled in care management programs at post-acute facilities, and high-performing skilled nursing facilities (SNFs) are selected for inclusion on the network.

3) Results are starting to show

Population health initiatives seem to be more targeted and organizations are more specific about what they want to measure. The result is that—beyond reports of pilots and early steps—we are beginning to see tangible, positive results from these initiatives. The joint venture cited above has achieved a 17% reduction in the number of unnecessary hospital days after surgery, 15% fewer hospital admissions and 21% fewer hospital readmissions. As another example, Banner Health reported on the successes of its telehealth program: 20% reduction in length of stay, 45% reduction in hospitalizations and a 27% reduction in total cost of care.

4) Health Information Technology (HIT) is necessary for success

As the number of population health initiatives increases, and the number of at-risk lives grows, organizations recognize that HIT solutions are required to achieve the efficiency, effectiveness and scale that the programs demand. Successful organizations employ and rely upon solutions for data aggregation, risk stratification, analytics, interoperability and population health management. Staten Island PPS, for example, reports that each of its 11 DSRIP projects actively underway has unique HIT requirements for success including longitudinal patient records, predictive analytics and utilization management, telehealth and patient registries.

One other theme, that overlays the rest, became apparent during the educational sessions. The journey to population health management will continue, but the routes will change. What works today may or may not work tomorrow as the relationships among the different stakeholders shift.

Caradigm offers population health solutions that offer scalability and adaptability over time. You can have a discussion with a Caradigm representative by leaving a note here.

1. “Value-Based Models: Two Successful Payer-Provider Approaches.” Clifford T. Fullerton, MD MSc and Mark Stauder. March 1, 2016.
2. “Volume-based to Value-based Care at a Pioneer ACO.” Julie Reisetter, MS, RN. March 3, 2016.
3. “Addressing the IT Challenges for a Startup DSRIP Program.” Joseph Conte, PhD(c). March 2, 2016.
4. “Transformative Payment Models.” Jody White and Brian Sandager. March 1, 2016.

On Day 1 of the Caradigm Customer Summit (CCS), we heard multiple provider organizations talk about how they are leaning in on population health, and are seeking to build the best practices and health IT to successfully scale their programs. On Day 2, we continued to explore the strategies and tools that can help organizations succeed with new value-based reimbursement models. Here are the highlights from another great day of learning at CCS.

Neal Singh Chief Technology Officer, Caradigm and Kendra Lindly VP, Global Product Management, Population Health and Analytics, Caradigm

Neal and Kendra provided insights into the overall vision of Caradigm’s product strategy as well as the collaborative development approach they take with customers. They also highlighted new applications and features that are in the roadmap across Caradigm’s four pillars of integrated solutions (Data Control, Healthcare Analytics, Care Coordination and Management, and Patient Engagement & Wellness).

Nicholas Greif, Project Manager Virtua and Jill Manz, System Integrator Virtua

Nicholas and Jill talked about how Virtua, a leading provider in South Jersey, is using Caradigm’s information security and population health tools to help improve patient care within their VirtuaCare ACO. They explained how over time, Virtua has continued to mature its population health IT infrastructure, and will be delivering actionable predictive analytics such as Sepsis risk scores to clinicians in their native EMR so they can take proactive action.

Federal and State Driven Programs Panel

Vicki Harter, VP of Care Transformation moderated a panel made up of John Supra from Greenville Health System, Scott Anderson from MyCareCoach and Todd Ellis from KPMG. They discussed how to succeed with the variety of Federal and State Funded programs that are available to providers today. The panelists agreed that although providers don’t have to have all the answers right now, they do need to start thinking about who they’re going to align and partner with, and how they’re going to get their hands on the right data and share it.

Michael Robinson SVP, Global Services, Caradigm and Mike Macedo Director, Application Services, Caradigm

The closing presentation was from Michael Robinson and Mike Macedo who talked about how to drive user adoption of new population health technologies. It’s an important consideration for providers when seeking new health IT because acquiring technology is only part of the journey. It takes deep collaboration between a technology partner and a provider to train and engage employees who are learning about new organizational strategies, workflows and IT systems. While it does take much effort to train users and drive adoption, Mike and Mike explained that the payoff is when employees become fully engaged in the process. They talked about the collective excitement that they’ve seen in recent customer deployments that energizes the entire organization. With that level of employee engagement, a provider is well positioned to succeed with their population health initiatives.

Day 2 also included more outstanding peer-to-peer discussion during roundtables on patient engagement, physician engagement and IT security organizational engagement. As mentioned in the Day 1 post, we’ll share best practices from those sessions in a upcoming blog series.

In addition to learning and sharing about population health, CCS is also about having fun and building relationships in the industry. It’s not always sunny in Seattle, but it always seems to be sunny during CCS. Our attendees were treated to a couple of beautiful days of weather on the Seattle waterfront, and were able to relax and get to know each other at evening events.

It was an amazing two days at CCS 2015. Caradigm is extremely proud to be collaborating with so many of the top provider organizations in the country and around the world. We look forward to helping our customers with their key initiatives as they continue to lean in on population health.

The Seattle Great Wheel lit up in Caradigm mulberry.

We were absolutely delighted to kick-off the 4^th annual Caradigm Customer Summit (CCS) at the Bell Harbor Conference Center on the beautiful Seattle Waterfront. As healthcare continues its transformation to value-based care, gatherings like CCS are great opportunities for provider organizations to engage with peers who are on similar journeys to population health. In truth, population health is still so new that everyone is learning together. With over one hundred senior healthcare executives from leading organizations in attendance, CCS is a unique event focused exclusively on population health.

My main take away from the first day was that provider organizations are now further along in their journey to population health and are “leaning in”. The dialogue has matured from “should we do it” to “how do we optimize what we are doing”. The business decisions have been made, technology has been evaluated, and now it’s time to operationalize and scale efficiently. Here are some of the highlights from the day.

Michael Simpson Caradigm CEO Opening Welcome

“Every organization across the U.S. and the globe has to figure out how we make this journey to pop health work. We have a common goal.”

In Michael’s opening welcome, he shared a number of statistics that show that the growth in population health is real and that momentum is building. While technology barriers to population health and threats to information security also continue to be real, Michael talked about how Caradigm customers are progressing, and as a whole are leveraging Caradigm solutions to tap into data from over 150 different systems in over a billion patient encounters.

 

Angelo Sinopoli, MD VP, Clinical Integration & Chief Medical Officer, Greenville Health System

“The discussion used to be with the HR representative. Now the cost of healthcare has gotten so high, the discussion is with the CEO.”

Dr. Sinopoli explained that Greenville Health System views population health as the key strategy that will help them better serve patients while also helping them be a leading provider in the state of South Carolina. He also talked about why they formed their state-wide clinically integrated network, the MyHealth First Network and how they will drive care management best practices through the Care Coordination Institute, which leverages Caradigm’s full suite of solutions including Caradigm Care Management.

 

Marian Lowe, SVP of Payer and Employer Strategies USPI and Ashley Wise, VP of Strategic Systems USPI

“Population health for us is about how do we create a meaningful network of providers that improves patient care.”

Marion and Ashley detailed USPI’s journey to population health. As one of the largest network of surgical centers in the country, USPI realized that as their national network of partners started moving towards clinical integration and value-based care, USPI had to build the capabilities to support those activities. USPI then formed a clinically integrated network and an accountable care organization and are using Caradigm’s solutions to support those efforts with data aggregation and analytics.

Matt Stevens Advisory Board – Population Health and the Retail Revolution

“Providers are trying to provide the right care in the right location - achieve meaningful geographic reach and clinical scope.”

Matt Stevens from the Advisory Board shared industry insights about how the retail revolution in healthcare aligns with the movement towards population health. He explained that providers must win at two points of sale: 1) they must secure enrolled lives and 2) win share of volumes. In order to do so, they must form the right strategic network and gain the health IT infrastructure that can lower costs, manage populations, increase access and improve the patient experience.

 

Regina Holliday, Patient Advocate

“We are all patients in the end. This is where I take my stand.”

Renown patient advocate, Regina Holliday capped off Day 1 with a moving presentation about the patient information challenges her family faced while trying to receive care for a sick family member. As provider organizations seek to transform care models and improve the patient experience as part of population health efforts, Regina asked providers to take a patient-centered approach and include patients in the care team in order to best serve their populations.

Also on the agenda were several roundtable sessions where attendees engaged in peer-to-peer discussions on topics such as analytics, care and chronic condition management as well as health data privacy and security. In future blog posts, we will share some of the best practices that came out of those sessions. Thanks to our phenomenal guest speakers and customer attendees, it was an inspiring day of learning on the first day of the Caradigm Customer Summit. Check back tomorrow for a recap of Day 2!

I had the pleasure of participating on a population health panel at an IHT² conference held recently in Seattle.

As you’d expect, moderator Mark Hagland, Editor-in-Chief of Healthcare Informatics, drew on a variety of perspectives – primary care, public health, IT – from a variety of healthcare providers and vendors – to discuss what’s happening in population health management today and where we’re headed.

Some of the key Population Health points covered were:

• Moving from episodic, single-patient care to managing the health of populations represents a seismic shift that will require many years and tremendous patience to achieve, despite widespread industry commitment and focus. It’s going to take many years, for example, for physicians to change their way of thinking from operating as individual problem solvers to serving as members of a broader care team. They’ll need evidence that team-based care works.

• The ongoing debate about the pros and cons of electronic medical records underscores the need to significantly streamline clinician workflows and deliver IT solutions that work in a practical way. While a paper-based system might not measure up in terms of data quality, it’s a highly efficient way of capturing information. We need to find a way to maintain that level of efficiency with technology while improving data capture and quality.

• Success in population health requires looking holistically at the lives of patients and populations – factoring in their social, economic and physical environments, not just clinical data. Time spent between a patient and a doctor in a clinic or hospital is extremely limited. The vast majority of what impacts a patient’s health happens elsewhere. We need to put the patient at the center, engage the patient in his/her care through creative approaches and incentives like games or competitions, and establish a comprehensive community health record, not just a personal health record or EMR. We need to make that community health record easily accessible by the entire care team, including the pharmacist, the behavioral health specialist, the care manager, the primary care provider, and equally important, the patient.

• To make progress in population health management, healthcare organizations need to start small, focus on making an impact in a discrete area, and expand on that success. For example, a provider in Canada began their population health efforts by focusing on HIV-positive individuals. They set up one central resource to identify all treatment associated with HIV patients, connected databases, and proactively tracked when patients were diagnosed, how quickly they were linked to care, when they were put on Antiretroviral Drugs, etc., and helped them with housing needs. Their approach can serve as an effective blueprint for managing the health of other populations.

• Success in population health begins with collecting the right data and performing analytics to identify not just those patients that are costing your organization the most time and money today but those patients of highest risk of costing your organization the most next year. Once that risk has been identified, the extended care team can work together to address those patients’ needs proactively and keep them out of the high risk, high-cost category. Those analytics capabilities exist today.

• Last but not least, while we’re all concerned about identifying and addressing gaps in care to achieve the highest level of quality possible, we also need to focus on revenue. If an organization can identify revenue opportunities, it can invest more in care optimization going forward. “Without income there are no outcomes.”