Population health analytics have been available for several years now, but many hospitals, health systems and health plans have been slow to adopt them. With payers increasingly emphasizing value-based reimbursement, you’d think all of these organizations would be moving rapidly to identify and stratify risk. So why has progress been so slow?
What we hear from both providers and health plans is the same concern: “Once I’ve identified and stratified patient risks, what do I do with this knowledge? The easy part is the analytics.”
These organizations lack two important support tools to manage population health effectively. First, they need a tool for storing and managing patient data that is gleaned from sources other than claims and electronic health records (EHRs). It might come from demographic data, social media data or from the patient directly, and it is critical to managing high-risk patients. The problem is that this information doesn’t have a home in provider EHR systems or health plan claims systems and, while many EHR vendors say they are going to have this in future versions, the truth is it will take them some time to do so. We also wonder if EHR vendors really understand the needs better than CRM vendors, who have been in the relationship management space for many years.
The second issue is a lack of clear protocols for disseminating and following up on patient risk information. Who is responsible? How will that person get the risk data? What steps need to happen to ensure that gaps in care are closed and risks are mitigated? How do we track the progress?
The two of us have worked with a wide variety of healthcare providers and health plans, and the lack of coherent population management strategy is an issue for the majority of them. As the adoption of value based reimbursement models is accelerating, the ability to build health and lifestyle profiles of individual members by aggregating data from multiple sources is becoming critical.
Fortunately, many health plans already have a tool that can help solve both of these issues — a cloud-based customer relationship management (CRM) system. Most people look at CRMs as a tool for marketing, sales and customer service, and it is true that they are useful in these realms. But they can serve an even higher purpose by managing information about the social determinants of health and enhancing communication and coordination of care across all providers, including social services and community support.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Provider organizations, on the other hand, are a bit behind the health plans as it relates to CRM, not only in use of the technology but also in the mindset of relationship management. The good news is this also presents providers with an opportunity to learn from what plans have done over the last several years and replicate best practices and avoid some of the pitfalls.
Let’s look at how a care coordinator could help a patient with a chronic disease who has missed most of her physician appointments over the past year and hasn’t regularly filled her medication prescriptions. The care coordinator could talk with her to learn more about her life and the challenges that are keeping her from taking better care of her health. The data could be stored in the CRM and used to develop a care plan that includes social and community services to help the patient better manage her disease. It could also keep track of all the different physicians who have treated the patient, which is often a challenge if the patient has multiple co-morbidities.
The advantage of this tool is that all caregivers can be given access to it, with the patient’s permission. This enhances communication between primary care physician practice, any specialists or urgent/emergency care providers, the health plan, the care coordinator and other helpers, such as community service providers and family members. Interactions with the patient could be documented here, keeping all stakeholders informed of new developments.
A health system using a CRM in this way could ensure all stakeholders in the system have access to important nonclinical data and more easily track the patient’s journey through the system. A health plan care coordinator using a CRM could track the patient’s status, arrange services as needed, alert caregivers to gaps in care or social factors that might cause poor outcomes, and set automation criteria that allow for automated digital interactions at a personal level. CRM gives all the stakeholders a common record of the patient’s status, needs and care that really isn’t available anywhere else and it provides an operational tool to help engage and track interactions
Start with the right team and take the time to design the process carefully
Most major CRM platforms are very robust and come with tremendous functionality out of the box that just requires configuration. The days of lengthy customizations to get a good usable tool in the healthcare environment are long past. The other critical component is a methodology for integrating data from population health analytics and other sources, so that as much relevant data as possible is loaded into the CRM automatically, reducing the need for human input.
Unlike most healthcare IT projects, CRM is a discipline, not just a technology or project. Ensuring success means using the right combination of people, process and technology. If you don’t have expertise in population health management, find a vendor who can help with system integration, software configuration, and protocol/workflow process design. Make sure that all the important stakeholders provide input as you design your system and processes. It’s better to go slow and do it right than to try to fix it after you start using it.
It is worth noting that the information you load into your CRM might be important in identifying risk as well as managing risk mitigation. If you know that a patient has a challenge that makes getting care more difficult, that’s an important factor to consider when assessing risk. A patient who lives far from primary care has transportation or money challenges or who has low health literacy generally will have poorer outcomes than a patient with identical clinical markers who doesn’t face these challenges. By pulling data from disparate systems and social interactions, a CRM system can provide the much needed comprehensive view of each member ultimately resulting in better outcomes, which is what this is truly all about.
Photo: shylendrahoode, Getty Images
