Care Management Solutions

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A New Approach to Care Management

Care Management in a Value-Based Era

The idea of care management—managing a selected set of patients to focus on reduced cost and better quality of care—has been around for a long time, primarily established in the payer space. However, with the growth of value-based incentives and risk-based contracting, healthcare provider organizations have started to think of care management, also called “complex care” and “disease management,” in the context of population health strategies.

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Care management, done at its best, will reduce the cost and increase the quality of care for those patients identified in the program. While Medicare data suggests that only 5 percent of a healthcare organization’s population consumes 50 percent of its resources, health systems must look beyond that 5 percent and also use a strategy that will allow them to identify and work with the patients they will impact the most.

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To achieve a full care management approach, most organizations have had to deploy multiple applications from multiple vendors—an expensive and frustrating experience. Additionally, most ACOs, Integrated Delivery Networks, and the like can have around 20 or 30 different EMR systems, spanning across the continuum of care, from post-acute settings to skilled nursing facilities, long-term care, and more.

Organizing a care management program can be difficult when multiple data sources are involved. Data integration is a key part of a well-organized approach. Additionally, the entire care team, along with the patient must be able to communicate and have dialogue, developing relationships that help and encourage patient engagement. More than just care coordination, there are five parts of a well-organized care management program:

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Current Options in Care Management Are Limited

There are three basic categories of Care Management solutions on the market today:

EMR suppliers: provider organizations have spent tens to hundreds of millions of dollars deploying EMR products for workflow and documentation at the point of care.

Health plans: in a fee-for-service and volume-based world, only the health plan was financially incented to address the top 5 percent utilizer patients. These programs were often referred to as “case management.” These case management products for health plans are well established and feature rich—if you are a health plan and driven predominantly by claims data. 

Standalone products: as care management shifts from health plans to providers, a new crop of population health and care management products has risen to the surface. This includes big name players who acquired products and services, and small independent startups.

There are a few basic weaknesses that can be applied to these generalized categories:

  • Lack of an end-to-end solution. None can offer all five parts of a complete care management solution.
  • EMR suppliers are weak in the analytics areas of patient stratification/identification and performance reporting/management. Also, they have proven poor interoperability among the multiple EMR suppliers found in most ACOs and IDNs.
  • Health plan products, while mature, generally lack transparency, flexibility of stratification, and lack clinical data handling.
  • The standalone suppliers are either a collection of poorly integrated parts or are point solutions focused only on care coordination or patient communication.

The Answer to Care Management Struggles

To solve this problem, Health Catalyst partnered with organizations who have had success in care management such as Allina Health in Minneapolis, MultiCare Health System in Washington state, Partners HealthCare in Boston, and Piedmont Healthcare in Atlanta to develop a unique process and technology called the Health Catalyst Patient Impact Predictor™ that dynamically generates portfolios of patients, prioritized by actionable suggestions for risk intervention. Current care management solutions use claims or EHR data, but rarely both, to stratify patients who meet two criteria: Those that are highest cost (with multiple complex conditions); and those posing the highest clinical risk. The Health Catalyst’s Patient Impact Predictor takes stratification to the next level with advanced client-configurable algorithms and variable weighting that analyze not only claims and EHR data together, but also socio-economic determinants, high-risk medication utilization, acuity of conditions, high-utilization predicted, and HCC scores. We call this concept maximizing your Return on Engagement™, a measure which will be an economic imperative for healthcare organizations who are at financial risk for achieving clinical outcomes and value-based care contracts.

At Health Catalyst, we believe a care management program must be able to answer the following questions:

  • Are we managing the right group of patients?
  • Are we having an impact for those patients?
  • Is there variation between care teams that may help us identify and communicate best practice?
  • Is there an opportunity to change how we identify patients or direct them to a different level of support that can positively impact health and program costs?

Health Catalyst’s Care Management Suite is healthcare’s first patient-centric, end-to-end, mobile-first population health solution that addresses all of these questions in five critical parts: (1) data integration, (2) patient stratification and intake, (3) care coordination, (4) patient engagement, and (5) performance measurement. Using advanced analytics, the Health Catalyst approach to care management can help organizations reduce the cost and increase the quality of care for patients identified as highly impactable. This unique approach, Patient Impact Predictor, goes beyond simple claims, cost, and diagnosis data. It results in holistic care incorporating socioeconomic data, social, and more.

Additionally, the entire care team, along with the patient, can communicate and have dialogue through the suite, developing relationships that help and encourage patient engagement. More than just care coordination, the suite is the only solution with products based on the five parts of a well-organized care management program:

  • #1—Data Integration: Aggregates, analyzes, and delivers data to the right people at the right time. Gives care team members access to multiple EMRs and data sources spanning the entire care continuum, from hospitals to pharmacies.
  • #2—Patient Stratification and Intake: Uses an agile patient stratification process to integrate current utilizations and trends, chronic conditions, active medications, and social determinants from disparate clinical and claims data sources.
  • #3—Care Coordination: Facilitates timely, all-inclusive care team communication and collaboration on patient assessments, care planning, and interventions.
  • #4—Patient Engagement: Mobile-first approach (smartphone apps) enables secure, real-time, multi-point messaging, assessments, and care planning to engage and support all care team members (patients, friends, families, social workers, care navigators, etc.) across multiple EMRs.
  • #5—Performance Measurement: Evaluates and reports on care management program effectiveness using metrics and measures appropriate to value-based contracting.

Health Catalyst Care Management Products

Patient Stratification integrates current and cost trends, chronic conditions, and social determinants risk models and disparate sources to identify the individuals most likely to benefit from proactive care management programs.

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Patient Intake is a workflow application that enables list of patients created by other applications to be routed to a series of users based on roles. Users can add, update or remove patients from the list before routing the patient record to the next person in the workflow.

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Care Companion is a mobile phone application for patients which supports the engagement of patients with the Care Management team of nurses, pharmacists, social workers and others in the process of improving individual patient outcomes.

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Care Coordination is a mobile, tablet based application, used at the point of care by care coordinators and team members to organize patient interventions including shared decision making for patient goals & activities, patient and team communications, as well as alerts and notifications for new admissions or decreasing patient engagement activity.

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Care Team Insights is a dashboard application for leaders in the care management organization to enable daily views of enrollment, utilization, risk, and cost by care team, facility, care program/family.

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View Webinar on Our New Care Management Suite On-Demand

Dale Sanders and the product development team will host a Care Management Suite Product Webinar at 1:00PM (Eastern) on Thursday, November 17, 2016. See live demos of all five care management products, and participate in a live Q & A session.  

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Speak with Someone at Health Catalyst About the Care Management Suite

To learn more about the Care Management Suite, Health Catalyst, and how our solutions and products might fit your needs. 

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