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Combining Criminal Justice, Health Data Creates New Opportunities for Meaningful Interventions

April 17, 2018
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Camden, N.J. research finds integration of public safety, public health data provides new lens on vulnerable populations
One of the things that will be fascinating to watch over the next several years is whether research demonstrates that the current efforts at multi-sector data sharing and an enhanced focus on social determinants of health pay off in improved health outcomes and lower costs. It seems logical that they would, but the focus is so new that it will require more research. 
 
My colleague Heather Landi recently reported on a panel discussion of organization leaders working to use health IT to collect and integrate social and behavioral health data. She quoted Abigail Fallen, senior program manager, health information exchange and data security at the Camden Health Coalition in Camden, N.J., who said, "We have a large data shop and we take data from different sources that are not linked in order to link them together and to identify trends that are driving patients to multiple hospital stays. Our data tells narratives about our patient population.”
 
One particularly promising avenue is better data sharing between public safety and corrections organizations and health providers, and once again Camden is at the forefront. Last year I wrote about how the organization worked to share data between health providers and jails.
 
“There was useful information in the jail data,” said Stephen Singer, the Coalition’s senior manager of analytics and information architecture. “It helped us with linking the same individuals across systems, and the jail had something we had nowhere else — several aliases that clients went by.” That gave the clinicians a wider set of names and made it possible to link people across hospitals. “We didn’t have a full picture unless we knew when they were incarcerated,” he said. “It gave us a much richer picture of those clients."
 
Now the Coalition’s leaders have published a paper on lessons learned integrating healthcare and criminal justice data. With a grant from the Laura and John Arnold Foundation, researchers from the Camden Coalition analyzed cross-sector data and found that a small number of Camden residents have an enormous and disproportionate impact on the healthcare and criminal justice sectors, neither of which is designed to address the underlying problems they face, which the study identifies as: housing instability, inconsistent or insufficient income, trauma, inadequate nutrition, lack of supportive social networks, mental illness, and substance abuse disorders. These unaddressed social determinants of behavior appear to drive a cycle of repeated arrests and hospitalizations, the research finds. 
 
Here are a few of the study’s key findings:
 
• There is a relationship between high use of hospital emergency departments (EDs) and frequent arrests, and a small subset of 226 individuals had extreme numbers of contacts with both hospital EDs and police.
 
• The study found that many of the factors that correlate with frequent hospital use also correlate with a high risk for crime and criminal justice involvement
 
• A majority of all Camden arrestees (67 percent) made a trip to the ED at least once during the study’s timeframe (2010 to 2014), with more than one-half (54 percent) of this group making five or more visits.
Integrating data across sectors using common identifiers offers a new view of an individual’s life and thus a more meaningful and complete understanding of the challenges he or she faces, the researchers find. 
 
Among people in frequent contact with EDs and police, data reveal significant variety in their experiences and behaviors, suggesting that interventions will need to be tailored to meet their unique needs.
 
The report stresses that only by breaking down data silos among agencies that serve vulnerable populations can we begin to address the root causes of behavior and prevent individuals from cycling through multiple systems.
 
That raise the question of whether society will continue to treat the symptoms of conditions such as substance abuse, mental illness, and homelessness by cycling people through hospitals and jails or whether they will be met through deeper treatment of underlying diseases and problems. “In other words, have we chosen a seemingly quick fix, where we repeatedly funnel people who need treatment into our jails and hospitals, over solutions that foster the long-term safety and well-being of communities?”
 
In the next phase of their work, these researchers will turn their attention to designing and testing interventions to prevent people cycling through these institutions. I look forward to following up on these important efforts when they publish again. 
 
 

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For UNC Health Care, Managing Provider Data is a Stepping Stone to High-Quality Care

August 16, 2018
by Rajiv Leventhal, Managing Editor
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As health systems continue to shift to value-based care, provider data management is becoming a critical piece

As part of the ongoing road to value-based care, there is now a greater need for health systems to manage information about health plan participation and network affiliations for their providers. Indeed, provider data management is critical to running a profitable and efficient business.

In North Carolina, the Chapel Hill-based UNC Health Care—a state-run health system comprised of UNC Hospitals and its provider network, the clinical programs of the UNC School of Medicine, and nine affiliate hospitals and hospital systems in the region—has quite an interesting history. From 2011 to today, UNC Health Care has been defined by its owned and employed framework, which has doubled in its size of providers, licensed beds, and employees, says Robb Malone, Pharm.D., system vice president of practice quality, innovation, and population health services, UNC Health Care.

In recent years, Malone recalls, the system’s leaders began looking at how healthcare was evolving forward, including how population health management was becoming a critical component of care management. They then realized that partners and partnerships—specifically how to support independent providers and work with the community—were needed. “We don’t have to be all and own all. We just have to be good partners that deliver good services to our partners and patients, to make sure patients get high-quality care,” says Malone.

That is how UNC Health Alliance, which is the health system’s clinically integrated network, was developed. It’s physician-led, notes Malone, adding that it includes independent providers meshed with UNC Health Care providers. “In order to deliver cost-effective, high-quality care , what do you need to do?” asks Malone. “We do what we’re good at, which is bringing healthcare services and high-quality providers to payers, and then you develop plans and products that leverage that network to manage the total cost of care, access to care, and to deliver high-quality care,” he says.

Of course, when talking about a system that doubled in size over a six-year period on its own, and when adding a focus on independent providers, the net outcome is a complicated system to work in and to coordinate care across, Malone attests. “In setting up that IT infrastructure, you need lots of solutions—from care coordination and care management platforms to reporting and predictive analytics. So we started investing in many different solutions, from people—business intelligence people, analysts, and data scientists—to solutions.”

Robb Malone, Pharm.D.

To this end, one of those solutions was Phynd Technologies, a Dallas-based company whose unified provider management (UPM) platform aims to help systems such as UNC Health Care manage all of their providers. The work the North Carolina organization is doing with Phynd—internally referred to as “provider data integrity”— involved tackling provider data management in three different areas: location management, health plan roster management, and then ultimately network management, explains Malone. “Like all clinically integrated networks, our network is built on the [elements of] the Triple Aim, but you cannot accomplish that unless you have the underlying structure and partnership with payers that gets you out of the fee-for-service environment into the value-based care world,” he says.

But for UNC Health Care to operate in this new payer-based framework, changes would be needed. “Like most systems, we have several contracts across different payers, and they arrange in complexity from narrow networks to open networks to [disallowing] out-of-network, to plans with different kinds of benefits.”

And as Malone notes, the UNC Health Alliance must manage their roster of providers who participate in the network, as well as their statuses in the network, and which contracts those providers are participating in. “Just because you are in the alliance doesn’t mean each provider participates in all the contract segments. And there’s no way that a referring provider and a patient can wrap their heads completely around their benefit limitations and what their network is. So we have to help patients and providers navigate that through decision support,” he says.

According to Malone, Phynd specifically helps the alliance maintain the roster at the provider level that would associate each provider with a given plan, and then allow operational leaders to deliver decision support at the point of care so that the provider knows how to connect patients with a provider in the network. “And more importantly, they will be connected with the preferred providers within our network who are operating at the highest level of expertise for delivering high-quality care and have accessibility to see patients,” he says.

The Phynd platform is a cloud-based solution, hosted by Amazon, with two main elements to its provider data management equation. One is that it enables clients to consolidate, synthesize and integrate their existing data—so taking information from their EHRs (electronic health records) and credentialing systemsbecause that information is often redundant, conflicting and not complete, explains Peter White, chairman and chief product officer at Phynd Technologies. The vendor also maintains an independent database of more than 4 million provider records that it aggregates internally. And then, notes White, there is a blending of these two worlds—external and internal data—that is pulled into a single-source-of-truth record. Health systems can then share that back out with their internal systems, their EHRs, and their credentialing systems, White says.

Previously at UNC Health Care, Malone recalls, there were a myriad of different technology platforms with very little provider data organization. “What you would see most commonly was operational leaders like me who would be using anything from Excel spreadsheets to a variety of vendor-based solutions. There was no single cohesive approach to provider data management or location management,” Malone says.

Most healthcare systems, he notes, even without an integrated network, are made up of a series of hospitals that have their own associated practices. “That gets complicated over a wide geography. Who would maintain the list of locations, the manager of those locations, phone numbers, services they deliver, and key contacts? [Previously], we would maintain it as best we could on our own within that given entity and that geography. But we had no complete look at our location and our resource management,” Malone admits.

What’s more, within the UNC Health Care ecosystem exists advanced medical homes, with the core belief that its primary care providers partnering with its specialists will deliver the best care for patients, says Malone. “We put a focus on developing medical neighborhoods that can deliver those services: keeping the patients at home or close to their home within a provider network, and conveniently geographically located,” he says.

For Malone, that means that one of the health system’s advanced medical homes can transparently see who the providers and what the services are located around the patient. Then, the patient will be easier to manage. “To be able to quickly retrieve the results, the feedback, the consults, and close the loop on the services that I am seeking for my patient, is quite valuable,” he says. “So basically, if I make a referral, I want to know that it happens in a timely manner and I want the results back to me in a way that’s convenient to me, so I can manage the patient and close the loop, from front to end.”

But if the data infrastructure is in a fragmented and redundant state, managing that patient becomes much more challenging. “If I don’t have those point-of-care decision supports in place to help me manage that patient flow, then how will I ever get it done? How do I know who is down the street or that there are services conveniently located to the patient? How do I manage and know that network? I need a system in place to support me and making the right decision easy: getting the patient to the highest-valued provider. That’s at risk here if you can’t solve that fundamental problem.”


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Dr. David Nash on Population Health: Physicians Don’t Grasp It

August 6, 2018
by Rajiv Leventhal
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The renowned healthcare leader weighs in on where the biggest gaps and opportunities lie in the ever-evolving population health landscape

 

In late June, Thomas Jefferson University’s College of Population Health and Navvis, a St. Louis-based population health company, announced what officials attest is the country’s first private sector-supported academic chair in population health—The Navvis Professorship of Population Health at Thomas Jefferson University.

The professorship, funded by Navvis, will aim to support the work of a dedicated faculty member at the Jefferson College of Population Health. “The academic research will be national in scope, with the goal of improving intervention effectiveness in real-world applications. will focus on identifying methods and best practices to create systemic, effective and scalable improvements in health, officials stated in the June announcement.

David Nash, M.D., is one of the best-known pioneers in the world of population health management and related areas, and is the dean of the Jefferson College of Population Health. In a statement at the time of the professorship announcement, Dr. Nash said, “Establishing an endowed professorship devoted to the health and wellbeing of whole communities is an invaluable investment in humanity.” He added, “This professorship, the first collaboration of its kind between an academic entity and a private sector company, demonstrates a commitment to translating the scientific method into real-world practice. We are grateful for the support that will ultimately empower people to take charge of their health through research, education, and programs.”

In a recent interview with Healthcare Informatics, Nash discussed the importance of this professorship, while also touching on broader population health issues and the landscape at large. Below are excerpts of that discussion.

What does the professorship represent in this current healthcare market and what do you see as its potential impact?

We think this is a paradigm shift and a watershed event, by having private-sector support for an endowed chair in our field. We believe this is the first ever [of its kind] in this field, making it really important. We will go recruit a major national scholar, hopefully a disruptor, who will help us bring this field to “2.0.” We have done a pretty good job; this month is the 10th anniversary of our college. And the Navvis professorship is the turning point for getting us to the very next level.

David Nash, M.D.

How would you describe what the population health landscape looks like, at a broad level, right now?

Let’s take population health management first. In population health management, the biggest issue at the moment now is the speed, or trajectory, in the movement from volume to value. We are in a valley, between two peaks—the peak of private practice fee-for-service and the peak of global payment. So the question is, how fast can we get out of this valley and make it from one mountain to the next? No one knows the answer, and that’s the scary part. We believe that based on the best available evidence, no matter which party you’re in, 60 cents of every Medicare dollar will be attached to an outcome measure in 2019. So we are moving inexorability from volume to value.

That said, this is not a done deal and it’s going to be a continued struggle, quite frankly. [Many] people are hoping to put a little steroid cream on this [problem] and assume it will be gone by the morning.

What are the pioneers doing in population health that those who are behind can learn from and replicate?

There are 10 schools of population health in the U.S. and we are tracking all of them, meeting and talking with their deans, in an attempt to raise all boats and help promote the field. There is tremendous energy in this arena. We have a text book, Population Health: Creating A Culture Of Wellness, that has been deployed in 80 graduate schools of medicine, nursing, public health, and health administration. And we are deep into preparing the third edition. We are still sculpting the field; we’re not done with the statue yet.

What are the biggest population health problem areas right now, as it exists today?

It’s a long list. Among the challenges is the lack of EMR [electronic medical record] connectivity, and the EMR in its current format is really an electronic chart. It’s not a source of information; only a source of data. The evidentiary basis of practice is still pretty modest. Eighteen percent of what we do is based on grade A evidence, and that in turn leads to inexplicable variation in what doctors do and inexplicable variation in price. This is a crisis. And then finally, medical error is the third leading cause of death in our country, regrettably.

Can EMRs, as they exist today, handle population health work, or are separate tools needed?

It depends on what camp you are in. We hope that Healthy Planet [Epic’s population health platform]—and the tools from its peer group from major vendors such as Cerner and Allscripts—will mature. In the meantime, there are a dozen add-on tools in play. We don’t have any research evidence to claim that one is more effective than another.

Do physicians and others have a common sense of what population health truly is? Can it mean different things to different people?

I honestly think they have no idea. They have never been exposed to it and they haven’t been taught this anywhere. They are learning as we go. The average well-trained physician in private practice has no real concept of any of this. As the payment system changes, their level of interest will increase. As we go from on the road from volume to value, their levels of interest will exponentially change.

We are still sculpting the new field. People are much more open than they were 10 years ago. Historically, we started the college two years before health reform when this vocabulary was largely unknown. We have come a long way. As you change the economic incentives, behavior will follow.

 


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HSX, Food Alliance Partnership Extends Data-Sharing to Food, Nutrition

July 24, 2018
by Heather Landi
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The Philadelphia-based Metropolitan Area Neighborhood Nutrition Alliance (MANNA) has become a participating member of HealthShare Exchange (HSX), which enables the food alliance to receive important medical updates from HSX on its clients. 

HSX is the regional nonprofit health information exchange serving Greater Philadelphia and the Delaware Valley, including southeastern Pennsylvania and southern New Jersey. MANNA is the well-established and widely respected Philadelphia nonprofit focusing on delivering nourishment to persons of modest means who are battling life-threatening illnesses, according to a press release.

Collaboration between these two organizations will help to guide modifications in the nutritional support services provided to ill low-income patients. With the daily updates from HSX, MANNA will now know when its clients have had a healthcare event involving an encounter with a medical center, and will be able to adjust services to these individuals accordingly, according to both organizations.

This new partnership will permit MANNA to stay more up to date on the health status and food-as-medicine needs of its clients.

“Taking advantage of HealthShare Exchange’s data feed will allow us to be an even more-active ongoing partner in our clients’ medical status. We look forward to using these real-time updates coming from HSX to ensure that our clients’ needs are met quickly and efficiently,” Nicole Laverty, director, nutrition and client services at MANNA. 

The food alliance now subscribes to HSX’s Encounter Notification service, which provides electronic alerts to MANNA when one of its clients has a healthcare encounter at one of the region’s medical facilities.  With knowledge of these healthcare encounters and the reasons for them, the community organization can reach out to patients in a more timely fashion and tailor nutrition services for individuals.

“One of our challenges has been to stay informed on the condition of each of our clients, so that we can better help them,” Ann Hoskins, MANNA’s director of policy and institutional affairs, said in a statement. “We’ve had a significant need, for example, for more timely data on patient visits to the hospital, especially their interface with emergency departments.”
 
With this partnership, MANNA will not only know about these events but will be able to query additional detail on the health status of their clients by accessing HSX’s clinical data repository. This service offers a portal to a database of more detailed reports on recent patient medical care, in the form of continuity of care documents (CCDs). The dieticians and other staff members at MANNA can then update a client’s indicated diet and required food restrictions, as well as their delivery schedule, in prompt coordination with the person’s medical care. Furthermore, MANNA will provide data back to HSX, including nutritional updates that can become part of the patient’s medical record in the regional data repository.

“We’re thrilled that, in this way, we can help MANNA’s staff to become an even better-informed and more crucial part of the care team of these chronically or severely sick patients in Philadelphia,” Daniel Wilt, HSX’s senior director of information technology and chief information security officer (CISO).  “We’ve come together with MANNA because we support their mission and because our two organizations believe, as we’ve said, that ‘data plus food equal better outcomes.’”

MANNA also has collaborated with another HSX member—Health Partners Plans (HPP), a regional Medicaid/Medicare insurance-benefit manager. Since 2015, MANNA has delivered more than 560,000 meals to more than 2,100 HPP members suffering from illnesses that include diabetes, heart disease, malnutrition, and kidney failure. Results from this partnership in Pennsylvania show lower HbA1c scores for 26 percent of diabetic members and decreased utilization and costs for inpatient admissions and emergency room visits. Findings reveal an overall medical cost reduction of 19 percent on a per-member-per-month basis for those patients receiving nutritional support. HSX member Aetna and other insurers have also added the food benefit for their Medicaid enrollees in the Philadelphia area.
 

 



 

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