The shift to value-based care models, coupled with the growing power of the consumer in the health care decision-making process, affirms the need for organizations to track the goals, barriers, and activities of their patients to manage quality, cost and performance data to succeed in the health care industry today.
This content is sponsored by Cerner.
However, organizations too often and too quickly become entangled in the veracity, volume, variety and velocity of large data sets. Instead of struggling to harness big-data, experts from Cerner suggest an organization frame its thinking around longitudinal data, or the collection of an individual's data elements that spans venues into their daily lives. The goals is the right data to drive engagement. Longitudinal data is more expansive and informative and it can function as the foundation for big-data down the line, per Tim Kostner, senior vice president of client development at Cerner.
"Core to Cerner's approach is the creation of a person-centric, longitudinal digital health record," says Kostner, adding that much of the data comprising these records comes from unconventional sources. In addition to EHR-driven data, like chronic disease and medication histories, a longitudinal record includes information such as a person's diet, exercise, alcohol and drug use, education, family and social aspects, housing, transportation, air and water quality and even personal motivation.
"Research increasingly points to the belief that nonclinical data sets have as much, if not more, impact on a person's health," says Ryan Hamilton, senior vice president of population health at Cerner. In fact, a population health model used by Robert Wood Johnson Foundation's County Health Rankings suggests clinical care accounts for just 20 percent of a patient's health. The remaining 80 percent is influenced by individual behaviors, social and economic factors, genetics, and the physical environment.
Tracking and analyzing a patient's health story can help providers better understand how to engage consumers in their health journey in both FFS and new VBC arrangements. Some large hospital systems – especially those leading the trend toward value-based care and population health management – have already begun using these longitudinal data strategies.
Value-based care is certainly a popular buzzword in health care today. But the reality is, many organizations are still evaluating and developing future strategies. A July 2017 EY survey of more than 700 health care professionals found 67 percent of health care organizations with revenue between $100 million and $500 million do not have value-based reimbursement initiatives in place at their organizations; the same is true for 61 percent of organizations with revenues between $500 million and $1 billion.
However, Hamilton believes hospitals need to start laying the foundation for value-based care as soon as possible. "I don't think anyone is debating if value-based care is coming. The real question is when and at what pace? The art is timing the market change against the growth in an organization's skills." Hamilton says. A strong value-based care foundation is built on a powerful population health management program, which requires longitudinal records and analytics.
That means hospitals, physician groups and other health care organizations need the right people, processes, tools and technology to aggregate, reconcile, organize and query longitudinal data to generate actionable insights and drive change in care management and health outcomes.
Organizations that have taken the wait-and-see approach to value-based care may be apprehensive to begin using longitudinal records, especially since the transition away from fee-for-service is a gradual process that will take years. Cerner's experts, however, believe it is never too early to get started.
Here are three common myths about longitudinal data analytics.
Myth No. 1: longitudinal data is for organizations ready to pursue value-based care contracts. "What's interesting is the same tools that help in value-based care can be used to optimize fee-for-service initiatives," Hamilton says. “Population health management tools can be used to identify when and where to plan a medical intervention, predict a patient's risk, assign patients to the right providers and measure performance to reduce or close gaps in care – all efforts that would support the operational, clinical and financial health of organizations operating in a fee-for-service environment.“
"By bringing in this data, it gives you a good idea of your cost, your quality and where your patients are going," says John Glaser, Ph.D., senior vice president of population health at Cerner. Identifying leakage is important for fee-for-service organizations to capture a greater portion of revenue and strengthen the foundation for care coordination further down the line. Plus, longitudinal data can help organizations operating under any model of care better understand the needs of their patients as consumers. For example, a young man living in Kansas City likely has different health needs than a mother in rural Missouri.
"The more we can know about you, the more we can personalize care to deliver better outcomes or better match your needs to the resources in your community" Hamilton says.
Myth No. 2: my organization has to be an "innovator" to use population health management programs. Emerging organizations are not looking invest time or money experimenting with analytics platforms. Instead, they want something that's ready to go, out-of-the-box. Some are concerned that analytics platforms are not there yet. However, Cerner's experts noted big-data analytics is entering its second phase of adoption.
"More and more, we are building standard content, taking best practices of large organizations who have pioneered [analytics]," Hamilton says. An organization should seek out partners that offer a broad portfolio of a solutions on a common platform that share the longitudinal data, manage IT costs and complexity, and allow for integration into the provider and consumer workflow. Enterprise solution providers are increasing offering advisory and operational service to help organization establish organization readiness and scale. "Organizations will need something that brings together data, helps clean it up and has applications on top of it, such as disease registries and data warehouses. Organizations need to convert data to insight, insight to action, and action to measurement closing the loop allowing the organization to learn from every decision. Hamilton says.
Myth No. 3: my organization doesn't have enough data to make analytics actionable. "In many cases, health care organizations don't have the size, scale or technical capability to aggregate the information and make it meaningful," Kostner says. "And in some cases, organizations don't have the large data sets needed to create new medical knowledge on how to best treat and manage the health of individuals."
While this may be true – especially for small, rural hospital systems, independent physician groups or other smaller providers – organizations don't need to possess huge amounts of data or skill to get the ball rolling with analytics.
"Cerner's solution is a cloud-based platform; inherent within that platform is big-data capabilities," Kostner says. Across its population health management clients, Cerner has data from more than 100 million individuals. The typical value-based care client starts with a single EHR, a claims file and an enrollment file, per Hamilton, and they "rapidly expand from there based on the access patterns of the people for which they manage"
It's not about data – it's about making data meaningful
Cerner offers a big-data platform called HealtheIntentSM, which is cloud-based, agnostic and scalable. It functions as both a data aggregator – with the ability to collect and reconcile data from a variety of sources – and also has analytics capabilities that can identify, score and predict the risks of individuals.
In addition to Cerner's portfolio of tools, people and services, the platform helps organizations shift focus from the frustrations of data aggregation, which often plague organizations and other front-line health care professionals, to using data analytics for actionable solutions. A June 2017 survey from Quest Diagnostics and Inovalon found 70 percent of physicians do not see a link between their EHRs and improving patient outcomes. Yet 71 percent said they would be willing to spend more time with their EHRs if the technology could offer unique insights for their patients.
"In a way, the question isn't big-data; the question is the analytics on top of it," Glaser says. "There are always going to be the challenges of getting data and cleaning it up, but the real leap forward is once you have the data, how do you analyze it so you know what's going on?"
With technical challenges of data aggregation removed from the equation, organizations are left to focus on the cultural and organizational aspects of their population health management strategy. This process begins with an assessment of organizational readiness and development of a clear mission. Organizations moving into longitudinal data need to identify their goals, from improving specific clinical quality metrics to bettering overall health management. Cerner's clients have used HealtheIntent for projects as specific as improving the rate of sepsis detection to those as sweeping as improving care coordination across 850,000 people.
"The use of longitudinal records and big-data is two-fold in its purpose," Kostner says. "One is to understand how to best treat individuals when they're in need of care and the other is to increasingly understand the information needed to keep people healthy and out of a care venue in the first place."
Getting started
No matter their progress on the journey to value-based care, the most important step organizations can take is the first one. Hamilton urges health care organizations focus on finish dates – and how long it will take to develop the skills and knowledge to thrive under value-based care. "What scares me is most organizations are focused on, 'When is the right time to start?'" Hamilton says. "Not enough organizations are contemplating how long it's going to take to become skilled at governance, engagement and coordination required to be successful in value-based care."
The best place to begin is by finding a trusted partner that offers people, processes and technology to help organizations define a comprehensive, longitudinal strategy that spans the care continuum. A well-thought-out strategy enables health care professionals to make objective, strategic decisions and provide support for care team members and patients who need to engage in care processes.
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