What Could the Proposed MSSP Rules Changes Mean for ACOs

Post by Brian Drozdowicz

Vice-President of Population Health, Caradigm

2014 was another year of learning for ACOs participating in the Medicare Shared Savings Program (MSSP). So far, the results have been uneven, as three out of four ACOs launched in 2012 and 2013 did not save enough to earn bonuses. Only five out of more than 300 ACOs felt confident enough to choose the option for a penalty and increased shared savings. The National Association of ACOs surveyed MSSP ACOs in October and found two-thirds were somewhat or highly unlikely to continue if they were required to accept penalties. Finally, on the Pioneer ACO program side, eight of the nine ACOs that left the program posted losses for the first performance year, and none of them earned shared savings.  

Given these results, many ACOs are understandably in agreement that they would like more time to acquire the infrastructure and expertise needed to revamp their models of care. In response to this feedback, the Center for Medicare & Medicaid Services (CMS) is proposing changes to encourage providers to stay in the program. A number of publications including Modern Health and Becker’s Hospital Review have posted good summaries about the proposed changes. I believe the key aspect of the proposed changes is that it would lessen the risk ACOs face in the short term while they gain traction in the program.

Clif Gaus, CEO of the National Association of ACOs, supports the extra time for ACOs because he said “It’s probably a decade-long process to redesign all of the care processes that lead to both better care and more appropriate care…There’s a big learning curve for many ACOs. They are almost new businesses starting from scratch.”

The proposed changes would create a much needed buffer, however, it’s also important for ACOs to realize that 2015 is the year they should accomplish the identification and implementation of technology needed to drive population health management and more shared savings. I found it interesting that CMS is also proposing to add new eligibility requirements to the program that will ask applicants to describe how they will promote the use of enabling technologies for improving care coordination as well as provide milestones and targets for the implementation of those technologies. This shows CMS has acknowledged the critical role that technology plays in the shift to population health although it is still a long ways away from making any specific recommendations.

Given our work with a variety of customers managing these challenges, I am more than willing to make recommendations about the various capabilities required to successfully support the transition to value based care and am passionate about helping others take that step. One of the most important things to focus on is to take a holistic technology approach that considers the entire organization – an enterprise population health approach. A narrow approach using point solutions can fall short because population health requires integrated technology to bring together data, analytics and workflows across the entire organization. For example, the technology requirements of a population health strategy are:

  • Aggregation, normalization and sharing of all of your data (e.g. clinical, claims, financial) in near real-time
  • Application of analytics to all of the data to stratify your population, uncover insights and enroll patients in programs  
  • Surfacing of the data, analytics and insights at the point-of-care (i.e. within care management workflows and EMRs) to make care more efficient and consistent for the targeted population

A gap in any of these requirements or a lack of integration between them creates inefficiencies that become a blocker to overall population health efforts. When there are synergies and automation between a platform, applications and workflows, that’s when tremendous efficiencies and improvements can be realized. This innovation is real, and Caradigm is the leading provider in the market delivering a comprehensive solution that enables enterprise population health. I’m anticipating that 2015 will be a pivotal year for ACOs as many adopt the technologies and strategies they will need to thrive. If you’d like to continue the discussion and learn more, send a note via this form.

DSRIP Leads to Population Health Management

Post by Vicki Harter

Clinical Product Manager, Caradigm

It’s challenging to provide care for the patients most in-need – the homeless, those with untreated, chronic health and mental illness. These patients often lack consistent primary care, and often only receive treatment when they go to the emergency room during an acute episode. It’s a lose-lose situation because the patients don’t sustain the improved health after leaving the ER, and costs are unsustainable for providers and U.S. taxpayers.  

The federal government saw the need for better coordinated care of Medicaid and uninsured patients, resulting in the creation of the Delivery System Reform Incentive Payment (DSRIP) program to help healthcare organizations transform how they deliver care to those patients. At its highest level, DSRIP is intended to advance the Institute for Healthcare Improvement “Triple Aim” of improving the health of the population, enhancing the experience and outcomes of the patient and reducing the per capita cost of care. DSRIP is also ultimately about Medicaid reform, moving to a system of care that promotes wellness rather than just manage sickness and promotes value of care over volume of care.

DSRIP points people in the right direction by emphasizing certain goals such as the “Triple Aim,” collaboration with community providers, avoiding preventable hospitalizations and clinical improvement for chronic diseases. What DSRIP does not do is specify how providers are going to accomplish those goals, which requires organizational change and new technologies. To complete the picture, healthcare organizations need a population health management strategy and solutions to enable that strategy.

Population health management solutions can reduce silos of care by sharing data and analytics across the community at the point-of-care. Patients are given a single plan of care focused on prevention and wellness that is then executed by a care team across the continuum efficiently and without redundancy. The result is an integrated community of providers that delivers better coordinated care to make patients healthier and keep them out of the ER and hospital settings.

The DSRIP program represents a great opportunity for eligible organizations to jumpstart a population health strategy. To learn more about the DSRIP program, you can watch this short video or contact us to discuss further.


Caradigm Employees Volunteer with Timmy Global Health in Ecuador

Post by Larry Nicklas

Senior Product Manager, Caradigm

Four Caradigm employees (Bryan Ferrel, Kathleen McGrow, Michele Kirkpatrick and Larry Nicklas) volunteered on a medical mission in Ecuador earlier this month. We asked Larry Nicklas, a Senior Product Manager for Caradigm, to share a few thoughts about his experience. It is a timely reminder that we have much for which to be thankful. Happy Thanksgiving!

What organization did you go with?

I went as part of a team organized by Microsoft that goes on an annual trip through Timmy Global Health (TGH) who works to strengthen local health systems and help end health disparities. We were based out of Tena, located in the Amazon Basin and would visit different villages each day that were 30 minutes to 3 hours away. Tena is the capital of Napo Province, about a 6 hour bus ride from Quito, the capital of Ecuador where we flew into.

What is healthcare like in Napo Province?

There’s a lot of health issues for the villagers that we visited with. Virtually everyone had a fever, cough, runny nose, and many had fleas and rotting teeth. Chronic conditions such as hypertension and diabetes were also common. In terms of healthcare resources, it’s pretty barren. A ”brigade” from TGH tries to visit 2-4 times a year. Usually, the nearest hospital is many hours away, but the locals don’t have transportation. If you can hitch a ride to the hospital, it’s like being in a facility from the 1920s.

What was the goal of the medical mission?

Each day, we set up temporary clinics in various villages to help as many people as possible get treatment, education and basic tools to improve health. It was pretty hectic as we were seeing as much as 125 people a day at a single clinic, from newborns to people in their 60s. Folks that need treatment beyond what we can provide on the ground are referred to other facilities, and TGH pays for these services.

What was the process like for patients?

The process was very similar to what patients experience here, although the setting and facilities were obviously quite different. Patients would be registered in a rudimentary EMR, then move on to different stations where they would explain why they need care, get basic vitals, can get blood and urinalysis work done, consult with a clinician, then get meds from the Pharmacy station, which was basically two dozen suitcases and plastic bins broken out by different drug categories. Most volunteers were assigned to different stations each day.

Did it change your perspectives on healthcare in the U.S.?

It made me think about how we have easy access to healthcare, but too often don’t bother to use it   compared to people who desperately need it, but don’t have a means to receive it. It also made me think about how easy it should be for us to maintain a healthy lifestyle and take care of ourselves better given the environment we live in.

Did you have a favorite moment from the trip?

I’d have to say it was a tie between interacting with the children and forming relationships with the incredible volunteer team. It was really eye opening for me to see people with so many medical and socio-economic problems who could still find it so easy to smile, laugh and play. There was also a deep camaraderie that developed within the team because of the unique experience we went through together – living in shacks in the jungle; seeing heartbreaking things in the villages, rallying each other to do our best to help. It was an amazing and emotional trip. I went to learn about a different culture and wound up also learning a lot about myself. We are truly lucky and blessed to live where we do. 


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Kathleen, Bryan, and Larry with a new friend




Five Essentials of a Population Health Management Strategy Webinar

Post by Sandy Murti

VP of Partnerships and Alliances, Caradigm

In a relatively short amount of time, population health management has become one of the most talked about topics in healthcare. As more healthcare organizations take on risk for populations of patients, they need a strategy to transition away from episodic, single patient care. Many are considering population health as the answer to improve quality, lower costs and succeed with risk.  

Some organizations can stall in their journey to population health when they get bogged down by the volume of information they need to synthesize to successfully execute population health management programs. Furthermore, the magnitude of organizational change management required can be considerable for a large health network embarking on this journey. This requirement for population health advisory services along with an investment in the right technologies is one of the primary reasons Caradigm has formed an alliance with a leading healthcare consulting services provider like Beacon Partners.  The alliance brings together Caradigm’s population health software and the population health consulting expertise of Beacon Partners.   

This Friday, Wendy Vincent, National Practice Director Strategic Advisory Services, Beacon Partners and Ed Barthell, MD, Medical Director, Americas, Caradigm will present a webinar about the essential components of a population health strategy for provider organizations.  On the webinar they will cover the core components of a strategy such as:

  • How to identify populations to manage
  • How to coordinate care through partnerships and technology
  • How to engage your organization
  • How to optimize your current technology investment
  • How to measure success

I hope you can join us. You can register for the webinar here.


The Importance of Patient Motivation in Population Health Management

Post by Steve Shihadeh

Senior VP, Sales & Customer Operations, Caradigm

As healthcare organizations take on more financial risk for patient populations, they must gain a much deeper understanding of their patient population in order to drive better outcomes. Realizing the full potential of population health management is limited by finite care management resources as well as each patient’s willingness to participate in his or her own outcomes. By stratifying your patient population based upon predicted future risk that considers patient motivation, providers can identify and prioritize patients most likely to be positively impacted by targeted care planning and interventions.

Factoring patient motivation into the risk stratification of a patient population is one of the exciting ways that Caradigm is helping innovate population health management. Consider the following example of two patients that I have a deep understanding of – my mom and my dad.  Both have chronic conditions, and would be identified by most providers as patients that are high risk or could potentially move to a high risk stratification. Inside of an EMR, the two patients look very similar, but the truth is they should be viewed very differently by providers.

My mom is the ideal patient. She follows her physician’s instructions, fills her prescriptions promptly, schedules her follow-ups, and takes exercise classes as recommended. On the other hand, my dad presents as a more problematic patient because he doesn’t follow his doctor’s recommendations. He’s the opposite of my mom in terms of participating in self-care even though he also has a chronic condition that needs ongoing management.

For a provider, it is extremely valuable to factor in patient motivation when stratifying populations to identify and prioritize patients like my parents. Providers are more likely to have much better outcomes from interventions with motivated patients. Care teams can better assess which patients will benefit most from certain types of interventions, so that they can manage their limited time in order to receive the highest return on intervention.  I am not saying “only focus on motivated patients” but I am saying “working with motivated patients can have the biggest positive impact for all”.

I have been asked, “How in the world do you measure patient motivation?” It starts with being able to aggregate and leverage all of a provider’s data (e.g. clinical, claims, financial). Next, Caradigm applies sophisticated analytics to that data with help of our partner LexisNexis with MEDai Science who has been refining and perfecting the accuracy of how they calculate patient motivation for many years. The data plus analytics then enables deep population stratification and providers can use that information to streamline care management workflows as well as surface it at the point-of-care to guide decisions.

I’ll be participating on the Data Analytics and Practical Uses panel at the Becker’s Hospital Review CEO Strategy Roundtable on November 4th in Chicago, and would happy to continue the discussion at the event or after.

Top 3 Myths About Population Health Management Data

Post by Bill Howard

VP of Solution Architecture, Caradigm

According to this recent survey of Accountable Care Organizations (ACOs) reported in a Healthcare IT News article, an astounding 88 percent report significant obstacles in integrating data from disparate sources and 83 percent say they have a hard time fitting analytics tools into their workflows. Keith J. Figlioli, Premier’s senior vice president of healthcare informatics says that the survey results suggest interoperability is a “pervasive problem among ACOs, and it could stymie the long-term vision for ACO cost and quality improvements if not addressed.” The cost of interoperability was cited as a factor preventing interoperability for many organizations.

The survey responses above are significant in that nearly all ACOs are unnecessarily struggling with core capabilities of population health that will hinder their ability to succeed as ACOs. The responses also reveal that there are misconceptions about population health data that need to be cleared up.

Myth #1: A lack of interoperability prevents the aggregation of data

Even if your hospital network uses dozens of non-interoperable systems to store clinical, claims, financial and other data, that does not prevent you from obtaining a single source of “truth.” Enterprise population health solutions include a data aggregation platform and specialized team that can aggregate and normalize all data from across your community. Closed-system vendors as well as point pop health solution providers struggle with this requirement because they don’t have the data aggregation domain expertise nor enterprise platform infrastructure to bridge the gap between non-interoperable systems.

Myth #2: The cost of interoperability is prohibitive

As described above, interoperability can be achieved through an enterprise data aggregation platform, however, costs should not be prohibitive. Costs and implementation complexity are controlled by leveraging standards, pre-built interface connectors, repeatable mapping and normalization processes, along with options for cloud-based deployments. Compared to the amount of revenue at risk for a typical ACO, interoperability has high ROI potential. Costs can be much higher with solution providers that do not have data management domain expertise and infrastructure because they cannot efficiently connect non-interoperable systems.

Myth #3: Analytics cannot be easily surfaced in workflows

Surfacing analytics at the point-of-care is one of the core value propositions of population health management. Workflow solution vendors often have trouble meeting this requirement because they don’t provide the analytics to integrate into a complete solution set. Many analytics vendors often cannot surface results at the point of care because they don’t integrate with EMRs or offer workflow solutions.  Enterprise population health vendors are able to deliver data and analytics at the point-of-care in near-real time because they provide a data platform, analytics engine and apps designed to work together.

To learn more about how Caradigm can help with your population health initiatives, check out the resources page on our website at www.caradigm.com.

How Population Health Management is Changing CFO Perspectives

Post by Matt Wood

Chief Financial Officer, Caradigm

As healthcare moves from fee-for-service to pay-for-performance, population health management is changing how Chief Financial Officers (CFOs) of health systems approach their roles. Population health aligns quality with revenue, which then aligns the goals of CFOs with Chief Medical Officers (CMO) and Chief Quality Officers (CQO) more closely than ever before. Mark Bogen, CFO and senior vice president of finance of South Nassau Communities Hospital in Oceanside, N.Y. describes the shift for CFOs in this recent Becker’s Hospital Review article:

“I think the biggest thing is CFOs…they’re going to have to continue to get out of their comfort zone with the traditional financial indicators that predict revenue, that predict cash flow, and be more aware of where we’re headed, how many lives are we covering and the utilization and the outcomes attached to the clinical pathways that we’re allowing access to,” he says. “I know that’s a tough thing to get used to, but quality and outcomes are where it’s at, so you’ve got to be in that loop.”  

Population health presents an opportunity for CFOs to increase margins through lower costs, shared savings and bundled payment programs, and increase revenue through the addition of other risk-based agreements. To realize those benefits, CFOs should understand the key requirements of population health solutions as much as the CMO and CQO and participate in the evaluation process as a key stakeholder. For population health to successfully increase margins and revenue, providers need solutions that can:

1) Aggregate and normalize all data (e.g, clinical, claims, financial) across all systems.

2) Apply analytics to that data to stratify populations down to an actionable number of patients with the highest ROI.

3) Surface data and analytics at the point-of care in near real-time to guide decisions and improve productivity.

Without these capabilities, investments in population health solutions run the risk of underperforming on quality improvement and therefore, not delivering ROI. As the internal subject matter expert on ROI and the owner of financial performance, CFOs should play an important role in population health as it can help pave a stronger financial path for their organizations. I believe that having more stakeholders aligned around quality is the first step to drive better patient outcomes, so I look forward to having more conversations with CFOs about population health.

What is Population Health Management Really About?

Post by Neal Singh

Chief Technology Officer, Caradigm

Population health management is still such a new concept that I often get asked the question, “what is pop health really about?” It’s a question that I enjoy having discussions about because it helps put into perspective where healthcare is today and why it needs to take a different path in the future.

Healthcare has historically been transactional. A sick patient visits a physician when they need care, receives that care and the physician gets paid for the transaction. Physicians get paid every time they see patients, whether patients get healthier or not. Electronic Medical Record systems (EMRs) also emerged to facilitate this type of episodic care. However, the downside of transactional healthcare is that it’s reactive and not coordinated, which leads to lower quality of care and higher costs. The passing of the Affordable Care Act in 2010 and the shift in reimbursement models to value-based care have challenged the transactional model.  

Hospital networks are now incentivized to make a population of patients healthier under risk-bearing financial arrangements. By aligning the economic incentives for care delivery and utilization among the patient, provider and payer, population health seeks to improve quality and reduce costs through proactive and coordinated care. New healthcare information technology has emerged to enable population health, and that’s what Caradigm delivers in four key capabilities: 1) Data Control 2) Healthcare Analytics 3) Care Coordination and Management 4) Wellness and Patient Engagement.

Here’s an example of the power of population health. Imagine a large provider with a total population of 1.6 million patients, 77,000 of whom are diabetics. Whereas many population health solutions can predict which 55,000 of those 77,000 diabetics are going to incur the highest costs next year, Caradigm® Risk Management powered by LexisNexis with MEDai Science can identify which patients should be prioritized because of their cost savings potential based on a number of factors including clinical risk, inpatient and emergency room visit risk, forecasted costs, patient motivation, and movers risk (i.e. the risk of transitioning to high risk over the next 12 months). In the case of this particular population, there are 900 patients who will be highly impacted by intervention and management and yield a significant cost savings.  That’s meaningful intelligence that helps large providers with constrained resources know where to take action today.

As exciting as that intelligence is, it’s just one part of the population health story. The story continues in better managing the care of those 900 patients and empowering them to take greater responsibility for their own care, but we’ll save those discussions for another time.

I am passionate about population health because it’s next-generation healthcare that benefits everyone – patients, clinicians, providers and payers. Leading healthcare organizations are already executing on it today, which will help them be the healthcare leaders of tomorrow. To learn more, please check out the resources page on our website at http://www.caradigm.com/en-us/resources/.



Why Care Managers Should Be Excited About Population Health Management

Post by Vicki Harter

Clinical Product Manager, Caradigm

Patient care is part science (i.e. tests, treatment) and part art (i.e. communication, motivation, prioritization). Today, effective population health solutions can link the science and the art in a game-changing way that will help care managers deliver better care, more efficiently.

Care managers are asked to do a lot. The typical care manager at a large hospital network has a full case load, which limits the ability to deliver quality care across a population. The reality is that we’re not going to have enough care managers to care for the growing number of patients, so we have to become more efficient. We also need to empower motivated patients to manage their own care.

Caradigm® Care Management was developed in partnership with Geisinger Health Plan based on extensive observations of their care management team. Together, we came to the conclusion that what care managers needed most was to 1) have complete data and analytics in a single workspace and embedded into workflows and 2) automate routine processes. Here are just a few examples of how a care manager’s life can be made easier:

  • Task lists and interventions are automatically generated from assessment responses that list the top interventions needed to get the highest risk patients to a better place and assure consistent work practice.
  • Complete medication histories can be brought into single patient views that display order history and fill history for easy review.
  • High risk patients can be tracked across the continuum through event-based alerts (e.g. admissions, discharges or blue tooth device alerts).
  • With a full 360 degree view of patients, care managers can see longitudinal data and patient responses over time, identify and address subtle changes and deliver patient centered care by incorporating patient personalized goals into care plans.
  • Patient workloads or specific tasks can be reallocated to other care managers or support staff, assuring “top of license” activity.
  • Best practices of care managers can be identified and then shared across the team.

This is exciting, transformational change. Care managers today are hunting down information from many systems and storing that information all over the place on sticky notes, notebooks, applications, and then must synthesize that into a care plan. Multiply that by 50, by 100, by 200 patients, and it’s challenging to do it efficiently. Caradigm’s population health management solutions are transforming care management, and I am thrilled to be part of the journey.

The Growing Complexity of Identity and Access Management

Post by Azam Husain

Senior Product Manager, Caradigm

Identity and access management (IAM) is getting harder. It used to be a single physician would view one record for one patient during one visit at one location, but now everything is multiplied. Healthcare providers are rapidly expanding their scope of influence by adding independent physicians, hospitals and other providers to their network. IAM is now a broader business challenge that not only affects security and compliance, but also patient safety, clinician satisfaction as well as IT resource utilization.

If anyone knows about the challenge of IAM, it’s Bobby Stokes, AVP Identity Management and Development Services of Hospital Corporation of America (HCA). HCA, recognized for security excellence, must share patient information securely and efficiently across 160+ hospitals, 1000 hospital affiliates, and 100,000+ users. Five percent of all U.S. inpatient admissions take place in a HCA facility. As Stokes said on last week’s webinar, “That’s an interesting mix of concerns.”   

Today, IAM is a balancing act. First, healthcare organizations have a responsibility to ensure the privacy of protected health information from internal and external threats. Inappropriate access to data has resulted in multiple data privacy violations recently (see here and here), and is an area that providers need to take greater control of. Second, data has to be easily available for clinicians to consume and comprehend. Clinician workflows can be streamlined by reducing the number of system log-ins and by providing patient context across those systems. Lastly, from a provisioning perspective, IT needs tools to manage the sheer volume of requests they are faced with. Without solutions that can automate provisioning processes, IT is forced to spend excessive amounts of time on user provisioning, which can also cause delays in clinician access.

If you missed last week’s webinar where Bobby Stokes talked about how HCA approaches identity and access management, then you can catch the recording here.