ORLANDO -- Reimbursements are increasingly linked to quality and value metrics, but providers often don't have the best tools to handle that transition. Payments tied to value will jump from about 20% today to more than half in the next 3 to 5 years, according to health technology vendor McKesson. However, physicians many times have a hard time knowing which patients to focus on and how to meet payers' new demands. Enter a new form of technology. Data analytics takes claims data, providers' electronic health records (EHRs), and any other piece of information available to help physicians become more aware of the patients they're treating. Using complex algorithms, software will break down which patients are most at risk for health events and which are high spenders, and help doctors to best treat them. The technology is all the rage at this year's Healthcare Information and Management Systems Society (HIMSS) meeting. A walk down the meeting's near mile-long exhibit hall and it's impossible not to notice the many vendors offering "population management" technology. However, some of the software is just being released here at HIMSS. Also, costs -- while cheaper than an EMR -- are still noteworthy. The price of software runs from as cheap as 40 cents per patient per month to in excess of a $1 per patient per month. Here are five ways the technology can help meet payers' demands for higher-quality and higher-value care. 1. Learning High-Risk Patients Physicians need to know which patients are and will be the drivers of health costs, so they can focus on them. That's the way to hold down costs and meet payers' demands. But while he was in practice, one former surgeon, Peter Edelstein, MD, chief medical officer of LexisNexis Risk Solutions, had no 0way of knowing which of the some 40 patients he dealt with daily were the ones he needed to focus on. That will soon be changing. "We can predict very accurately which of those patients are going to the ED [emergency department] in the next year and who is going to be hospitalized," Edelstein told MedPage Today. Such analysis simply isn't possible with today's EHR, the vendors say. Knowing who is most likely to visit the emergency department, providers can then place those patients in a care management plan to help stave off those visits. "Instead, of looking at 6,000 diabetics," Edelstein said. "We give them 925 diabetics who can be acted upon and the provider can save $6 million." Not only can they learn who are the sickest patients, they can figure out who is likely to be a problem in the immediate future. Vendors here said their technology can do all of that by breaking down the claims data and EHR information available. 2. Quality Compliance Physicians can drill down on other aspects of their patients to see how well doctors are keeping up with screenings and other preventive services. Those measures are often the basis of quality bonuses payers give. Systems cross-reference the patients' history with recommended guidelines on treatment. For example, a practice can look at all its diabetes patients and see how many have received an eye exam in the last year to rule out neuropathy. The data can be broken down by not only disease states like diabetes, but in many other ways as well, including looking at high-risk patients. 3. Learning Which Patients Are 'Motivated' While it's possible to learn which patients can best benefit from a care manager, it's not often easy to know who will follow those managers' plans. But new software can look at things such as how often patients visited the physician, how often they filled their prescriptions, and how well they follow discharge orders, all to determine which patients would be considered "motivated." "Are they someone we can influence to control their costs?" said Caradigm's Wilson To, PhD, in an interview with MedPage Today. 4. Sharing Health Information The rise of data analytics can make it easier to share patient information, Dave Caldwell, chief marketing and sales officer of Humana's technology arm. Health systems are unwilling to make their patient information available for security and competitive reasons. While they make patient information available to doctors in their system, it remains elusive to those providers outside their network. But Humana's population management technology seeks to change that. Its system can grab a specific patient's information from other doctors -- assuming they make it available -- when providers using their system ask for it. Humana's technology also carries the same utilities as other systems, such as determining patient risk and analyzing outcomes. 5. Better Managing Your Practice's Workflow Deloitte's ConvergeHEALTH, another of the many technologies on display here, allows doctors and practices to look at specific events, how they were handled, and what outcomes they produced. For example, a surgeon can look at how many patients weren't called by staff before surgery to be prepped on what they need to do before coming in for the procedure. They can also figure out what medications patients were prescribed and when, to help better manage recovery. Such knowledge might be able to improve efficiencies in the operating room and patients' post-op outcomes. Source
