My last post detailed the “Pop” in Population Health. As an industry, we think about patients when we think about the “population” in Pop Health, and indeed patients are at the core of Pop Health. Providers, however, are facing a new set of populations – the collective group of sub-populations they care for. Put another way, the evolution of Pop Health and risk-based care has generated a complex business landscape for healthcare providers. Providers will need to lean increasingly on technology and data to enable the clinical and business cases around healthcare.
Let’s consider an example of a provider managing a group of sub-populations. A provider could be participating in a Clinically Integrated Network (CIN) that runs a Medicare Shared Savings Program (MSSP) ACO and also has an Medicare Advantage (MA) plan. They could also be participating in two bundled payment programs, have Accountable Care Network (ACN) relationships with three employers, and their state could be remaking their Medicaid program. On top of everything is their traditional Fee-For-Service population. That adds up to at least nine sub-populations amongst the provider’s complete population – that’s their “population of populations.” That group is dynamic and evolving – as needs and times change, so too will these populations and how they are measured and cared for.
Caradigm Technology Driving the Pop Health Revolution
At Caradigm, we live for this type of healthcare complexity. We designed our data foundation, the Caradigm Intelligence Platform (CIP), from the ground up to be both transactional and analytical, which not only allows for powerful analysis, but drives real-time intelligence to applications so that the intelligence mined in the data can be put to use. Most platforms are either one or the other – transactional to power applications (e.g. EMRs are built on transactional databases) or analytical (many “big data” solutions to date are analytical platforms). Each and every piece of relevant data from the provider system – from clinical records, labs to claims can be ingested into CIP. This means all of a provider’s data can be located in one place and can be used together to generate highly functional intelligence for patient care. From baseline risk-adjustment to contracted clinical quality and outcomes, today’s providers and CINs require real-time intelligence to manage such diverse populations.
At a population level, Caradigm looks to the analytical applications in its product suite to drive real insight into a provider’s populations and to manage to contracted quality and financial arrangements. The Caradigm Risk Management application is built upon a partnership with MEDai, a LexisNexus company, to drive industry-leading prospective risk profiles of populations and individual patients. Most risk applications only look retrospectively or only in a clinical vein, however our risk management application distinguishes itself on the broad set of big data available in CIP and the 25 year history MEDai has in predictive analytics. Further, Risk Management looks at six key predictive indexes on a patient-by-patient basis. This means that a provider can not only understand clinical and financial risk on a patient basis, but also the patient’s specific “Motivation” and “Mover” risks. The Motivation Index details a patient’s likeliness to respond to any intervention. The Mover Index corresponds to a patient’s likelihood of becoming more ill during the next 365 days. This means that a provider can more accurately assign care management and follow-up assistance to patients in an efficient manner that up until now could not be provided. Providers would have to use more blunt force and address a population of the top 10% of A1cs or 10% highest cost patients without any insight as to whether the patient would or could respond to any intervention. This leads to much more precise care and financial outlay in a risk-based system. Targeted insight means highly actionable and effective pop health care.
The Caradigm Quality Improvement application, built directly on top of CIP, highlights the current quality measure status for a provider across each population and contract. For example, the QI application tracks ACO33 measures, allowing for the identification of up to date gaps in care on a patient-by-patient basis that via CIP can be surfaced directly at the point-of-care to drive quality improvement in the appropriate setting. Caradigm’s Utilization Management Analytics application takes a look at some of the costliest medications, procedures and providers to help pinpoint areas of high spending.
Together, these applications help our customers manage not only their total population, but their sub-populations as well. Each risk-based contract – whether MSSP, ACN, bundled payment or direct-employer purchasing – brings a population with its own unique clinical and financial risk factors and gaps in care. Caradigm not only drives success in these early days of Pop Health, but because of CIP and the nature of the suite of applications, will enable health systems to rapidly expand their risk-based contracting and arrangements to drive true value-based population health.