Intermountain's Bold Population Health Move

April 9, 2013
With the aid of a federal contract, Intermountain Healthcare leaders are pushing ahead to reframe the terms of care delivery to patients, particularly those with chronic illnesses. Intermountain's Lucy Savitz, Ph.D., shares some early learnings with Healthcare Informatics.

On June 15, the federal Centers for Medicare & Medicaid Services (CMS) announced that it had awarded a $9.7 million contract to the Salt Lake City-based Intermountain Healthcare, as part of its Health Care Innovation Awards initiative. The vast Intermountain Healthcare, an integrated health system encompassing 22 hospitals, 185 clinics, a medical group with about 900 employed physicians, 33,000 employees, a health plan division called SelectHealth, and other healthcare services, cares for people across virtually all of the state of Utah, as well as southwestern Idaho.

Daron Cowley, media relations director at Intermountain, confirmed for Healthcare Informatics that Intermountain was awarded the three-year contract to further its work in transforming how healthcare is delivered to improve the quality of patient care while helping to hold healthcare costs down. Cowley confirmed that medical cost savings anticipated from the three-year project are anticipated at more than $67 million. The results and processes developed through this initiative with be shared with other integrated patient care organizations nationwide, in collaboration with CMS.

In a press release issued on June 15, Lucy Savitz, Ph.D., director of research and education at Intermountain Healthcare’s Institute for Health Care Delivery Research, said, “This award greatly accelerates our ability to put into practice new ways for patients to partner with clinical teams in making decisions that will reduce potential health risks; take a population-based view of care delivery design and decision-making; and align financial incentives to insure sustained excellence in the care we are able to provide to our community.”

On the same day the award was announced, Savitz spoke with HCI Editor-in-Chief Mark Hagland regarding the initiative and Intermountain’s broader efforts at population health management. Below are excerpts from that interview.

What was the origin of this initiative at Intermountain?

At Intermountain Healthcare, we have a major initiative called our Shared Accountable Organization, our version of an accountable care organization. We’ve been working and planning towards that for over a year; and we’ve recently named a director over that, Joe Mott; and my institute has been pledged to support that effort. And Dr. Brent James, our director, is leading this. So it really about creating accountable care. The purpose of this proposal is to accelerate that piece. There are a number of elements of this that will be phased in over time. One of the predominant pieces will be shared decision-making tools, IT tools, working with [the San Francisco-based] Archimedes, using their IndiGO [short for “Individualized Guidelines and Outcomes”]Model. The IndiGO Model supports two levels of applications. One is for shared decision-making between a care provider and patient at the point of care, helping to assess the patient’s risk and determine what interventions might work best. It’s a very user-friendly model. And one of our goals is to enhance that tool and add depression. It covers adult care, including asthma, diabetes, congestive heart failure, and other chronic conditions.

Lucy Savitz, Ph.D.

You were the beta organization working on the IndiGO Model?

The IndiGO Model uses our patient data and runs off of a clinical data warehouse. It takes that tool and integrates it within our electronic patient record, to provide seamless, up-to-date information to our patients while we’re treating them; and it’s very, very powerful and exciting.

Can you provide an example of how the modeling process works?

The Archimedes website provides a good explanation of IndiGO. But an example might be, let’s say I’m a 62-year-old woman, I have diabetes out of control, I have osteoarthritis, and I’m overweight. It would use information from our clinical data repository based on my situation, and would produce a bar chart showing what impact different actions might have on my situation. So for example, if you take fish oil, it will reduce your pain from osteoarthritis by a certain percent; if you exercise, it will diminish the effects or your diabetes by x percent. So it’s a very useful tool.

Is the tool now being used?

It exists; it’s not yet being used at Intermountain. But this award accelerates the pace at which we can implement some of these interventions, like the Archimedes tool. So we’ll begin here in selected clinics the urban central region here in Salt Lake City at Intermountain; and then we’ll phase it to our whole urban central region; and then ultimately across the whole system. But we’re doing it in a systematic way to make sure it’s valuable and successful in enhancing provider-patient relationships.

The second thing is that it allows us to do something called “hot-spotting.” From a population health perspective, it will help us to do analytics to determine where there are groups of patients where we can particularly intervene. At the same time, it produces jobs. And there are a couple of IT jobs we’ll be recruiting for in the very near future. And we’re proud that in the last few years, Computerworld has called us one of the best places for IT people to work with; so we’re hoping this will bring in some people to work with us on our transformational journey.

With regard to population health—what broad, strategic and IT learnings have you accumulated so far as an integrated health system?

You almost can’t separate the strategic and IT learnings. And the ability to do population health at an organization like Intermountain Healthcare, because of the availability and longevity of data, allows us to do this at a certain level. I wrote a paper in 2000 when I was at the School of Public Health at the University of North Carolina, with Ed Wagner and others, on population health. Basically, what you’re trying to do with population health is to use largely clinical epidemiological techniques to be able to understand patterns and flows within the patient population, and that information can then be used in multiple ways, including in better designing healthcare delivery. We know that a very small percentage of the population tend to use the most resources. They tend to have three or more chronic conditions, and it does not matter which three or which came first, and that includes mental health, which is why we added depression. We know, for instance, that two-thirds of our diabetes patients have a co-morbidity of depression. And population health, with this kind of information, can help us target specific care delivery interventions, and keep them out of unnecessary admissions to the hospital and unnecessary ED visits.

What do you hope to happen in the next few years with the contract?

I hope that the tracks that we’ve laid and the plans we’ve put in place will be put into action with our SAO. We’ve made a lot of progress in these areas, but not to the full degree we’d like. These funds will be pivotal in that process. And one of the roles we play is that we are a model learning organization, and we can show what’s possible.

Besides your own health plan, would you be working with others on your SAO?

With Medicaid, and also with other local health plans. And there’s an award for community engagement, and I’m the director of our community engagement program here, and I’ve been working on more actively engaging patients on how to better improve the quality and safety of the care we deliver.

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