Why Effective PHM Requires A Real-Time Clinical Perspective

By Pranam Ben, founder and CEO, The Garage

Clinical laboratories have been an essential component of safe and effective care delivery since at least the early 20th Century. Yet only in recent years have healthcare providers begun to explore ways to leverage that clinical lab data, along with numerous other types of information, to manage populations of at-risk patients — even prevent potential adverse health events.

Effectively managing patient populations is important for clinical integrated networks (CINs) not just because it is in the best interest of patients, but also because it can deliver financial dividends to the organization. As hospital and health system profit margins continue to shrink, driven by greater expenses, CINs and other provider organizations need to explore new methods to deliver care efficiently and reduce costly care interventions.

The key is to capture the widest scope of available timely data from multiple sources, especially clinical labs, and then analyzing that information to monitor populations and intervene when a potential negative outcome is identified. When properly deployed, organizations can decrease costly emergency department care and readmissions while improving adherence to providers’ treatment plans. Both of these population health management improvements can drive increased reimbursement under value-based payment models.

Leveraging Lab Data

Lab values are responsible for 60 to 70 percent of all critical clinical decision-making such as admittance, discharge, and medication, according to one highly cited study. Lab results, however, are only recently being fully leveraged with other patient data from the EHR, claims, patient portals, disease registries and other sources to better understand patient behaviors and predict outcomes. This applies to a single patient, but also for populations as well.

For example, a provider organization can leverage patient lab data, as well as metadata such as zip code, gender and age group to identify trends among similar patients over the last 10 years. In collaboration with their technology partners, physicians can develop analytic models based on that data to target designated patient populations and the associated reporting requirements of any value-based care program.

To be useful for clinical decision making, lab values and other data need to be updated in real-time, or as timely as possible. Timeliness can be a challenge when CINs depend on laboratory testing ordered by physicians outside their organization, where results can take days to weeks to obtain. Rather, organizations need near-instant access to lab and other data from throughout the care continuum so they can ensure that individual interventions as well as at-risk population trend analysis is accurate and reliable.

Seamlessly Linking Disparate Systems

Whether capturing values from a single internal lab or a large, nationally respected lab company, organizations need a centralized virtual location for accessing data and analytics to drive physicians’ decisions. That is where population health management technology plays an essential role.

CINs that are already fully integrated across a single EHR platform in their hospitals, clinics and rehabilitation centers may have an advantage in that they only need to integrate one such system with a population health management tool. Few CINs, such as those that were created exclusively for accountable care organization (ACO) programs, are all technologically aligned in this way. For instance, ACOs formed from independent physician practices and medical groups, and perhaps a community hospital, may face a major integration challenge integrating five or six EHRs with a population health management tool.

More advanced, cloud-based population health management platforms, however, can be easily integrated with any EHR system. That means that these tools can easily capture information from across the care continuum and normalize the data so that every provider can easily access and interpret the information regardless of their location or specialty.

When vital data is accessible in real-time, physicians can have deeper insight into their patients’ health status and risk level. Providers can then efficiently and confidently move forward with interventions and treatment plans while managing reporting requirements on standard quality instruments such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program’s (QPP’s) Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).

Making The Data Do The Work

Although nearly all patient information is now available electronically, too many physicians and providers need to manually access, capture and combine data from multiple systems, including the lab, to have a holistic, but also granular view of their patient or population risk level and care utilization. Not only do physicians no longer have time for such investigations, this inefficient process adds to costs that ends up impacting revenue under value-based care payment models.

Instead, CINs and other integrated healthcare organizations are recognizing the need for a centralized population health management tool to deliver timely clinical insight in a fraction of the time. When combined with crucial lab data and other information from across the care continuum, CINs can reduce care costs to maximize their reimbursement in value-based care payment programs, such as the QPP.