The Best Way to Prioritize Your Population Health Management Efforts

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iStock_000022129270XSmallPopulation health management means assuming accountability for the overall cost of care provided to a defined group of people. Whether you define “population” in the broadest sense, as all the lives in a given geographic area, or in a more circumscribed sense, such as a patient population of assigned Medicare beneficiaries, one thing is clear: Population health management will require healthcare providers to care more effectively, efficiently, and safely for more people—despite shrinking reimbursements and rising costs.

Population health management involves improving and maintaining the health of a defined subset, or cohort, of patients. Effective population health management starts with clearly defining those cohorts and determining on which clinical processes to focus improvement efforts.

Problems Arise When Patients Are Viewed as ICD and CPT Codes

For most organizations, cohorts are simply patients that fall within a specified group of administrative codes, such as ICD or CPT. But relying solely on administrative code groupings often excludes patients who should have been included in the cohort and targeted for a particular population health management strategy. Considering additional factors, such as supplemental administrative codes, clinical observations (lab tests, imaging findings), medications and procedures, can result in more robust, clinically meaningful cohorts.

How an Analysis Tool Like Health Catalyst’s KPA Makes a Difference

When it comes to clinical processes, a small subset of healthcare’s thousands of processes account for the majority of care delivered. It’s a classic example of the Pareto Principle, which suggests that 80 percent of effects stem from 20 percent of causes. In healthcare, we might apply this principle by saying that 20 percent of all clinical processes account for 80 percent of the costs or that 80 percent of waste comes from 20 percent of the processes. Obviously these numbers are not exact.  But what the Pareto Principle tells us is that to improve population health management, we must prioritize; we must identify and focus improvement efforts on the 20 percent: those “Golden Few” processes that can make a real difference.

The Health Catalyst Key Process Analysis (KPA) application applies Pareto analysis to each health system’s data to identify the care processes, care process families and clinical programs that offer the greatest clinical, cost and safety improvement opportunities. The application determines the highest variation and highest resource consumption by integrating and analyzing clinical and financial data. Based on ICD-9 and CPT codes and APR-DRGs, it sorts each patient encounter into a three-tiered hierarchy as follows:

  1. Care processes (the most granular level of the hierarchy) are groupings of administrative codes supplemented by clinical observations. For example, hyperlipidemia, coronary atherosclerosis, AMI, PCI, CABG, and cardiac rehab are all care processes.
  2. Care process families comprise all the care processes linked by a common condition. The care processes in the example above belong to the ischemic heart disease care process family.
  3. Clinical programs are all the care process families that fall within a certain domain. For example, the cardiovascular clinical program includes the ischemic heart disease, vascular disorders, heart failure, and heart rhythm disorders care process families.

Advancing Population Health Management with a Late-Binding(TM) Data Warehouse and Applications

Stratifying clinical data in this manner and combining it with financial data highlights the programs, families, and processes that hold the greatest potential opportunity for cost and quality gains. Health Catalyst’s advanced solutions match our analytical data to your knowledge of the organization, allowing you to pinpoint exactly where to invest improvement effort for the highest ROI. These solutions include:
Health Catalyst’s Late-Binding™ data warehouse platform, which integrates data from disparate transactional source systems and provides a flexible foundation for analyzing data and prioritizing improvement opportunities with the greatest upside potential.
Health Catalyst’s Advanced Applications, which run on the data warehouse platform. Advanced Application Suites, designed for each clinical program, feature four categories of “starter set” clinical content:

  • Care process models
  • Triage criteria
  • Care management modules
  • Aim statements related to triage criteria and care management modules

Together, the Health Catalyst Late-Binding™ data warehouse platform and Advanced Application Suites give healthcare organizations the infrastructure they need to implement and measure outcomes of improvement initiatives to support effective, efficient population health management.

For additional information you can read the white paper I just published, Population Health Management: Implementing a Strategy for Success.

What is your strategic approach to population health management? Please add your comments below.

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