Using Health Data and Analytics to Improve Health Outcomes

Attention to data and analytics is rapidly proliferating across health care delivery services and population management systems. There is a thirst for more information, while many healthcare executives will simultaneously report that they are drowning in their current data and information. Additionally, health systems including payers and providers have invested heavily in information technology tools, and are frustrated that they are not able to get to, or utilize the health information they have. There remains an uncertain pathway forward to track, analyze, report, and utilize existing health care data.

The use of health care data and analytics are challenged by both the volume and the strategy of what information to consider, how to use it, and how to know what it means. This is due in part to complex elements and interactions of service utilization; costs of care; differentiation of chronic and acute illnesses; identifying and recognizing undiagnosed health conditions; interactions between and the integration of physical and behavioral health conditions; health system and provider efficiencies and effectiveness; and, person-centered care, among others. Provider systems and payers are willing to invest in health information data; technology; and analytics; if they can demonstrate, support, and provide effective population health outcomes.

The challenge in the design of health information data and analytics tools is to recognize what information has the greatest utility and provides useful roadmaps for care coordination strategies that support improved individual and population outcomes. Therefore, it is important to determine what the key drivers of poor health outcomes are, and what factors have the greatest impact on patient engagement and activation for improved health status. The benchmark for evaluating any health care data and analytics information tools should be their utility in identifying which populations have the greatest potential for health improvement, and their capacity for generating work flows that support patient engagement and activation through care coordination activities.

The key to addressing population health analytics is to recognize the important impact of the biological, behavioral, and social factors that that influence health status and drive outcomes. Any tools that fail to recognize or account for these factors will necessarily fall short in their utility and effectiveness. The InfoMC InSpotlight health data analytic tools are designed to account for these fundamental elements of health care utilization and the identification of key individuals with a highest likelihood of improved health outcomes. InSpotlight tools support the generation of care coordination workflows that target key factors in poor health status and care plans that improve outcomes. To learn more about the InSpotlight analytic tools see the InfoMC issue brief at: InfoMC InSpotlight Brief_Sept2017.

By Allen S. Daniels, Ed.D., Director of Clinical Solutions, InfoMC

Achieving Medicaid Efficiency

Evolving shifts in the health reform agenda and funding processes are drawing greater attention to the challenges that states face in their Medicaid programs. A recent review in The Hill (http://thehill.com/blogs/congress-blog/healthcare/335761-medicaid-efficiency-is-needed-now-more-than-ever) cites the need for Medicaid efficiency, now more than ever. They report that: “The decrease in this critical funding source, coupled with sharp increases in drug prices, and the addition of nearly 17 million new enrollees since 2013, has put enormous pressure on the nation’s largest healthcare program. There are currently 74.6 million people enrolled in Medicaid and CHIP (Children’s Health Insurance Program), the state-administered programs that provide healthcare to low-income individuals and families; and the downward revenue and upward cost trajectories have threatened the sustainability of these essential services.” Proposed legislation is being designed to close funding loopholes that shift payment responsibilities to states and their Medicaid plans, and away from other funding sources. The Medicaid Third Party Liability Act will result in massive savings for states, and also empowers Medicaid managed care programs with the same rights as state Medicaid agencies.

Practical Solutions for Population Health Analytics

A number of challenges confound the use of administrative health data to identify and prioritize those who are at the greatest risk of poor health outcomes. Central challenges include the timeliness, quality, and utility of claims and other administrative health data. Additionally, many who work with available health data resources report that they are swimming in too much information, and their inability to translate it into useful analysis leads them to a sense of drowning.

A key issue in health data analytics is the inability to extract and translate actionable information for care coordination. Many systems attempt to construct analytic platforms that are so detailed and complex that the result generated have limited end-user utility. Additionally, most health analytic systems fail to adequately account for the influences of behavioral health and social determinants in their design.

Care Management Tools for Transitioning to Value Based Care

There is broad uncertainty about the evolving future of US health care reform initiatives.  Multiple sides are lining up to address the challenges and opportunities presented by the Affordable Care Act (ACA). Some believe that it needs replacement, while others think that it can and should be modified and salvaged. However, regardless of the political affiliations and strategic priorities, most agree that there is a significant need to promote value based care.  This approach recognizes that current health care costs are not sustainable, and new care management approaches must be deployed to contain spending and improve health outcomes.

Recent improvements in health information technology have supported care that is provided within the walls of a health care provider’s offices.  While electronic health records (EHRs) can inform individual clinical practice, they fall short in their ability to span the full spectrum of providers and services that impact the care and health outcomes of broader populations.  Primary care physicians (PCP) lead care teams, yet they cannot effectively coordinate the flow of planning and service information among the providers and systems including health care, social services, and community resources that influence patient well-being and health outcomes.

Understanding the Social, Physical and Behavioral Determinants of Health in the Identification, Stratification, and Analytics of Population Health Management

Although there is increasing uncertainty about the future of the Affordable Care Act and the evolution of health reform, the commitment to improved population health outcomes will prevail regardless of any changes or amendments. With continually escalating costs for health services and the challenges of managing chronic conditions among large populations, quality and cost improvement initiatives will always prevail. A sustained focus on the fundamental aspects of the social, physical, and behavioral determinants of health supports the integration of services and the coordination of care.

MACRA, Care Coordination, and Evolving Health Care Reform

Several recent reports suggest that approximately one-third of seniors rely on family members to help them coordinate their health care needs. Strikingly, another third report that no one helps them coordinate the care they receive among multiple health care providers and facilities. This lack of care coordination services is particularly troubling in light of the fact that as many as 85% of seniors have been diagnosed with at least one chronic or serious health condition, and well over half of all seniors have seen as many as three or more providers in the past year. Additionally, these health care challenges worsen with a lack of care coordination following hospitalizations or at the onset and management of serious illnesses.

Health Information Technology and Population Health Management

In order to achieve the goals of better and more affordable health care that leads to improved population health, a strong health information technology ecosystem is required. These systems must support informed patient and provider decision-making, and transform health care systems to enhance access and input from coordinated care teams beyond the traditional confines of clinical providers and hospital facilities. There is clear evidence that the burden of illness goes well beyond health conditions themselves, and includes a comprehensive array of biological, social, and behavioral determinants.

Hoarding Patient Data

Organizational cultures are uniquely designed to preserve their status quo. These norms inform and direct the human resources of institutions in order to maintain and preserve their standard operations. Language, information, and data bind organizational culture and sustain the values and principles of their missions.

Significant change in organizations requires a fundamental transformation of culture, values, and operations. This is particularly true in health care where provider systems have evolved in proprietary silos and patient level health information has been preciously hoarded. Health care reform requires a significant transformation which includes an environment where quality is a highest level priority, and cost is based on the value of services provided and outcomes achieved.

Care Coordination Technology Solutions That Support Medicaid’s Managed Long Term Services and Supports (MLTSS) Programs

Open Minds’ recent market intelligence report LTSS Shift – Finding the Opportunities by Athena Mandros cites 2013 expenditures associated with Medicaid’s Long term Support and Services (LTSS) reaching an astonishing $282.9 billion – 9.3% of the $2.4 trillion in national health care expenditures for 2013. Additionally, Mandros notes that approximately 41% of the 2013 LTSS spend was for non-residential institutional levels of care like nursing homes, assisted living programs, and continuing retirement communities, compared to 52% in 2008.

InfoMC Healthy Behavior Change E-Guide

A cornerstone of population health and individual health outcomes are the fundamentals of healthy behaviors.  These are the building blocks of how people are able to understand and manage their own health.  This includes not only illness management, but also health promotion and wellness maintenance.  Healthy behavior change is the foundation of all physical and behavioral health.