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Challenges in Population Health Management

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Many obstacles remain in how to access multiple sources of data necessary for managing the health of a population

As HCI Editor-in-Chief points out in September’s cover story, many organizations are moving forward with population health initiatives tackling many problems like reducing preventable readmissions, ED utilization, and frequent flyers. At the core of all of these types of initiatives are a number of common elements, one of them being the ability to provide physicians in practice with real-time data on their patients. However, many challenges remain in how to access these multiple sources of data, and how to make decisions on which IT resources to use to analyze it.  

Matthew Cinque, managing director, performance technologies at The Advisory Board Company pointed out in a recent conversation that much of the world of population health is not all that new since payers and health plans have been doing these types of activities for years for their members. It’s just that population management hasn’t been a primary area of focus for providers until the Affordable Care Act passed in 2010, which created an appetite for change and technologies in this area.

“What is new is that providers are now doing this, or if you want to refer to the early ’90s with managed care, they’re doing it again,” he says. “The types of technology that are necessary go beyond what health plans have used and really need to be provider focused.”

For example, as Cinque explains, if a healthcare organization wants to know what percentage of diabetics had an A1C test in the last six months, traditionally they would look at the claims-based data that showed if a lab test had been given. But much more than that is now needed for population health; providers require the lab result showing the A1C levels, and that data has to flow into the appropriate clinical information systems for analysis.

Another challenge is gathering all the relevant data from multiple data sources, says Cinque. One example, he says, is when a hospital wants to know what’s driving its mortality rate. If the question is then drilled down to how to prevent COPD patients from being admitted to the hospital in the first place, this requires data from different sources. And the question is for providers, Cinque says, what clinical data sources—from laboratory, ePrescribing, and practice management systems—can be currently accessed.

Organizations, like Iora Health that I reported on last week, are finding that electronic health records (EHRs) are just not enough to analyze and report on the health of a population. “I think there has been a relevant amount of disappointment with the ability to pull actual information out of those electronic medical records and truly use robust registry capabilities,” says Cinque, who has been seeing an increase in investment in registries and data warehouses to perform these capabilities.

At the ground-level, other organizational challenges and questions arise, says Cinque, when it comes to purchasing the technical infrastructure for population health. Who is in charge of these initiatives? What part of the organization should be making these decisions? Who is going to make IT investment decisions and decide what tools to buy? Whose budget does it come from? Who are the users of the population health tools? How are providers going to organize themselves for value based payments?

Keith Figlioli, senior vice president, healthcare informatics, at the Charlotte-based Premier health alliance, said it best when talking to Mark Hagland for the September cover story, when he said that he believes strongly that “This idea of just having a dashboard is not enough. You need to put context around that data. Think about the EMR and CPOE journey, and how hard it’s been to put content in there; so imagine how hard it will be to wrap rich content around these information systems more broadly.”

The age of population health is continuing to evolve. Many healthcare organizations are experimenting with their own employee health plans, and the Pioneer ACO program and Medicare Shared Savings Program will be issuing their own learnings. What is your organization doing in terms of population health? Please leave a comment below.