For more than a decade, Healthcare Informatics/Healthcare Innovation has honored those at the forefront of healthcare IT innovation with its Innovator Awards Program that recognizes leadership teams from provider organizations across the U.S. that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance. Realizing that innovation is taking place across the various sectors of U.S. healthcare the last few years, as part of the program, we have opened up nominations to vendor solution companies as well.
This year, the vendor track of the Innovator Awards Program entailed four product categories that solution providers could submit toward: Value-Based Care, Patient Engagement, Data Analytics, and Data Security. The team at Healthcare Innovation is proud to announce the winning companies in each of these four product segments:
Value-Based Care: CitiusTech
Patient Engagement: Pegasystems
Data Analytics: LeanTaas
Data Security: Protenus
Throughout the remaining four Healthcare Innovation magazine print issues in 2019, each one of these companies will have its story of health IT innovation told. For this May/June issue, we begin by profiling the Value-Based Care category winner, CitiusTech.
As stated by the Healthcare Innovation editorial team, “As the U.S. healthcare system pushes forward in the transition from volume to value, innovation is taking place along multiple dimensions. Healthcare technology companies are part of the overall solution, and we at Healthcare Innovation want to recognize their contributions. Regarding the value-based care category winner, they added, “This story is a particularly good example because CitiusTech is helping to turbocharge transformative work on the part of patient care organizations.”
Value-Based Care Winner:
CitiusTech
Facilitating value-based care delivery remains a hefty challenge for the leaders of patient care organizations. Among other things, the ability to scale the facilitation of analytics and broad decision support around population health management remains highly problematic, as the U.S. healthcare delivery system was never designed for population health management at scale.
That’s why solutions that can help patient care organizations move forward at scale are being widely sought nowadays. It’s in that context that Healthcare Innovation is recognizing the Princeton, N.J.-based CitiusTech as the winning organization in the Value-Based Care category this year.
At the core of CitiusTech’s capabilities is BIC-RMM, a comprehensive solution that helps healthcare organizations to build, edit, and manage clinical quality measures (CQMs) that providers must report on, under Medicare requirements. Importantly, the BIC-RIMM solution allows users to configure and operationalize CQMs, cohorts and alerts without any dependency on IT. It leverages BI-Clinical’s high performance Rules Engine to process and deploy pre-built as well as custom measures and KPIs.
What was the thinking that went behind the building of this capability? “The capability we’ve built, interestingly, applies equally to providers and payers. Historically, they were distinct, separate worlds,” explains Rizwan Koita, CitiusTech’s CEO. “There were products serving one group and the other. The rules management module is probably the only platform certified by both ONC [the Office of the National Coordinator for Health IT] and NCQA [the National Committee for Quality Assurance], for doing things that typically were done by separate platforms. So that’s a big ‘aha,’ in the way that we constructed the platform. Now, if you look at the world of healthcare,” Koita says, “there’s no question that value-based programs, pay for performance, and bundled payments all involve programs designed to incentivize providers and health plans to deliver fee for value. Now, imagine I’m a hospital system and I’ve taken on value-based contracts from private insurance companies or government programs. For me to manage and take risk on those, it’s typical for me to look at my patient population and then analyze what my true cost of care is, to make appropriate tradeoffs, and there’s a lot of computation I need to do. I have to have the ability to compute key performance indicators to submit to CMS [the Centers for Medicare & Medicaid Services] or private insurance companies. As importantly, I need internal tools in order to be able to compute the effectiveness of a lot of things, per cost of care. A new procedure, medication, device—is this new thing performing?”
It was his and his colleagues’ understanding of the challenges of performing data analytics at scale to facilitate care delivery under value-based contracts, that led Koita and his colleagues to create CitiusTech’s BIC-RMM solution. Fundamentally, they recognized the geometric levels of intensifying complexity involved in managing quality measures at scale. “I’ll ask my marketing team to send one HEDIS rule. And you’ll see that each rule is actually a five- to 15-page document with literally hundreds of inclusion/exclusion and numerator/denominator elements; so now, you’ve got 3,000 pages of complex elements for every rule,” Koita says. What’s more, all of this is unfolding in a dynamic world with constant changes in the measures being applied, he adds.
Fundamentally, Koita notes, BIC-RMM was built, and is being evolved, to help organizations achieve greater agility in responding to constantly changing quality measure reporting requirements on the part of federal and private payers in healthcare, by allowing care teams to define custom population-specific measures. That in turn enables accurate and timely identification of gaps within targeted populations, and is key to improving outcomes.
How does Koita see the industry evolving forward around value-based contracting and the analytics needed to support it? “I see the growth of value-based programs in the U.S. being a very significant trend,” he says. “I see healthcare organizations needing more and more technology and analytics support to drive their business. And the ability to use data to run the business, is eventually going to be a key differentiator in a business where the financial margins become very, very slim. Imagine I was running a company where the operating margins are 2 percent, and I can leverage data to improve that operating margin by 1 to 2 percent more, that’s very significant. If I’m in an industry with a plus or minus 2 percent margin, adding 1 to 2 percent is phenomenal. And most providers are within plus or minus 5 percent margins. So even a 1 percent difference can prove to be huge.”
