Consider these four analytic integrations at the point of care for population health
We know that integrating analytics at the point of care contributes significantly to population health success. But which integrations should your organization tackle first? Consider these four:
- Real-time data: In population health, it’s critical that staff work as efficiently as possible, making proactive decisions based upon solid and timely information. As such, analytics should work against real-time data to ensure that health organizations are focusing on the right patients at the right time. For example, consider the discharge of a congestive heart-failure patient who has been a frequent visitor to the emergency room. Knowing exactly when the discharge occurs in order to take proactive action to prevent complications and near-term readmissions is an effective way to both improve the patient’s health and manage costs.We know that integrating analytics at the point of care contributes significantly to population health success. But which integrations should your organization tackle first? Consider these four:
- Risk stratification: Employ risk stratification to drive care management processes. When closely integrated into a care manager’s workflows, he/she can be notified of risk scores and then take immediate action. Risk stratification is an important tool to allow care managers to focus on patients that have the highest return on intervention. Traditionally, as risk scores changed, they bounced between spreadsheets or other software systems that don’t talk to each other. That resulted in a tremendous amount of manual intervention – and increased odds for manual errors. Automate risk stratification so that a score that passes a given threshold is routed directly to the appropriate care manager for immediate action. This forces a consistent approach for all patients and is an extremely effective means of ensuring consistent care – one of the core tenants of accountable care.
- Clinical workflow tools: Integrate analytics with clinical workflow tools to identify care gaps in standard quality measure steps (ACO33, HEDIS, PQRS, etc.) and facilitate the closure of those gaps. Consider the diabetic who needs annual eye and foot exams. Integrating this information into a workflow saves time and is much more effective than if that information was sitting in a standalone spreadsheet or other system. Automating the workflow in value-based settings is a simple way to ensure that physicians are providing quality care through a consistent approach and are rewarded appropriately.
- Automated communications: Integrate quality-improvement data with automated tools, such as text messages, emails, or integrated voice response, to close care gaps. This is more cost effective than using clinicians to make patient phone calls. Their time is better spent focusing on caring for sick patients rather than attempting to close gaps in care. That’s where automated systems, based upon patient preferences, come in. These technology-based approaches can motivate patients to take actions with the same results and at lower costs.
While you may also wish to consider other analytic integrations at the point of care, these four are an excellent place to begin.
Surveys and Studies
Is communication population health’s major pain point?
Results from a new survey of 955 healthcare professionals commissioned by PerfectServe identify doctors and nurses struggling to get in touch with each other to coordinate care as a fundamental obstacle to improving population health. Conducted online by Harris Poll between February 12 and
While 95 percent of respondents agree that successful care collaboration leads to reduced readmissions, 96 percent say that inefficient communication is a barrier to effective population health management. Sixty-nine percent of clinicians feel patient care is often delayed while waiting for important patient information. Interestingly, four in 10 respondents (40 percent) do not believe that the electronic health record (EHR) is enough to successfully coordinate and communicate with other members of the extended care team. Among clinicians, the EHR is used as the communications mechanism only 12 percent of the time. On the security front, about three in five respondents (61 percent) say that HIPAA regulations pose an obstacle to communication and collaboration within the care team.
Noteworthy other connectivity findings from the study include:
- More than half of clinicians (52 percent) admit they don’t always know the correct care team member to contact in a given situation;
- 71 percent of responding physicians say they have wasted time trying to communicate with the broader care team;
- Only 25 percent of physicians strongly agree with the assertion that they can usually contact colleagues for collaboration or consults in an effective manner; and,
- Nearly half of physicians (48 percent) report being frequently contacted erroneously when they’re not caring for the patient in question.
The most common current communication technologies used in optimizing population health management represent the tried and true: Phone calls (83 percent) and online patient portals (74 percent) lead the pack.
Read the complete research findings at www.perfectserve.com/survey.
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