Monthly Archives: September 2015

Leaning in on Population Health (Part 1): Caradigm Customer Summit 2015


Post by Christine Boyle


Chief Marketing Officer and Senior Vice President, Caradigm

We were absolutely delighted to kick-off the 4th annual Caradigm Customer Summit (CCS) at the Bell Harbor Conference Center on the beautiful Seattle Waterfront. As healthcare continues its transformation to value-based care, gatherings like CCS are great opportunities for provider organizations to engage with peers who are on similar journeys to population health. In truth, population health is still so new that everyone is learning together. With over one hundred senior healthcare executives from leading organizations in attendance, CCS is a unique event focused exclusively on population health.

My main take away from the first day was that provider organizations are now further along in their journey to population health and are “leaning in”. The dialogue has matured from “should we do it” to “how do we optimize what we are doing”. The business decisions have been made, technology has been evaluated, and now it’s time to operationalize and scale efficiently. Here are some of the highlights from the day.

Michael Simpson Caradigm CEO Opening Welcome

“Every organization across the U.S. and the globe has to figure out how we make this journey to pop health work. We have a common goal.”

In Michael’s opening welcome, he shared a number of statistics that show that the growth in population health is real and that momentum is building. While technology barriers to population health and threats to information security also continue to be real, Michael talked about how Caradigm customers are progressing, and as a whole are leveraging Caradigm solutions to tap into data from over 150 different systems in over a billion patient encounters.

 

Angelo Sinopoli, MD VP, Clinical Integration & Chief Medical Officer, Greenville Health System

“The discussion used to be with the HR representative. Now the cost of healthcare has gotten so high, the discussion is with the CEO.”

Dr. Sinopoli explained that Greenville Health System views population health as the key strategy that will help them better serve patients while also helping them be a leading provider in the state of South Carolina. He also talked about why they formed their state-wide clinically integrated network, the MyHealth First Network and how they will drive care management best practices through the Care Coordination Institute, which leverages Caradigm’s full suite of solutions including Caradigm Care Management.

 

Marian Lowe, SVP of Payer and Employer Strategies USPI and Ashley Wise, VP of Strategic Systems USPI

“Population health for us is about how do we create a meaningful network of providers that improves patient care.”

Marion and Ashley detailed USPI’s journey to population health. As one of the largest network of surgical centers in the country, USPI realized that as their national network of partners started moving towards clinical integration and value-based care, USPI had to build the capabilities to support those activities. USPI then formed a clinically integrated network and an accountable care organization and are using Caradigm’s solutions to support those efforts with data aggregation and analytics.

 

Matt Stevens Advisory Board – Population Health and the Retail Revolution

“Providers are trying to provide the right care in the right location – achieve meaningful geographic reach and clinical scope.”

Matt Stevens from the Advisory Board shared industry insights about how the retail revolution in healthcare aligns with the movement towards population health. He explained that providers must win at two points of sale: 1) they must secure enrolled lives and 2) win share of volumes. In order to do so, they must form the right strategic network and gain the health IT infrastructure that can lower costs, manage populations, increase access and improve the patient experience.

 

Regina Holliday, Patient Advocate

“We are all patients in the end. This is where I take my stand.”

Renown patient advocate, Regina Holliday capped off Day 1 with a moving presentation about the patient information challenges her family faced while trying to receive care for a sick family member. As provider organizations seek to transform care models and improve the patient experience as part of population health efforts, Regina asked providers to take a patient-centered approach and include patients in the care team in order to best serve their populations.

Also on the agenda were several roundtable sessions where attendees engaged in peer-to-peer discussions on topics such as analytics, care and chronic condition management as well as health data privacy and security. In future blog posts, we will share some of the best practices that came out of those sessions. Thanks to our phenomenal guest speakers and customer attendees, it was an inspiring day of learning on the first day of the Caradigm Customer Summit. Check back tomorrow for a recap of Day 2!

The “Population” in Population Health


Post by Brad Miller


Vice-President of Clinical Solutions, Caradigm

In my last post I wrote about the 3 P’s of Population Health – Population, Patient, and Practice. Pop Health has become a ubiquitous concept not only in healthcare IT (see HIMSS 2015), but in healthcare at large. That said, there is no one way to define Pop Health – it can mean many things to many people. I am hoping the 3 P’s will help start a new way of thinking about the definition and execution of Pop Health. In this post I will talk about the ‘Pop’ in Pop Health – the Population.

Traditionally, providers have had three distinct populations – Commercial, Medicare and Medicaid. Sure, there were a couple of exceptions, but by and large those three were the types of populations that comprised a provider’s total population. That status quo has changed dramatically as Pop Health has begun to take hold and more “sub-populations” have been created to meet the distinct financial, quality and health challenges faced by purchasers, payers, providers and patients. Here are a few examples:

Medicare Populations:

  • Traditional: This is the fee-for-service sub-population of Medicare, and is an approach and population that CMS is planning to fade out over the next couple of years.
  • Medicare Advantage: MA plans are essentially outsourced traditional Medicare patients – a commercial insurance company takes responsibility for managing a Medicare population. Well executed MA plans with a pop health strategy can lead to significant quality and financial opportunities for providers and payers.
  • Medicare Shared Savings Program (MSSP) and Pioneer ACOs: In this sub-population, a provider agrees to drive savings and quality across a Medicare population. The provider must not only create savings relative to a baseline, but they must maintain quality standards (ACO33s) as well if they wish to partake in those savings in part or in full.

Medicaid

  • Medicaid programs vary greatly from state to state. Currently, most states are in the midst of Medicaid reform – the ACA has greatly expanded Medicaid eligibility and many states are either consolidating Medicaid programs or restructuring them all together to meet this demand for access and quality. This can greatly increase population variability for a health system.

Commercial

  • Traditional: Here we have the traditional fee-for-service patient where volume of patient services typically drives system revenue.
  • Direct Purchasing: Where purchasers of healthcare, typically companies or local/state governments purchase care directly with a health system and with a contracted quality standard required to maintain good standing.
  • Accountable Care Networks (ACNs) or Clinically Integrated Networks (CINs): Health systems teaming up to enable large, direct healthcare purchasing contracts. These organizations share financial risk and resources like IT systems or drive purchasing agreements.
  • Bundled Payments: This has typically been a subset of direct purchasing, except a purchaser has arranged for a fixed-fee for a procedure – typically high-cost procedures like knee or hip replacements. This places the provider at risk and incentivizes them to drive better outcomes through quality.

A Population of Populations

While these sub populations are likely to be quite familiar to a number of readers, noting them together highlights the sheer number and complexity of the Populations that are a part of Pop Health. Indeed, providers now have a “Population of Populations.” Why did I run through the list of sub-populations above? While most of the sub-populations are self-evident on their own, I find it useful to literally see the number and diversity of a provider’s care models and contracts. In this time of increasing model and population diversity and complexity, providers are also taking on more risk. Providers are changing multiple, complex and difficult variables in their business and operational models to serve these populations. Most healthcare workflows and technology were established in a time of transactional fee-for-service, not dynamic and highly interactive pop health. Each sub-population has its own needs, financial drivers and quality measures, and new technology will enable providers to scale to meet the demands of those requirements. Real-time data and analytics, feeding a scalable technology platform and applications will enable providers to manage this Population of Populations. I’ll get deeper into “the how” when I take a closer look at the technology requirements needed to manage these populations in my next post. For now, the “Pop” in Pop Health has truly become a “Population of Populations.”