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Caradigm Carves Out a Niche in Rapidly Developing Sector

May 26, 2017
by Heather Landi
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In 2012, the Barrington, Ill.-based GE Healthcare and Microsoft Corp. (Redmond, Wash.) announced the launch of a joint healthcare IT venture, Caradigm, which would focus on developing and marketing a technology platform and collaborative clinical applications focused on enabling better population health management. Combining Microsoft’s capabilities in building platforms with GE Healthcare’s experience in clinical workflow solutions, the new joint venture aimed to help healthcare organizations use real-time, system-wide intelligence to improve healthcare quality and the patient experience.

Five years ago, when Caradigm launched, population health management was an emerging area on the healthcare provider side. Fast forward five years, the need for big data in healthcare IT has fueled explosive growth for population health and data analytics technology solutions, and the population health management market, in particular, is rapidly maturing and evolving.

“The population health market today is crowded with a lot of different vendors and a lot of different solutions,” Mark Allphin, research director, value-based care, at the Orem, Utah-based KLAS Research, says. “Part of the challenge that providers have dealt with the last few years really is around figuring out what piece of the population health pie they want to swallow. When you mention population health to a provider they could be thinking of it in terms of three or four different things. And, with each specific aspect of population health, there is yet another list of vendors, who are willing, able and ready to help. As you look at the market, it has created a big push for many different vendors to enter the space to help meet some of these different needs.”

Five-year-old Caradigm, which is based in Bellevue, Washington, is carving out its own niche within the market with an end-to-end enterprise approach to population health, and with a focus on the hospital and integrated delivery network market. In April 2016, Microsoft sold its 50 percent stake in Caradigm to GE Healthcare, and later that same month, Caradigm named Neal Singh as CEO. Singh, who previously served as the company’s chief technology officer, replaced Michael Simpson, who led Caradigm for four years.


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Neal Singh

According to Singh, Caradigm maintains a steadfast focus on population health, even as it expands its solutions offerings to meet healthcare providers’ evolving needs.  “In fact, I can go back to our first HIMSS, in 2013, when we had our independent booth, and we have not changed our main banner since then—it said population health back then and it says population health now and that continues to be our focus.” Further, Singh says Caradigm’s population health enterprise solution, from its core inception, was designed as a “real-time data analytics platform to provide analytics, care coordination and workflow applications all around a single foundation of a unified platform.”

Singh continues, “What differentiates us from many other players in the industry is, first, what started out in Microsoft as a real-time, scalable data platform, that’s the key to our foundation in terms of being able to get data across multiple entities and organizations, including clinical, claims and financial data, and doing it at scale, and now we’re getting into social data. And then we have an integrated suite of applications that are sitting on top of that platform, a unified set of applications for doing either risk stratification to identify your population of patients at risk, care coordination to manage the patients, quality improvement to measure and manage quality, and then utilization and financial analytics to understand your cost drivers and bring them under control.”

Caradigm’s 200-plus customers include Greenville Health System, Billings Clinic and Virtua, and other large integrated delivery networks (IDNs), accountable care organizations (ACOs), academic medical centers, government facilities and community hospitals. Caradigm solutions are operating in more than 1,500 hospitals worldwide, connect to over 500 customer systems and to data for more than 175 million patients. In addition, its identity and access management solutions are employed daily by over 1.2 million users.

Scaling up Population Health

The population health management vendor market is fast-evolving and very competitive, as the large electronic health record (EHR) vendors are expanding their capabilities for population health and data analytics. As hospitals and health systems move forward into population health initiatives, it’s natural for executive leaders to look at their EHR vendors, KLAS’ Allphin says, largely because of the workflow functionalities.

“Caradigm is an interesting solution as one of the vendors that have come into the market from an EMR-agnostic perspective,” Allphin says. “A lot of these organizations oftentimes are looking for a flexible platform that can work in an environment filled with diversity, where there are all different types of EHRs and EMRs and different systems, and that’s where Caradigm looks very attractive to some of these providers. And, thus far, that’s the market they seem to be serving the best at this moment.”

Caradigm is able to support IDNs and CINs because its suite of enterprise solutions was designed to handle complex data aggregation requirements and leverage that data to drive workflow efficiencies necessary to scale population health initiatives.

Singh says Caradigm’s platform can work with 400-plus systems, including clinical, claims and financial systems. “And now with social data and behavioral data that we’re getting into, we have this unique ability, which was incubated in Microsoft and we’ve taken that in our DNA and grown that, so that even with clinical data across multiple EMRs, what differentiates us is that we have the ability of bringing that together in a real-time basis.”

Essentially, Caradigm offers an end-to-end enterprise approach, Singh says, with a single unified platform across all of its applications. “A lot of the players in the space, they say they have an end-to-end approach, or a suite of applications for population health, what they really mean is that they have built add-ons that are plugging in or they have acquired a bunch of companies and technologies that they bundle together from a marketing perspective,” he says. “Why this is important is because when you have a suite of applications built on a unified platform, from a customer perspective, these applications can have workflow that can seamlessly go across applications, they have a unified interface, and a unified customer experience. More importantly, because you have a single unified platform, you can incrementally add applications without having to worry about deploying brand new platforms for each of the applications that you have.”

Singh says another foundational element of Caradigm’s approach to data analytics and population health is its focus on driving time-to value for customers. St. Luke’s University Health Network (SLUHN) a regional, integrated network providing services at six hospitals in Pennsylvania’s Lehigh Valley area, worked with Caradigm to deploy care management tools to support the health system’s participation in the Bundled Payments for Care Coordination (BPCI) program. SLUHN is one of the largest BPCI participants in the country, having signed up for 44 of 48 available episode bundles, and the health system needed tools for care coordination that would span both inpatient and outpatient settings, as well as combine its claims data with clinical data from its Epic EHR system. According to Chad Brisendine, CIO of SLUHN, Caradigm’s care coordination tools enable multi-disciplinary care teams to share information and streamline workflows as patients move from acute to post-acute settings.

“Through our partnership with Caradigm, our teams are already seeing benefits that include quicker turnaround times to initiate patient care, improved transitions of care workflows and enhanced sharing of clinical and claims data from inpatient and outpatient systems,” Brisendine said in a statement when the partnership was announced last fall.

Addressing Health Systems’ Evolving Needs

Even for experienced healthcare provider organizations, who are rapidly adding and changing payer agreements, population health management is an evolution, many healthcare industry leaders say. An important source of confidence comes from technology solution vendors who are responsive to customer needs and readily adapt to the latest requirements.

Singh acknowledges that in the five years since Caradigm launched, the pace of change in the healthcare industry has rapidly accelerated. “Providers are facing the challenges of scaling their programs to more locations and to include more patients, to provide additional services as well as employee education strategies and training to address more data sources that come in. We’re seeing that expand, and go across multiple states, as with large clinical integrated networks, super CINs as they are called, and large ACOs, and mergers and acquisitions coming into play, so we’re seeing that evolution also occurring at the same time.”

He says the company has made it a top priority to serve customers’ evolving needs by expanding its solutions portfolio. Shawna Cooper, director of program management at Caradigm, adds that the company’s solutions have been designed to be “configurable and future-proof” to keep pace with the accelerating pace of change in the healthcare industry.

To this point, just in the past six months, Caradigm has rolled out solutions and functionalities specifically targeted to help healthcare organizations with risk stratification as well as to facilitate two key value-based care programs—bundled payments and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The company expanded its quality measure library and user-built lists and workflows to help organizations analyze performance on measures for both tracks of the Quality Payment Program: the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs).

“Essentially, the way that we’ve designed the solutions is to make sure that as these regulatory needs come in, and MACRA is an example of a regulatory need, and also bundled payments, which is on the federal register as well as on the commercial side of the house, to be configurable and future-proof,” Singh says. “As an example, in the case of MACRA, there are a set of quality measures that you have to measure in terms of managing gaps in care. So, we have, as part of our suite of applications for quality improvement, and as MACRA came out with their requirements, we were able to rapidly configure those measures. The same thing in the case of bundled payments, where you are managing the entire floor of bundled payment patients, from soup to nuts, we built that capability into the system. And, more importantly, as bundled payments vary, the workflows vary. We were able to configure those workflows based on what the needs of customers are, and in many cases, the customers can self-configure them.”

For risk stratification, Caradigm developed an application that aggregates data from multiple EHRs in real time, creates segmented patient lists using clinical indicators, identifies patient that meet defined criteria and then integrates with Caradigm’s care management solution to streamline patient enrollment into care management programs.

Cooper says the vision is that the tool will incorporate a “multi-factor holistic view of a patients’ risk, including social determinants, behavioral indicators and financial indicators.” She adds, “We believe that combining a broad range of data to be used in risk stratification activities really will provide additional insights for providers, and enabling population health analytics to better identify patients who can most benefit from support.” She also notes that identifying patients who are the top spenders or have the highest predictive risk “is the easy part.” “What’s harder to see is the risk-mover, to see those people that seem like that are just getting a little bit worse over time. We want to catch them before they get into that top level category and that really is the goal of risk stratification. You’re not just dealing with the top level, you’re dealing with people that you can really affect change on.”

Looking at the population health management solutions vendor market broadly, Liam Bouchier, senior advisor at the Chicago-based healthcare IT consulting firm Impact Advisors, sees a trend of ongoing consolidation and he expects that consolidation to continue. “A lot of the vendors that were emerging a number of years ago are starting to be acquired, have already been acquired, or are creating partnerships with other vendors to deliver solutions,” he says, noting in particular the acquisitions of Phytel and Explorys by IBM and Evolent Health’s purchase of Valence Health. “I think the market is going in the same direction as the EMR market went; over the last 10 years we’ve seen a movement toward a single vendor strategy and a single integrated system with the likes of Cerner leading the market. And you certainly see the same thing with the population health space.”

Liam Bouchier

Singh acknowledges that the population health management vendor market is becoming increasingly crowded as EHR vendors continue to evolve and focus on population health. “I think it reinforces our strategy that population health is the direction the healthcare industry has to move towards. And we said that five years ago, and we continue to say that. I think that’s where we see EMRs following our lead,” and he adds. “We see ourselves as not in competition with EMRs, we actually see ourselves as being an extension of the whole ecosystem that meets our provider customers’ needs.”

When asked what they are most excited about regarding Caradigm’s work right now, Cooper replies, “I’m really excited to see us continue to be part of the evolution of the healthcare landscape.”

Singh says, “We are focused as a company on innovating and delivering what we would call rapid time-to-value for our customers, and as a simply as possible, so they can positively impact more patients’ lives and scale population health effectively and efficiently. I feel so invigorated and excited about coming here, working with our employees, our customers and the industry to really change the game over healthcare and population health management.” 

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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


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We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



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