As they sort out their population health management efforts, provider organizations are increasingly realizing that they are masters of their own destiny when it comes to value-based care.
In the absence of a "one-size-fits-all model that generates positive outcomes across all metrics," Chilmark instead took a look at three different health systems that have been pursuing pop health for years, drawing lessons from the clinical and technology choices they made as they sought success in the era of accountability.
The takeaway? Despite their different approaches, many factors affecting the ability to drive value are within their own control. Enterprise-level strategy is key to developing sound population health management frameworks – especially when it comes to setting business and clinical goals before implementing technology and workflow.
And good vendors are essential – however they might fit into the larger strategic framework. Providers should select "one key IT partner, but be prepared to recruit others to fully enable strategy, as PHM solutions remain immature," according to the Chilmark report.
The report profiles three diverse but representative health systems. New Jersey's Trenton Health Team pursues pop health by leveraging a health information exchange that relies on a single-sourced vendor. Boston-based Partners HealthCare, meanwhile, "has taken an extremely broad build-and-buy" approach to its IT systems. And Wisconsin's Marshfield Clinic has self-developed its own proprietary platform for EHR and pop health integration.
Trenton Health Team: learning from longitudinal exchange
Trenton Health Team recognized back in 2010 that it needed to have a longitudinal patient record across the motley array of EHRs at use in it provider sites, so it set about implementing an HIE to connect them.
"As its needs matured and evolved beyond being able to see a holistic patient history across multiple sites of care, THT recognized the need for advanced analytics and workflow tools to enable it to help with community-wide care coordination. Through this process, THT went through two IT vendor relationships that were not able to keep up with rapidly advancing needs. The continuous learning and on-the-ground experience led THT to its third technology solution provider."
That vendor, CareEvolution, helps the health system manage data aggregation, harmonization, risk stratification, notification, workflow management and more.
"THT continuously seeks to balance its view into its own data insights as well as its view into what it is clinically attempting to accomplish. It strongly believes neither data analysis nor PHM goal-setting can exist in isolation of each other," said Chilmark.
Partners HealthCare: to build or to buy?
Partners HealthCare has been a longtime leader in population health, having embraced the process in earnest more than a decade ago and having "continuously evolved its clinical and business strategies, enabled by heavy reliance on supporting in-house and vendor- based PHM technologies," according to the report.
The Partners' culture of innovation "reveals itself in its technology approach to PHM," said Chilmark: It has vetted "a wide range of HIT vendors and has executed contracts with an astounding number of them. Yet, if a tool does not yet exist in the current market that will meet its needs, it does not hesitate to build that tool on its own. As such, (Partners') development strategy serves as a bellwether of PHM HIT maturity and capabilities."
The decision whether to build or buy is "reached by determining the cost-benefit of each, including speed to deploy. If the decision is to build internally, PHS then subsequently leverages its internal department to potentially commercialize those specific IT solutions it has developed in-house."
As for vendors Epic is the health system's EHR, in both acute and ambulatory settings, and Partners puts it to work for bi-directional alerts to improve care coordination, clinical decision support to enable point of care adherence to evidence-based medicine and more. Partners has also contracted with Health Catalyst to develop "approaches and tools related to performance monitoring and data analytics."
Marshfield Clinic Health System: Homegrown history
Marshfield was making use of electronic data as far long ago as the 1960s, when it built an electronic health record thanks to requests from its own physicians. Its EHR was fully in place by 1985 – a quarter-century before the HITECH Act spurred nationwide health IT adoption.
MCHS is now in the midst of implementing its next-generation EHR, MCIS Clinicals. With it, the existing CattailsMD system is being reconfigured to better meet Marshfield's population health management needs, according to Chilmark, which notes that the new system offers:
"Configurability: Experience taught the MCIS team exactly how and where providers need system flexibility. The system now allows for end-user configuration as much as possible without the need for the practice to make a request of MCIS, which in turn makes the health system far more agile. Examples include quickly creating a foot exam form, adding a new clinical decision support guideline, or editing a benchmark for the provider to self-elevate his or her own stretch target.
"Real-time data alignment: The replatformed system eliminates data discrepancies that often occur with the traditional EDW and data latency approach. It now integrates real-time PHM metrics at the point of care, with data consistency across components including order sets, the patient portal, care reminders, care management assessments, and PHM."
Population health management is a complicated process with an array of different approaches, said Chilmark, and specific market circumstances vary for healthcare organizations.
While healthcare organizations' approaches to PHM vary widely, "all can benefit from common best practices that can serve as a baseline" and then "modify from baseline to reflect its particular starting point and the variables within its ecosystem," according to the report.
For those looking to get their pop health efforts off the ground, it's worth taking lessons from cases studies such as these and staying aware of this "emerging collection of best practices, lest they risk reinventing the wheel at their own cost."
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