Monthly Archives: March 2015

The Future of Healthcare – Patient Engagement is Due for a Paradigm Shift

Post by Scott McLeod

Director of Product Marketing, Caradigm

Just as healthcare is making the shift from volume to value, the concept of Patient Engagement needs to be reimagined in several important ways:

View patients as healthcare consumers with varying levels of engagement in their own care…
Some patients will actively choose how, where and when to access healthcare based on cost, quality data and other patient’s reviews. They expect personalization and patient-centricity from their healthcare providers, and make decisions based on being directly responsible for healthcare costs.

Other patients may feel overwhelmed by managing their health and will require a more guided and supportive approach to understanding, monitoring and potentially confidently managing their conditions at some point.

Acknowledge the impact of factors such as behavioral economics in decision-making…

The reality is people often don’t make rational decisions – in fact, many irrational factors influence thinking such as:

  • Status Quo bias: “This is what I’ve always done…”
  • Complexity Aversion bias: “Too many factors to consider…”
  • Present Time bias: “Going to the gym now is too hard…”
  • Peanuts effect: “It was only 1 donut a day (for 10 years)…”

Important health-related behavior changes need to be framed for patients in recognition of these biases – the long-term impacts of old habits can be re-framed relative to current goals, incentives can be created to establish more immediate payoffs for difficult changes and seemingly overwhelming tasks can be broken into a series of smaller, achievable wins that build confidence and belief that “Yes, I can do this.”

Health goals and behavior changes must be made relevant to each patient by relating them to individual, personal priorities:
For behavior change to occur, care has to fit meaningfully into patient’s lives. Patients are motivated more by personal goals rather than potentially overwhelming healthcare metrics. Patients care more about spending time with their grandkids or being able to walk their dog rather than controlling blood glucose levels or lowering blood pressure. By understanding these priorities and reaching patients with relevant, personalized messages at the right time outside of the care setting, the likelihood of successfully triggering positive health-related behaviors increases dramatically.

For success in population health management to be achieved, Patient Engagement must evolve from being a non-essential, ‘nice to have’ function to a critical driver of success. By clearly demonstrating the value and ROI that patient engagement can bring to the management of populations, the role that patients play will finally be recognized – for the impact it can have in their own success and that of care teams. When patients are truly activated to participate in their own care and own the management of their health, the industry will be transformed.

How Some Accountable Care Organizations (ACOs) are Taking the Lead

Post by Christine Boyle

Chief Marketing Officer and Senior Vice President, Caradigm

The number of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) has continued to grow steadily as there are now approximately 405 participants after the latest wave of 89 newly accepted applicants.[i] Participating as a MSSP ACO gives healthcare organizations a low-risk means to start transforming to value-based care while they change processes and acquire new health IT infrastructure. Although the program is still fairly new, having only been around since 2012, about 25 percent of ACOs have started to separate themselves from the pack by being able to generate shared savings.[ii]

Being able to generate shared savings is crucial for ACOs because the underlying premise of value-based care is that coordinated, preventive and evidence-based care will both improve the health and  lower the per capita cost of a defined population. Furthermore, the sharing in cost savings helps offset reductions in fee-for service revenue, pay for new health IT infrastructure, and builds organizational momentum for the expansion of risk-based contracting. However, generating shared savings has been an elusive goal for the majority of MSSP ACOs to date.    

Dr. Randall Williams, MD wrote an interesting article on this topic recently on Pharos Innovations discussing why most ACOs have fallen short of generating cost savings. His hypothesis is that “…most ACOs are still working on basic organizational issues like:

  • Integrating their doctors
  • Getting CMS claims data into a format that can be analyzed
  • Documenting and reporting quality performance metrics

While that work is necessary, it is not at all sufficient. It won’t generate the cost savings required to get to the shared savings bonus opportunity.” [1]

Dr. Williams believes that the ACOs that have been successful in generating shared savings have focused heavily on reducing avoidable admissions and readmissions.  He makes an excellent point that ACOs need to transition from a tactical focus on operationalizing their ACOs to a strategic one that will drive greater results. 

Transforming to value-based care is a complex process because it impacts the entire organization. For ACOs to achieve greater results they have to move away from siloed efforts and approach value-based care as a series of interconnected activities. It is not just solely about data, not solely about analytics and not solely about clinician workflows. It’s about all of those activities operating in an integrated manner and augmenting each other. This is known as an enterprise population health approach that integrates data, analytics, and workflows across the entire organization to support new care models. An enterprise approach leads to synergies and efficiencies across the organization that are the difference makers when trying to drive results as quickly as possible for a targeted population.

2015 is a critical year for ACOs to hone in on the strategies and health IT infrastructure that will help them move into the leaders group of ACOs generating shared savings. We have just published a new whitepaper entitled “ACO Best Practices for Shared Savings” that explores this topic more by profiling the strategies used by a few successful ACOs and recommending what ACOs could be doing differently this year.

Download the whitepaper here.

[i] Evans, M. (2014, December 22) 89 ACOs will join Medicare Shared Savings Program in January. Modern Healthcare. Retrieved from

[ii] Kocot, S., Mostashari, F., White, R. (2014, February 7) Year One Results from Medicare Shared Savings Program: What it Means Going Forward. Retrieved from:

[iiI] Williams, Randall, MD. Want to win with value based purchasing? Start with the fundamental challenge. February 2015.

The Future of Healthcare: Innovating Coordinated Care

Post by Scott McLeod

Director of Product Marketing, Caradigm

One of the most impactful developments in healthcare today is the movement towards coordinated care. It’s essential as more healthcare organizations engage in population health management and participate in a broader health network with a variety of partner providers. Many providers have recognized that the care of a high-risk patient is a team-based activity that requires the coordination of a variety of clinicians and care givers serving different roles. It also involves a series of processes – intake, screening, assessment, developing a plan of care, reviewing a plan of care, making contact with care givers, reviewing medications, etc. To deliver the best patient outcomes possible, providers need to ensure that these processes are being completed efficiently and consistently across the team.  

The idea of coordinated care is not new, but being able to deliver it effectively is starting to become a reality as new health IT emerges to help enable it. A care team is made up of a diverse group of clinicians and family members that can include primary care physicians, specialists, a lead case manager, an in-patient case manager, a field coordinator that works on non-clinical tasks, a pharmacist, community organizations, and family and friends that may be providing support such as transportation or helping pick up medications. That’s a lot of people and a lot of information that is needed to properly care for just a single patient. Multiply that by potentially thousands of patients in a care management program, and it becomes clear why coordination and efficiency can be challenging.

Here’s how health IT can innovate care coordination. First, it brings together all the data and information needed to care for a patient from all systems across the health network. All care givers have a 360 degree view of the patient that includes the plan of care, medications, lab results, vitals, documents, immunizations etc. When an update is made, all care givers have that update in real-time. With a full 360 degree view of patients, the care team can see longitudinal data and patient responses over time, identify and address subtle changes and deliver patient-centered care by incorporating patient personalized goals.

Second, it transforms the efficiency of clinician workflows, which leads to increased productivity and consistency of care. Physicians can see care gaps and close them while still in the presence of a patient. Care plans, task lists and interventions can be automatically generated from the patient’s clinical information and assessment responses. Complete medication histories can be brought into single patient views that display order and fill history for easier review. Patients that may need immediate attention can also be tracked across the continuum through event-based alerts (e.g. admissions, discharges or Bluetooth device alerts). Lastly, all of the needed tasks are being assigned to the right team members assuring “top of license” activity.  

From the patients’ perspective, they’re on a better path to become healthier as they receive care focused on wellness and preventive measures. They’ll also receive a better patient experience as they don’t have to repeat answers and all care givers are up-to-date on their information. Care coordination is one of the foundational strategies healthcare organizations must employ to achieve the Institute for Healthcare (IHI) Triple Aim of 1) Improving the patient experience 2) Improving the health of populations and 3) Lowering the per capita cost of care. With a little help from innovative new health IT, coordinated care can become a reality.

The Future of Big Data in Healthcare

Post by Neal Singh

Chief Executive Officer, Caradigm

The idea that there could be undiscovered insights residing in large data sets that can be used to drive innovation is fascinating. That’s why Big Data has so many people excited, including myself. In healthcare, Big Data is essentially a core component of population health management, a strategy that is helping healthcare organizations transform to value-based care. Although most healthcare organizations are still in the early stages of both strategies, there is no question that Big Data and population health will play major roles in shaping the future of healthcare. Let’s explore this issue further to better understand what steps healthcare organizations can take to realize the full promise of Big Data.

Getting to Big Data

The traditional healthcare organization is evolving beyond the walls of the hospital. Providers must now coordinate care across a broader health network that can include a large number of clinical partners often using a variety of technology systems. Although it can be a challenge to bring data together, it is the first required step towards gathering large quantities of data. It is also important to consider that clinical data is only the starting point. Where Big Data in healthcare starts to get really innovative is when clinical data is combined with other types of information such as claims, financial, lab, pharmacy, unstructured data (e.g. clinical notes), etc.  Providers that can establish the processes and tools to automate the aggregation and normalization of data regardless of the system or structure they reside in will be set up for Big Data success.

From Data to Insights

After an organization achieves data aggregation, it should celebrate because that is a major accomplishment. However, that is only step one in the journey because the data has to be turned into insights that can drive improvement. One of the most powerful uses of healthcare data is in predictive modeling, which helps providers understand their patient populations and anticipate where they can have the highest return on intervention. For example, providers can measure patient motivation, and use it to predict which patients will follow physician instructions and benefit most from targeted interventions. They can also predict which patients will become the sickest next, i.e. those that are most likely to transition from low to high clinical and financial risk over the next 12 months, so they can intervene proactively. As risk has shifted from payers to providers, this ability to understand the risk in a population has become essential.

From Insights to Action

The last, but most important, step is to surface insights and information within clinician workflows in real-time so that they can take action and improve outcomes. For example, a physician can see gaps in care for patients and close those gaps while still in their presence. A care manager can be alerted when a high-risk patient is admitted to the emergency department to ensure proper transition of care. A clinical analyst can monitor patient data on a large number of patients who have had catheters inserted, and alert a nurse when the data shows that a patient is showing signs of a potential infection.  

Most exciting is that all of the above use cases are not hypothetical or years away from becoming reality. They are all possible with today’s health information technology. These innovations stemming from Big Data are starting to take hold, but it will take time for them to truly become the norm in healthcare. There is no doubt, however, that momentum is building for both Big Data as well as population health, and that they will play leading roles in healthcare’s future.