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Black Book: PHM Growing in Importance, but Providers Lack Tech Infrastructure to Support it

January 30, 2017
by Rajiv Leventhal
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Black Book’s most recent report on the state of population health management (PHM) has revealed that it is among the fastest-growing areas in the healthcare IT space.

The research also found that several effective end-to-end solutions are emerging. “Record population health management spending underscores its increasing importance with a reported $8 billion invested in digital health in sum in 2016, with the majority going to population health and patient experience tools,” the report stated.

However, even as PHM solutions are quickly becoming a priority for healthcare organizations, in Q1 2017, 81 percent of providers are tackling population health projects without a strategic technology purchase that meets all their needs. Nearly a third of those providers are using value-added tools from their electronic health record (EHR) vendor as a stop-gap solution.

The research included more than 6,600 respondents from physicians practice, hospitals, health systems and chains, ACOs (accountable care organizations), IDNs (integrated delivery networks) and IPAs (independent physician associations), who responded over the last nine months of 2016 to measure vendor performance in eighteen Black Book key performance, satisfaction and usability indicators specific to the population health and value-based care solutions.

Indeed, the majority of hospitals (83 percent) and physicians (86 percent) responding to the Black Book survey state their community health information exchanges (HIEs) are still too insufficient or simply not operating at the point where they solve the reliable data needs of population health modeling.

What’s more, there have been many recent mergers and acquisitions (M&A) in the healthcare IT space this past year aimed at achieving end-to-end PHM and value-based care solution offerings. “We’re also seeing consultants utilizing the M&A strategy to beef up their EHR, interoperability and data analytics bases, as well as the merging of some consulting firms and PHM companies, and company rebranding to maximize focus on PHM solutions,” Doug Brown, managing partner of Black Book Research, said in a statement.

“In order to maximize the value and benefits of a PHM solution, it is imperative that providers and payers master the art of data capture,” added Brown. “Collecting continuous data on whole populations, from the sick to the healthy, will help fuel the immense data appetite for next-generation PHM solutions.”

Researchers noted that clinical data has previously been mostly limited to EHRs, which is “why it’s no surprise that six of the top 20 PHM vendors are EHRs with two-thirds of the installs represented in this survey.”

Historically, EHR clinical data consisted mostly of health snapshots during doctor and/or hospital visits. “As PHM solutions continue to grow, there will be a concurrent expansion in all the different ways of gathering clinical data at the point of care (POC) and in near-real time,” said Brown.

Also on the rise are solutions that utilize both claims and clinical data to identify at-risk patients, help locate missing or inconsistent clinical documentation, and enhance collaboration between providers, patients and payers. “As payment models continue to shift toward value and payers and providers assume greater risk, they will need tools to help improve collaboration and communication as they work to meet the Triple Aim (improve patient satisfaction and care quality while reducing unnecessary cost),” said Brown.

“Next generation PHM will not be achieved via old-school directives to cut staff, slash expenses, and pushing PHM work with the lowest-cost tech vendor,” noted Brown. “The new era of how providers get paid is going to impact the entire organization, and most hospitals aren’t remotely prepared for it.”

Black Book measured end-to-end capabilities of PHM vendors on six criteria of functionality—six for non-EHR vendors and four for EHR vendors as the majority of best-of-breed/non EHR vendors focus entirely or primarily on big data and analytics.

The top three core EHR PHM vendors (end-to-end solutions) were Allscripts, Cerner and Epic, in that order. The six best-of-breed PHM vendors (end-to-end solutions) were: IBM Watson Health, Evolent Valence, The Advisory Board, Optum, Wellcentive Philips, and Caradigm, in that order.

Meanwhile, organizations on the transition path to PHM must prioritize three foundational elements, according to survey respondents: information-powered clinical decision making (98 percent); primary care-led clinical workforce (96 percent); and patient engagement and community integration (93 percent).

And, 90 percent of all surveyed decision makers on hiring an external consultancy agree that they prefer an advisor with both population health management and revenue cycle management expertise in 2017. Of the 58 PHM head-hunting firms contacted by Black Book, about one-half claim they are currently experiencing difficulties finding qualified PHM process experts to fill open positions, and 90 percent anticipate longer searches ahead for next generation-qualified PHM staff as the industry confronts PHM expert shortages through the next year.

Hospital executives primarily attributed the increased demand for PHM advisory services on several factors out of their scope of current experience, according to the research:

●      77 percent have no strategic plan activated for transforming PHM or value-based care solutions end-to-end to confront known deadlines because there are no internal experts identified;

●      Of the 84 percent stating they are either acquiring, replacing either (or all) PHM IT solutions, vendors, current service delivery processes or outsourcers within the next 12 to 18 months, less than 20 percent of hospitals have begun comprehensive vendor selection activities and 79 percent are considering external consultants to assist them;

●      89 percent of CFOs confirm they are confident that the hospital does have the appropriate FTEs budgeted for PHM transformation activities; and

●      80 percent of CIOs responding to the survey state they do not have the information technology or staff in-house needed to transform PHM end-to-end as their executive team envisions.

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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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Thursday, December 13, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more substantial role in improving outcomes and reducing cost of cancer care.

In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

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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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Kerda DeHaan

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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