Monthly Archives: March 2016

Progressing with Population Health and Big Data

Post by Neal Singh

Chief Executive Officer, Caradigm

Last year, I wrote this blog post about the great potential of big data to drive innovation in healthcare. With the rapid progress organizations are making with their population health strategies, I thought it would be a good time to revisit this topic because of its importance to the industry. To be honest, healthcare organizations are still in the early adoption phases of big data.  Only a few organizations are dealing with petabytes of data, which is typically the threshold people think of when it comes to big data. However, I do see significant progress. Big data is in the process of transitioning from a research-oriented activity to a main stream agenda item that enables multiple population health scenarios. Let’s explore why.

Population health is driving the data explosion

Whether healthcare organizations are ready for big data or not, many are faced with exploding amounts of data at their disposal as they embark on new population health strategies. Within a single health system, it is not unusual to have several hundred IT systems and applications in the portfolio, and to have 50-75 that are actually exchanging data. Population health often requires a better understanding of your patient population, utilization, costs, quality, and chronic conditions across multiple systems and or with many partner organizations. This likely involves extending beyond your EMR to other disparate EMRs and IT systems outside your enterprise. Therefore, one needs to aggregate, normalize and share clinical, operational and financial data from many IT systems across the community—including EMRs, billing systems, payers, pharmacy systems, labs, and HIEs. Also consider that today, most of the data sets in the industry tend to be structured. We are now beginning to see early use of unstructured data (i.e. clinician notes), which can contain highly valuable patient information (e.g. ejection fraction for patients with congestive heart failure). Additionally, I see increasing interest in other new data sets such as consumer, genomic, demographic and social data (e.g. fitness devices, purchasing history, Twitter, Facebook) integrated into scenarios for population health. There is no end in sight for the growth of data in healthcare, which I find incredibly exciting because of the ability to draw new value from it.

The mechanics of big data are being established

In order to realize the full value of their data, organizations have been establishing the mechanics of how that data needs to be aggregated, transformed and stored. It’s important to have the right population health data platform in place that can automate numerous processes, or else big data efforts can struggle to get off the ground. Healthcare organizations leading the way in big data have been adopting data platforms for healthcare that have the following capabilities:

  • Automated data ingestion from any originating source in any format in real-time that has existing pre-defined configurations or parsers for a variety of data formats, e.g. HL7, CCD and CCLF, and unstructured.
  • Automated transformation of data regardless if data is in different terminology code sets or structures that includes semantic mapping for code conversion and pre-built tooling that facilitates normalization and deduping of data from pre-defined and custom sources.
  • Automated modeling of data that uses pre-defined healthcare entities that can accommodate most clinical and claims data as well as custom entities to accommodate customer-specific data.
  • Open data sharing APIs that provide untethered read and write access with source systems and the ability to share data with analytics and self-service reporting solutions.
  • Role-based security with auditing.

Initial population health scenarios are being explored

The scenarios for big data are limitless and I believe that one day they will expand to untapped data sources such as social media, consumer purchasing, and even things like smart clothing. Until that day arrives, big data can still have a significant impact on how you manage a population at an aggregate as well an individual level. Here are a few initial scenarios that organizations are already exploring today:

  • Build and share a true longitudinal patient record to see all relevant patient data (e.g. labs, pharmacy, claims, analytics) that covers the full continuum of care.
  • Employ predictive models (i.e. risk stratification), which are especially effective with large data sets so that you can focus your resources where they will have the greatest impact.
  • Expand the scope of your analytics to new areas such as measuring the quality and financial performance of individual clinicians as well as overall organizational financial and utilization analytics.

It’s fantastic to see that healthcare is innovating through big data and population health. The organizations that have built their infrastructure strategically should be in great position to keep refining what they’re doing today while scaling and building new use cases. If you’d like to discuss how Caradigm can help with your big data strategies, then leave us a note here.


HIMSS16 Trends: The Maturation of Population Health

Post by Scott McLeod

Director of Product Marketing, Caradigm

The educational sessions at HIMSS16 serve as a barometer of the progress of population health management as a priority for healthcare organizations.

This year, after three days of attending sessions, I note four key themes—

1) Current economic realities are driving new strategies

The changing market is not just a distant-future consideration. Payment reform from CMS and private payers is already occurring and will accelerate. Local markets—in which healthcare organizations must compete—face shifting roles and demands of employers and consumers. In one local market, a reported 75% of payments are tied to risk contract. Facing the fact that maintaining the status quo is not sustainable in the long term, organizations are setting new strategic directions that balance external forces and internal capabilities to achieve success under commercial and Medicare programs.

2) Collaboration is key

Healthcare organizations must work with others to realize the revenue under value-based reimbursement. This includes building relationships with non-contracted physicians and other (often competing) organizations to form accountable care organizations, clinically integrated networks or performing provider systems to provide the geographic coverage required for an assigned population. In addition, organizations are changing their relationships with employers and payers to seek win-win contractual arrangements that improve the quality of care for patients served and manage the costs for all stakeholders.

For example, Inova Health System and Aetna launched a joint venture to form a new health plan, Innovation Health, working together for improved care, cost and quality. Care coordinators steer members to appropriate programs and provide coaching. High-risk patients are enrolled in care management programs at post-acute facilities, and high-performing skilled nursing facilities (SNFs) are selected for inclusion on the network.

3) Results are starting to show

Population health initiatives seem to be more targeted and organizations are more specific about what they want to measure. The result is that—beyond reports of pilots and early steps—we are beginning to see tangible, positive results from these initiatives. The joint venture cited above has achieved a 17% reduction in the number of unnecessary hospital days after surgery, 15% fewer hospital admissions and 21% fewer hospital readmissions. As another example, Banner Health reported on the successes of its telehealth program: 20% reduction in length of stay, 45% reduction in hospitalizations and a 27% reduction in total cost of care.

4) Health Information Technology (HIT) is necessary for success

As the number of population health initiatives increases, and the number of at-risk lives grows, organizations recognize that HIT solutions are required to achieve the efficiency, effectiveness and scale that the programs demand. Successful organizations employ and rely upon solutions for data aggregation, risk stratification, analytics, interoperability and population health management. Staten Island PPS, for example, reports that each of its 11 DSRIP projects actively underway has unique HIT requirements for success including longitudinal patient records, predictive analytics and utilization management, telehealth and patient registries.

One other theme, that overlays the rest, became apparent during the educational sessions. The journey to population health management will continue, but the routes will change. What works today may or may not work tomorrow as the relationships among the different stakeholders shift.

Caradigm offers population health solutions that offer scalability and adaptability over time. You can have a discussion with a Caradigm representative by leaving a note here.

  1. “Value-Based Models: Two Successful Payer-Provider Approaches.” Clifford T. Fullerton, MD MSc and Mark Stauder. March 1, 2016.
  2. “Volume-based to Value-based Care at a Pioneer ACO.” Julie Reisetter, MS, RN. March 3, 2016.
  3. “Addressing the IT Challenges for a Startup DSRIP Program.” Joseph Conte, PhD(c). March 2, 2016.
  4. “Transformative Payment Models.” Jody White and Brian Sandager. March 1, 2016.

HIMSS16 Day 2: The Emergence of Care Transformation

Post by Vicki Harter, BA, RRT

Vice President, Care Transformation

I am so thrilled to be at HIMSS16 this year with my newly formed Care Transformation team that includes fellow clinicians, Natalie Benner and Ruth Light. It was also a pleasure to speak in the Population Health Knowledge Center and converse with a number of the attendees afterwards. Having recently moved from a product strategy role at Caradigm to my new position as the VP of Care Transformation, I am excited to be able to collaborate with providers and customers about their population health strategies even more this year. We all know population health requires more than just new technology solutions. The team of clinicians delivering care and how they deliver that care has to evolve as well. What makes it challenging for providers is that there’s no single “right” way to do it. Caradigm’s Care Transformation team was formed to help organizations find their optimal approach given their goals, strategies and resources. Below are a few questions that can be helpful to think about if you are interested in care transformation.

Who should be added to the care team?

As I alluded to above, there are many different ways to set up your care teams depending on your particular area of focus. Some providers partner closely with primary care physician groups and will share resources such as a social worker, behavioral health counselor or a non-clinical admin that helps clinicians work “top of license”. Others may focus on designing care transition teams that ensure effective handoffs between care settings. Community-based services such as transportation can also be a highly effective addition to care teams that can drive immediate results. Providers have had success reducing unnecessary ambulance and ED utilization for non-emergency situations simply by providing access to a taxi service.

How do we align different workflows?

It’s critical to think about care pathways as an end-to-end process. Ask yourself “How do they connect?” “How can we make processes consistent between them?” “How do we remain patient-centric?” After providers take initial steps in population health, often the next step in their journey is to map and align different workflows and teams. Providers need aligned goals, metrics and protocols across the spectrum. Silos between teams need to be removed to enable an efficient patient-centered approach to care.

Can we support different care settings?

Being able to provide effective care in different settings is also critical because patients often move between them (e.g. acute to post-acute, ambulatory to assisted living). For patients with no regular caregiver support, care may be best delivered in a long-term care or skilled nursing facility for which providers must have a plan. For other patients, a medical home with embedded services such as behavioral health and access to community-based services may be the right fit. Effective handoffs between care settings must be established to avoid gaps and lapses in access to services. Being able to communicate and share a plan of care across an interdisciplinary team is also essential for complex patients.

How do we connect with the patient?

Every clinician that I speak with agrees that patient engagement is vital to improving health outcomes, but also agrees that it is extremely difficult. Even contacting a patient can be challenging because providers often have outdated contact info. In order to scale population health programs, providers need their patients to have “skin in the game” and participate in their own care. Providers might be able to create a registry of the most expensive patients, but it’s just as important to find out why they are the most expensive. For example, are they not taking their medications because they don’t have transportation, can’t afford them or are they confused by the different medications that have been prescribed by multiple specialists? Motivating patients and changing behavior is not easy, but it’s important to think about how it fits into the care team’s responsibilities and workflows.

How can technology help?

Coordinating care across the continuum is difficult because legacy health IT infrastructure was not designed to support risk-based care approaches. When I ask clinicians what do they need technology to help with, I hear a lot of common responses. They wish they had access to real-time lab info because while claims data is great, it is dated. Others tell me they wish they had integrated EMRs. They wish all providers could be connected so that everyone can have a true encounter and care summary even if it was out-of-network. Did a patient get admitted? Did a patient get discharged? Scaling population health according to patient risk-level is also another core challenge where technology can be extremely helpful, which is a topic that I’ll cover more in a future blog post. The truth is technology can help in a lot of areas, but how you sequence and scale that investment will depend on your particular organization.

These are the types of questions that I am so excited to help providers tackle this year. The Care Transformation team is in the Caradigm Booth #5427 this week at HIMSS having discussions with providers. If you miss us at HIMSS, you can reach out to us after by leaving a note here.

Vicki HIMSS16

It was an enjoyable experience presenting in the Population Health Knowledge Center

HIMSS16 Day 1: Seeking Interoperability in Population Health

Post by Neal Singh

Chief Executive Officer, Caradigm

The healthcare world assembled in Las Vegas with the kick-off of the Health Information Management Systems Society (HIMSS) Annual Conference. An issue that I expect to have many conversations about at HIMSS16 is the ongoing challenge of interoperability. Organizations engaging in population health continue to be frustrated by disparate information systems that result in outdated and incomplete patient information. This greatly hinders organizations’ ability to effectively coordinate care between providers in different settings, close gaps in care, and manage overall utilization and financial risk. The demand for interoperability has reached a crescendo as it is now a must-have in order to succeed with population health.

As I noted in this recent blog post about the Fast Healthcare Interoperability Resources (FHIR) standard, while FHIR is part of the discussion around interoperability, it is not a cure-all for all data challenges. An ideal solution starts with the foundation of an enterprise data warehouse (EDW) that can support a multitude of data standards and is designed specifically to model healthcare data and share it with other applications. This piece of the solution aggregates, normalizes and models your data, creating a rich data asset that can be used to drive action in any native or third-party application. True interoperability also requires bi-directional integration with any EMR in your community to enable the exchange of electronic care plans, care summaries, and other clinical data within the community.

There has not been an enterprise data platform like this in our industry, until now. At HIMSS16, Caradigm  announced Open Exchange, which works in conjunction with the Caradigm Intelligence Platform (CIP), an EDW for healthcare. The HIMSS ConCert certified solution is unique in our industry for its ability to enable interoperability of EHRs and other data source systems needed for population health. Caradigm is demonstrating its capabilities this week as part of the HIMSS16 Interoperability Showcase, which is the culmination of our participation in several collaboration events with other health IT solution providers.

We are extremely proud of our team’s efforts with Open Exchange and CIP that underscores Caradigm’s industry leadership in innovating healthcare data exchange. If you are attending HIMMS16, then we invite you to stop by the Caradigm booth #5427 or the Interoperability Showcase to discuss your interoperability needs and learn more about how Caradigm can help. Also, don’t miss my colleague, Vicki Harter, who is speaking tomorrow in the Population Health Knowledge Center about how providers can approach different value-based strategies in a presentation entitled – ACOs and CINs and DSRIP, oh my!


Neal Accepting HIMSS Award

I was very proud to accept Caradigm’s award for the HIMSS ConCert Certification of Open Exchange