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What to Look for in an Identity Governance and Administration Solution for Healthcare

Post by John Lammers

Vice President and General Manager of Identity and Access Management, Caradigm

In my previous post, I discussed the unique challenges that healthcare organizations face in the arena of identity governance and administration. In this follow-up post, we will review what to look for when choosing a solution for your healthcare organization.

First, let’s review what we mean by identity governance and administration. Gartner’s Magic Quadrant Report for Identity Governance and Administration[i] defines this as a set of identity management capabilities including: managing identity life-cycles, managing entitlements, and handling access requirements.

There are many supporting capabilities that are required to go from a set of point technologies to a fully-integrated solution for your organization, for instance: workflow orchestration, data validation, auditing, and reporting. In the healthcare IT environment, reach is quite important as well given that healthcare organizations utilize many disparate systems to provide the best possible patient care. Integrating those systems into a common process while automating as much of the identity management and identity governance activity as possible is essential, both to guard against breaches and to ensure that clinicians have secure and appropriate access to the applications they need from day one.

The following are identity governance challenges presented by the healthcare environment and what you can look for in a solution to address each of these.

Complex Staff and Identity Lifecycles

If you’re a typical hospital, change is your new normal. You have visiting specialty practitioners, students who come and go in waves and roles changing regularly. In recent years, we’ve seen a 70% increase in merger and acquisition (M&A) activity.[ii] All of this adds up to complex staff and identity life cycles. To mitigate the one-off and not-so-one-off changes, a strong solution is needed to support your organization’s control.

What to look for:

  • Workflow capabilities that help you orchestrate all of the activities within your processes
  • Unification of the human and automated parts of the process, so that you avoid identity management activity happening outside of and invisible to your process
  • Support for large inflow or outflow of staff in a short time
  • Support for staff members with changing roles or multiple roles

Flexible and Scalable Role Requirements

We see it over and over in our work with healthcare organizations. Different specializations, different sites, different systems and processes. It all adds up to a need for strong role management.

What to look for:

  • Ability to handle large numbers of roles
  • Ability to model your organizations roles and policies
  • Ability to detect outliers and inconsistency in roles
  • Ability to take action to resolve inconsistencies

Diverse and Continuously Evolving Technology Ecosystems

Healthcare IT organizations strive to deliver the highest quality, most capable systems to clinical staff. Taking advantage of innovative and best-of-breed tools leads to a diverse and continually evolving ecosystem of technologies. It’s critical that your identity management and identity governance solution encompass all your systems. One-off approaches to access control, auditing, and provisioning/de-provisioning accounts leads to situations where a clinical user has access to some of the applications they need; or when leaving the organization, have their access removed from some of those applications. This results in lost visibility, but also the potential for lost productivity and even security breaches. You need a solution that puts all your systems under a single identity governance process, and because that’s always easier said than done, the solution needs to give you a way to cover the basics right away, and then deepen integration (i.e., add automation) as time allows and based on ROI.

What to look for:

  • Ability to integrate with multiple HR systems
  • Ability to integrate with diverse IT support management ticketing systems
  • Flexible integration with of a diverse set of EHR (Electronic Health Record) systems, including systems that don’t provide easy remote access, such as systems without APIs, pre-accessibility era web applications, native apps, and even green screen systems
  • Facilities allowing you to handle operations manually and automate on your own timetable, while incorporating manual operations within a single, unified identity management process
  • Tools that put automation in the hands of your staff by making it easier to integrate applications
  • Services available to augment the capabilities of your staff

Scale and Criticality

Scale and high-availability matter to everyone, but every organization is unique in its specific needs. You need options that cover your scenarios today and will flex to accommodate changing needs.

What to look for:

  • Ability of the vendor to articulate their approach to high availability
  • Flexibility in the approach to disaster recovery and to services to guide you as you build your disaster recovery plan
  • Horizontal scaling (more capacity at a single location)
  • Geographical scaling (distributing capacity so that it’s near the users)
  • Throughput scaling (ability to handle bursts of high demand on the system)
  • A history of operating at scale in real production environments

Proactive Risk Mitigation and Breach Defense

No one wants to be in the news as the organization that just experienced a breach. No one wants to sideline valuable employees digging out information in response to an audit. Healthcare organizations must integrate risk mitigation into their day-to-day operations, and your identity governance solution can facilitate that.

What to look for:

  • Risks presented in a way compliance officers and managers can understand
  • Ability of take immediate action on a risk
  • Ability to leverage data to cross-check access that should be happening with access that’s truly occurring
  • Ability to integrate with complementary products, such as Fair Warning
  • Ability to create your own reports to surface risks unique to your organization
  • Audited workflow for all account actions
  • Support for scheduled, system-mediated and audited reviews of user privileges by managers and compliance staff


Over these last two posts, we’ve discussed the special challenges that identity management and identity governance present for healthcare organizations and what you should consider when evaluating solutions. Formulating your strategy for identity management and identity governance requires that you solve a multi-dimensional problem. At Caradigm, we address healthcare identity holistically. The importance of this approach is that we’re able to ensure that each aspect of the solution works with and complements the others. We have two decades of experience in healthcare identity and have assembled the industry’s only single-vendor identity and access management suite that covers the entire scope of identity management, secure access, and identity governance. To learn more about Caradigm’s solution to healthcare identity and access management, visit us at



What Are The Key Population Health Management Capabilities?

Post by Michelle Vislosky

Senior Population Health Market Executive, Caradigm

Like a Rubik’s Cube, the functionality and performance metrics for population health management can be difficult to define, align, and deploy. The Institute for Healthcare Improvement Triple Aim for healthcare proposes three linked goals for population health management: 1) Improving the individual experience of care 2) Reducing per capita cost of care and 3) Improving the health of populations. However, with legislation and payment models still evolving, so too are the requirements to perform population health management. It’s challenging to determine what are the key population health management capabilities required to achieve the Triple Aim.

The health care industry has a number of population health management models, but they are often defined by the current capabilities of providers, payers, and vendors, rather than what is needed. Additionally, the models do not easily translate to the required business models required by the various value based payment arrangements and their combinations. Further complicating matters is the overlapping responsibility for the overall health improvement of individual patients and populations by both the public and private sector, including payers, providers, and community organizations.

The HIMSS Clinical & Business Intelligence (CB&I) Committee creates practical and unbiased tools and resources to help healthcare organizations use clinical and business intelligence to execute population health management initiatives. In 2017, the CB&I Committee’s Population Health Task Force will create a HIMSS population health management model that identifies the various population health domains and their capabilities and map these to the payment arrangements. The payment arrangements will include the current payment models from CMS, commercial payers, employer-based, and provider owned health plans. The model would be the fifth dimension to the HIMSS Healthcare Value suite:

Once finalized, the HIMSS population health management model will contain a set of resources with content relative to each population health management domain available on the HIMSS website. Like a Rubik’s Cube, it will be able to define the population health capabilities required if deploying a specific payment model or combination. These population health management model resources will include domain summaries such as sharing of “best practices” via blogs and white papers, ROI templates and examples, sample RFP language, and Lunch n’ Learn sessions, (short 20 minute recorded webinars). The model will help to develop education resources and pathways for career development. It could also be used in the future as a means of highlighting and mapping the vendors at the annual HIMSS meeting that offer those population health management capabilities. HIMSS will also share and collaborate with affiliates and the industry at large to further refine the population health management model as the requirements of the Accountable Care Act evolve.

If you are interested in learning more or participating in the development of the HIMSS population health model, you can sign up at

MACRA Final Rule: Empowering Physicians and Health IT

Post by Corinne Stroum (Pascale)

Director, Program Management – Healthcare Analytics, Caradigm

It’s the moment that Medicare Part B clinicians and healthcare administrators have been waiting for. The final release of the MACRA Quality Payment Program! Health & Human Services released the rule amidst much publicity, a response to thousands of comments and industry feedback throughout the year.

I would summarize the theme of the final ruling as, “Empowering physicians to achieve the Triple Aim through choice and health IT”.  My colleague Dr. Brad Miller, who contributed to the ideas in this post, also said it well in this recent blog post: “CMS’ ultimate goal with MACRA is to move healthcare further to a system based on quality, and to accelerate the shift in how providers use technology to improve patient care and outcomes.” Here are some of our key takeaways on the final release:

  • Per the earlier “Pick your Pace” communique from acting CMS administrator Andy Slavitt, clinicians can still choose one of three participation pathways for Performance Year 2017:

      – Submit minimum data by March 2018 to avoid a negative payment adjustment

      – Submit partial data to earn neutral or minimal positive payment adjustment

      – Submit complete data to earn a moderate payment adjustment

  • Clinicians will not be scored on the Resource Use category until 2018. In the absence of Resource Use, the Quality category raises to 60% of the MIPS composite score for PY2017.

– Overall, while choosing which quality measures to choose will remain a challenge, by pushing out the Resource Use category until 2018, CMS is giving providers more time to analyze their data and intelligence to drive the necessary practice changes for improved Resource Use performance.  Identifying these areas for RU and enacting change represents a significant practice and workflow re-design effort for providers and this extra year represents a more realistic timeframe under which providers can adapt.

  • Clinical Practice Improvement Activities have been renamed to the simpler, “Improvement Activities” category.
  • CMS has provided much clearer guidance on how existing alternative payment models (APMs) will qualify for different categories:

 – As previously assumed, CMS established the quality reporting requirements for Medicare Shared Savings Plan (MSSP) Track 1 as sufficient for the Quality category.

– Medical Homes, and advanced APMs, will earn full credit for the Improvement Activities category; MSSP Track 1 and Oncology Care will receive points based solely on their APM participation.

  • Advancing Care Information requirements differ based on EHR edition:

– Patient-generated health data is an opportunity for those reporting prior to the 2017 edition to start learning from the copious amount of wearable and patient-reported data now in the marketplace.

  • CMS has supplied the healthcare public with fantastic, easy-to-use resources on the new CMS Quality Payment Program (QPP) site.  Users can select and export their a la carte activities or measures for easy tracking.

Taken together, these changes reflect the ability of healthcare organizations to choose how they adopt MACRA.  First, providers have been given a little more breathing room to gather their understanding and strategy for MACRA overall.  This helps with the widespread sentiment that providers were overwhelmed on how and what to report in the first year.  Second, there is a more gradual focus of scoring on smart fiscal skills and slowed rollout of large downward payment adjustments which aims to decrease overall MACRA performance and financial anxiety.  Finally, CMS motivates providers to get ahead of the rule by supplying incentive bonuses for underrepresented types of quality measures or for demonstrating advanced registry usage.

2017 represents a time for providers to get educated on MACRA’s subtleties, gather needed data and intelligence and develop go-forward strategies to effectively evolve with MARCA.  This includes the hefty task of experimenting and training their practitioners, support staff and their tools like software solutions needed to succeed in future years.  This means organizations now have an opportunity to get ahead of the requirements by creating a MACRA strategy in the remaining 2016 and beginning of 2017 to establish a flexible foundation for MACRA success.  More directly and simply, CMS has listened to providers and given them more space and time to develop practice responses and strategies to adapt to this brave new MACRA world.




Where to Focus on Improving Chronic Disease Care

Post by Deb Leyva

Account Executive, Caradigm

Strategies for chronic disease management have to evolve because of the enormous increase in patient volume that’s expected. CMS statistics cited in this article project that the number of total people covered by Medicare will jump from 55.3 million in 2015 to 80 million by 2030.[1] Today, about 69 percent of Medicare patients have two or more chronic conditions.[2] Faced with an aging and co-morbid population, health practitioners are being pressed to identify the right strategies to prevent chronic disease and lower costs.

The challenge is knowing where to focus initial efforts. Many organizations are continuing to experiment in accountable care, however the overwhelming majority have found it difficult to lower the cost of care for a defined population. To explore this topic further, I thought it would be helpful to revisit this article by the Centers for Disease Control and Prevention (CDC) that listed four domains that providers should think about when seeking to improve chronic disease care.

Domain 1: Epidemiology and Surveillance: Gather, analyze, and disseminate data and information and conduct evaluation to inform, prioritize, deliver, and monitor programs and population health.

Domain 2: Environmental approaches that promote health and support and reinforce healthful behaviors (statewide in schools and childcare, worksites, and communities).

Domain 3: Health system interventions to improve the effective delivery and use of clinical and other preventive services in order to prevent disease, detect diseases early, and reduce or eliminate risk factors and mitigate or manage complications.

Domain 4: Strategies to improve community-clinical linkages ensuring that communities support and clinics refer patients to programs that improve management of chronic conditions. Such interventions ensure those with or at high risk for chronic diseases have access to quality community resources to best manage their conditions or disease risk.

To encapsulate these domains, the CDC is recommending care that is preventive, coordinated and engages patients. Also heavily implied in the domains is the idea that new health IT infrastructure is needed to support these changes. While I believe that these recommendations are fundamentally sound, they are broad and don’t specify where providers should focus.

Many of Caradigm’s customers choose to start with improving care coordination because of its central importance to driving population health. The importance is highlighted further because care coordination impacts all of the CDC Domains. For example, the ability to aggregate and share data (Domain 1) should be part and parcel of care coordination improvement efforts. So should increasing the use of preventive care (Domain 3) as well as the linkage with community-based organizations (Domain 4). Improving patient engagement (Domain 2) for co-morbid patients typically needs to be led by care managers through high-touch efforts involving a team of clinicians, family members and friends.

In my role with Caradigm as a customer account manager, I can tell you that it’s amazing to be in the room with a customer that has reached a consensus on their top population health priorities. For example, they may lay out the four or five specific care management workflows they want to improve first. Defining clear goals and a path to achieve them is a huge achievement in of itself. There’s no question that changing how an organization cares for the chronically ill is a long-term and highly iterative pursuit. No one has all the answers today, but focusing your efforts gives you a better chance to drive initial results and build momentum for your overall population health strategy.

[1] Sullivan, Tom. Chronic care management: Is the $50 billion market more hype than reality? HealthcareIT News. April 26, 2016.

[2] Lochner, Kimberly A ScD and Cox, Christine S, MA. Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 2010. Originally published:

Nine Notes from NAACOS16

Post by Scott McLeod

Director of Product Marketing, Caradigm

I was recently at the Spring Conference of the National Association of ACOs (NAACOS) in Baltimore, and attended nearly a dozen sessions. Given the continued challenges many accountable care organizations (ACOs) have had in achieving shared savings, the biannual NAACOS events are excellent opportunities to hear from leading ACOs from around the country. In listening to the speakers as well as conversing with other attendees, I came away with nine key observations.

1) Difficulty: ACOs in general, are working hard to be successful, but that success is hard to come by. Comments I heard confirmed the statistic that only about a quarter of ACOs achieved shared savings. Due to this difficulty, there appears to be an increased appetite for tools that can increase the likelihood of success.

2) Uncertainty: There remains a great deal of uncertainty about value-based care—even among the winners. I spoke with a physician from one of the most successful Medicare Shared Savings Program (MSSP) ACOs, but he admitted that to some degree, they “didn’t know how they did it.”  This uncertainty affects decisions to continue in programs or engage in new ones, and also affects IT investment decisions. Providers must weigh the size of any IT investment against the possible return.

3) Benchmarking: As any shared savings are based on the comparison of actual utilization against the Centers for Medicare and Medicaid Services (CMS) established benchmark, there is strong interest in the methodologies CMS uses to establish the benchmark, e.g. historical v. regional fees, and the process for “rebasing” those benchmarks over time.  There is also interest in analytics solutions that can help (1) determine whether or not to participate in a specific program based on the benchmark, and (2) help manage their network of providers against the benchmarks for programs in which they participate.

4) What’s Next:  Organizations are considering participation in CMS’ Next-Generation ACO (NGACO) program.  While it provides some advantages for home health, telemedicine and skilled-nursing facility (SNF) waivers, it also comes with two-sided risk (i.e. greater potential upside but the addition of downside risk). Given the difficulty and uncertainty noted above, organizations are proceeding very cautiously and trying to garner as much information as possible before deciding.

5) Bundled Antipathy:  There is a level of antipathy among ACOs for awardees in BPCI (Bundled Payment for Care Improvement).  This antipathy results from the fact that CMS does not want to double-count (and double-credit) savings realized. Any savings realized for beneficiaries that qualify for bundled-payment services are credited to the BPCI entity and deducted from the potential shared savings of the ACO.  This is true even if the beneficiary is a member of the ACO. There is some feeling of unfairness as the ACO is responsible for a beneficiary’s utilization over the entire year while the BPCI entity only has to manage utilization during the length of the episode of care.

6) Variability of PAC: Whether for bundled payments or MSSP, several presenters called out the wide range of costs in post-acute care, and cited it as a big opportunity for cost management. This recent Wall Street Journal article also discusses the same issue of variability of costs.

7) Survival of the Fittest: While providing quality care to patients is always central to a provider’s mission, competing within their market is also on their minds. Strategies and initiatives adopted are business decisions that include the goal of capturing market share from competitors.

8) Diversification: The advice to the audience from a panel of large, mostly successful ACOs was to nurture other sources of revenue until the hoped-for shared savings were realized. This includes continuation of fee-for-service (FFS) business, participation in the episode-based BPCI, etc.  There was evidence of one-off agreements with large employers for a specific bundle or set of services.  As the industry makes its shift to value-based reimbursement, I expect we’ll see lots of different activities (though headed in the same direction) rather than a unified strategy.

9) Patient Care vs. Population Health:  Although ACOs are participating in a variety of value-based initiatives, the language of presenters and participants tended to focus on the quality care of patients more than managing the health of populations.  This may be a reflection that many of the speakers were physicians, but it seems that there remains a mindset around individuals rather than populations.

As fast as healthcare has been evolving recently, I look forward to tracking these and other trends over the course of the year. I hope to circle back to them during the Fall 2016 NAACOS event to see if they have changed.

Lessons Learned from a Medical Trip to Ecuador

Post by Ron Reis

Field Marketing Manager-EMEA, Caradigm

Recently, fellow Caradigm employee, Larry Nicklas, and I travelled to Tena, Ecuador to take part in the volunteer Timmy Global Health medical trip. Several members of the Caradigm team had volunteered in the past, and it was upon hearing about their experiences that I was inspired to volunteer. Timmy’s volunteer ‘brigades’ visit regions where there is very limited or no access to healthcare and set up makeshift clinics in a number of communities.

Most of the volunteers’ journeys involved 15+ hours travel time and several flights. Doctors, nurses, dentists, an ophthalmologist and general-purpose volunteers converged in the Amazon basin from other areas in Ecuador and as far as North America and Europe to volunteer their time and expertise.

A Clinic Under a Tin Roof

Being a Spanish speaker, I had the unique opportunity to rotate through various stations as an interpreter and engage with patients. The stations were small areas often separated by cords and hanging sheets. They included patient history and registration, vitals, consultation rooms and a working area for dentists, an ophthalmologist and in some cases a counsellor was also available. I found working alongside the doctors and nurses eye-opening as I was blown away by the level of care and compassion displayed to each patient despite the sometimes rudimentary conditions.

Even though Timmy Global Health and the local partners did an excellent job of preparing the community for our visit, I can only imagine how unusual it must be to see a bus load of international volunteers descend upon a community and set up a makeshift clinic for the day. For this reason, I made sure to welcome patients like I would a family member. The crux of my role was to engage with the patients so I would take a knee, crouch to eye level and verbally walk them through what the clinician was about to do and why. For example, I would say “we are about to put this around your arm to measure your blood pressure” or “we are going to check your baby’s temperature to see if he or she is running a temperature.” Especially when helping dispense medicine at the pharmacy station, it was extremely gratifying to see when patients had a sense of ownership of their treatment and gained an understanding of what each pill was for and when it was appropriate to take it.

Working with mothers and young children was especially endearing. One day one of the doctors requested a blood sample from a young girl who was about 5 years old. She could tell straight away what was coming and cried loudly as the nurse pricked her finger. After the blood was collected, we countered the girl’s sobs by clapping and cheering enthusiastically, and she eventually gave the nurse a big hug and smiled. Her mother looked on with a huge smile as well, and I think was reassured that we were there not just to provide healthcare, but to care.

Lasting Impact

Having lived in developing nations before, I was conscious of flying in, doing my part and flying out, having only made a short-term impact. I’m glad to say that Timmy Global Health does an excellent job of balancing short-term medical needs while also referring more complex cases to local medical centres or the capital. Even in such a remote location, it was also clear that basic prevention and patient engagement is essential in order to create a sustainable health system. The teams worked with the locals on prevention programs such as employing fluoride varnish to protect against tooth decay, teaching songs to children about the benefits of brushing their teeth regularly, and giving advice to older patients on how to better cope with arthritis pain. Timmy Global Health are also implementing safe drinking water projects in communities where there is limited access to drinking water and plumbing, which should help decrease some of the most common ailments we saw.

After I returned home to London, I realized that I was much more cognizant of the increasing number of homeless in the city. Thinking back to my time in Tena prompted me to talk with an elderly lady one cold rainy day and provide her with a hot meal. Some would describe volunteering as a selfless act, I tend to regard it as an investment, in me as a person and our collective wellbeing. Volunteering with Timmy Global Health and working at Caradigm, a population health company, have changed me for the better. In both cases, I am proud to be part of something bigger than myself and being able to make what I hope is a valuable contribution to the world we live in.

Larry Ecuador 2015

Larry Nicklas supporting the Pharmacy Station


Ron Ecuador 2015      

Me in the “Kids Corner”, where children received preventive treatments


HIMSS15 Day 1 Recap

Post by Scott McLeod

Director of Product Marketing, Caradigm

It’s always enjoyable to be at the Health Information Management Systems Society (HIMSS) Annual Conference, which kicked off today in Chicago. The sheer volume of people (around 38,000+) who come from all over the world to learn about and discuss innovation in healthcare is amazing, and makes HIMSS the industry gathering.  

Caradigm had a bustling opening day in the exhibition hall as we hosted the first two of a series of outstanding interactive panel sessions to be held in our booth this week. Here are the highlights from today’s panels:

Population Health Trends and Insights Panel

Panelists were Ken Kleinberg, Senior IT Analyst from The Advisory Board Company, Dr. Peter Edelstein, Author and Patient Advocate, Brian Drozdowicz, Caradigm SVP of Global Population Health and Patty Enrado, Senior Editor, HIMSS Media who served as the moderator. To initiate discussion among the panelists, Patty shared preliminary results from a HIMSS Analytics population health research study and asked the panelists to respond. It was a lively discussion centered around where organizations are today with population health and where they are headed in the future. Some of the key points that came up in the discussion were:

  • 22 out of 25 respondents said population health would be a high organizational priority by next year. The panelists agreed that we have reached the tipping point for organizational awareness of population health, but are not there yet on execution because population health is complicated and requires new tools.
  • Respondents indicated that the top challenges providers are having are related to data aggregation, change management, and budget constraints. While the panel agreed that budget and resource constraints are common, providers can mitigate the challenge by honing in on programs and tools that can help them achieve quick wins such as data aggregation.  
  • Initial successes in population health are coming from a variety of different areas such as patient engagement and outreach, building IT infrastructure and care and case management. The panelists commented that experimentation with different population health programs is an effective approach until a provider learns what strategies are working for them. Aligning on goals and how to measure success is important to establish before implementing a program.
  • To further mature population health strategies, respondents indicated that they need to keep bolstering their IT infrastructure, form more partnerships and affiliations to expand coverage, and be adaptable. The panelists talked about how providers should take the long view and build infrastructure that can scale. An ACO that manages a few thousand lives today needs a clear technology and strategy path forward to grow to hundreds of thousand lives managed.

Succeeding In Accountable Care Panel

Panelists were Wendy Vincent, National Practice Director Beacon Partners, Sameer Bade, Caradigm VP of Clinical Solutions and myself as the moderator.  This panel was an excellent follow up to our earlier pop health session as the conversation centered on specific foundational strategies ACOs should be considering to drive quality and lower costs. Some of the recommendations discussed included:

  • Start by obtaining a deep understanding of your population, and use predictive modeling to identify patients who are most likely to become high risk in the coming year in order to prioritize interventions.  
  • Build a strong foundation of primary care and patient centered medical homes (PCMH) that can help improve outcomes for a targeted population.     
  • Establish strong physician leadership in the ACO and also restructure physician compensation to align provider incentives with value-based care.
  • Remember that you can’t manage population health with an EHR alone. As providers scale programs and form clinical networks, the amount of data that needs to be aggregated from disparate systems multiplies very quickly. Providers also need a higher class of population health analytics and workflow tools to help them drive results.

If you’d like to receive the complete research reports from the panels today, send us a note here. Also, check back tomorrow for a recap of Tuesday’s activities as Caradigm will be hosting three more panel presentations in booth #7307.


 Caradigm HIMSS

Planning Your DSRIP Implementation

Post by Vicki Harter, BA, RRT

Vice President, Care Transformation

We are in the middle of a broad and dynamic effort to reform Medicaid. In 2014, 30 states reported having some delivery system reform initiatives underway with that number increasing to 40 states in 2015.[1] Delivery System Reform Incentive Payment (DSRIP) programs are one example of Medicaid reform that is top of mind for provider organizations because of the significant funding available to support the transformation of care to Medicaid beneficiaries. Nine states (California, Illinois, Kansas, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, and Texas) have indicated that they plan to implement or expand DSRIP programs in FY 2015, so for providers in those states, it is the right time to strategize how to implement a successful DSRIP project supported by health information technology (HIT).

The following are a few recommendations to consider in order to get your DSRIP Year 1 off to a strong start.

A Key First Win is Integrated Health IT (HIT)

In order to truly transform how healthcare organizations meet the needs of the Medicaid population, silos of care must be brought together. Healthcare collaboration has been challenging across the healthcare community due to the lack of interoperability of IT solutions, which prevents the aggregation and sharing of information across a diverse team of care givers. Integrated HIT across a health system should be one of the first goals of a PPS (Performing Provider System) because it enables the longitudinal information required to accomplish DSRIP projects including care coordination and population health management. When evaluating solutions, keep in mind that the integration of HIT is outside the scope of many population health solution providers that focus on a specific area of population health such as analytics or workflow efficiency. The ability to aggregate and share all data within a diverse PPS is a capability that few solution providers are executing on today.   

Factor in Speed of Results with Performance-Based Payments

DSRIP waiver funds are allocated with the achievement of specific performance metrics. Initially, those metrics will be process based, but they will become performance based for the majority of the program. In order to receive full funding amounts, implementation plans should consider the scale, speed and scope of deployment. As PPS’ are committing to take on a number of different projects, it’s important to identify synergies and efficiencies that can accelerate clinician processes and results across multiple projects. Without those efficiencies, clinicians can become bogged down by the amount of change management and new processes being introduced.  Examples of new efficiencies that are possible include:

  • Identifying patients that are most impactful in order to achieve faster results from targeted interventions.
  • Enabling an interoperable, longitudinal patient record across the PPS so clinicians don’t have to log into many different systems for the information they need.
  • Team-based care with clear roles and responsibilities assuring “top of license” activity.  
  • Enabling quality analysts and other clinicians to see performance analytics and gaps in care in real-time so those gaps can be closed quickly and even while still in the presence of a patient.
  • Automatically generating personalized care plans, task lists and interventions for care team members to enhance efficiency and reduce variations in care.
  • Utilizing those personalized care plans to generate self-management action plans for patients so they can engage in self-care.

Take An Enterprise Approach to Transform Care

The goals of DSRIP align very closely with population health approaches as both seek to transition from fee-for-service, episodic care to value-based care for a population across a community of providers.  The ultimate goal is health delivery transformation, which can’t be accomplished with a narrow, point solution approach. Point solutions for population health can be counter-productive to DSRIP goals because they sustain the silos and inefficiencies that DSRIP was intended to address. The difference with an enterprise population health approach is that it integrates all of the core capabilities needed for population health and true care delivery transformation: integrated information systems, health care analytics, care coordination and patient engagement.  An enterprise approach is also extensible, which allows providers to support today’s needs while planning for the initiatives of tomorrow.

Caradigm is the leading enterprise population health company that can help organizations succeed with their DSRIP initiative. To learn more about how Caradigm can help you plan your DSRIP implementation, please visit our DSRIP page, see our recent DSRIP press release or send a note here

[1] Smith, Vernon K. Ph.D., Gifford, Kathleen, Eileen Ellis Health Management Associates and Rudowitz, Robin and Snyder, Laura Kaiser Family Foundation. National Association of Medicaid Directors. Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015. October 2014. 

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.