Many factors affect whether initiatives focused on closing care gaps will be clinically effective and make sense financially. Advanced data and analytics can help payers and providers identify the best opportunities for interventions as well as appropriate investment levels.
During a webinar hosted by Becker's Hospital Review and sponsored by Allscripts, Scott Stratton, chief data scientist, and Meghan West, senior product manager, both of Pulse8 — part of Allscripts' Veradigm family of analytic solutions — discussed population health challenges and how Pulse8's solutions can help payers and providers identify and pursue the best opportunities.
Four key insights:
- Payers fail to appreciate provider difficulties in dealing with persistent population health challenges. While the industry has faced issues such as incomplete patient information, inability to effectively address care gaps and difficulty executing care plans, payers tend to organize themselves without consideration for the provider experience. According to Mr. Stratton, most providers deal with 10 to 20 different payers. "Just one plan has multiple touch points with a provider's office when it comes to risk adjustment, claims and quality," he said. "It's very frustrating to the provider staff to put requests into context and make sense of them."
- Providers need a cohesive way to understand and prioritize opportunities for interventions within their patient population. They need to be able to:
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- Find opportunities early enough to improve odds of success.
- Maximize finding opportunities while minimizing waste from false signals.
- Quantify opportunities, accounting for the clinical likelihood that they are real.
- Account for self-resolving factors that that eliminate the need for intervention.
- Model impact of key program assumptions on expected results.
- Contrast cost vs. lift or other outcomes of the strategy and constraints.
- Pulse8's Dynamic Intervention Planning solution use data to identify and prioritize opportunities. "Our assertion engine applies expert rules from published research and treatment guidelines while the inference engine brings in the power of statistics," Mr. Stratton said. "Then we determine whether we have sufficient evidence to create an opportunity that's worth pursuing." The system also takes into account the relative value of each condition, time interval, intensity and the chances that the situation will self-resolve to better determine the optimal budget for the intervention. "It makes for a very informed, very specific dialogue, about the best use of resources," he added.
Providers can use data to identify which opportunities will work best clinically and financially, prioritize opportunities, target interventions, close gaps and improve financial returns. A provider will conclude, "I'm doing fewer interventions, but my total return is actually much greater because I'm highly focused where it's going to do the most good," Mr. Stratton said.
- Engaging providers is essential. Four integration strategies can help engage providers. Even the best data has no value if providers don't use it. The key is to engage providers. Four strategies are:
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- APIs. This is the tightest level of integration, with APIs sitting inside of the EHR. These interfaces provide a direct link with EHRs.
- Embedding a pop-up app within EHR. This integration sits in the background, monitoring. The embedded app triggers the embed app if opportunities present.
- Electronic transfers. Data can be pulled from EHRs in batches.
- Links and alerts. Authorized individuals can link to a secure portal for relevant patients, see alerts and resolve them. "Provider alerts allow us to present these open gaps directly to providers in a very meaningful way," Ms. West said, "because they are able to address opportunities without getting bogged down with noise in the data."
By taking advantage of solutions such as Pulse8, payers and providers can better identify the best interventions, improving both clinical outcomes and financial performance.
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