Customer Experience and Design

Meeting the Challenge of Managing Population Health

In the closing weeks before the Christmas holiday, I made a whirlwind tour of several large integrated delivery networks (IDNs) in search of the newest Holy Grail in healthcare: Managing Population Health. The race to Accountable Care Organizations and Shared Savings performance contracts has resulted in a new level of enterprise data integration never imagined by most provider organizations. The idea of combining claims data, from CMS or third party health insurers, with their internal clinical information systems was capturing their attention as they pondered managing the health of their served populations. A key concept began to emerge that Population Health Management is multidisciplinary by definition – each stakeholder in the ACO would require customized information to play an effective role and, most importantly, an effective population health management strategy requires data from a variety of sources that need to be integrated for analysis.

Just as healthcare organizations began to grapple with the famous integration of in-patient and out-patients for meaningful use, accountable care and managing re-admissions, along comes Shared Savings performance contracts. The need to have timely data to “course adjust” quality measures, referral patterns and perform risk stratification put a whole new twist on business intelligence efforts of overworked decision support teams. The ability to ingest claims data from the new partners in the performance contracts posed challenges to data integration. The ability to track performance metrics to manage the new emphasis on health and wellness as against traditional metrics treating illness called for more sophisticated data acquisition from points of care and aggregation of data to determine gaps in care.

The challenge is simple: time! The demand for the ability to manage healthcare enterprise information for accountable care is not just now, but NOW! Healthcare administrators need immediate enterprise data warehouses to integrate claims data, data from acute and ambulatory settings and flexibility to add new data sources as the reach of accountable care organizations expand into skilled nursing and other healthcare services. The solution is three-fold:

  1. Health Information Exchanges – to bridge the interoperability gap between care settings
  2. New Healthcare Integrated Data Models that encompass both traditional payer and provider information together
  3. Enterprise Information Management Frameworks – yes, frameworks for building the data warehouse of today that can be flexible and extensible for tomorrow

There are many single point clinical data warehouse solutions in the marketplace at a time when that approach will only lead to more complexity. The practical solution is not one that only analyzes claims a dozen ways or another that only has the view of the EMR data. The best solution is going to be an independent and, here’s the key, integrated view of the data. The enterprise information framework will encompass the entire life cycle of data and provide a means of solving the data integration problem of the moment for performance based contracts but then grow in the future to allow analysis of the unstructured data that healthcare professionals value.

Finally, healthcare organizations striving to manage population health need to discuss the performance metrics that really matter to their organization. The choice of the right metrics that move stakeholders to the correct decision points to achieve the goals is crucial. With hundreds of performance metrics available it will be vital to focus on the ones that when addressed yield the best results. In the race to manage the health of a served population – doctor know thyself.

Are you interested in discussing the management of Population Health and related tools further? Visit us in Booth 1274 on the HIMSS show floor!

About the Author

Enterprise Architect with specialized skills in Enterprise Application Integration (EAI) and Service Oriented Architecture (SOA). Consultant and a trusted advisor to Chief Executive Officers, COOs, CIOs and senior managers for global multi-national companies and healthcare organizations. Deep industry experience as a consultant in manufacturing, healthcare and financial services industries. Broad knowledge of IBM hardware and software offerings with numerous certifications and recognitions from IBM including On-Demand Computing and SOA Advisor. Experienced with Microsoft general software products and architecture, including Sharepoint and SQL Server. Deep technical skills in system integration, system and software selection, data architecture, data warehousing and infrastructure design including virtualization.

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