On the eve of HIMSS18 and the highly anticipated release of the seminal Chilmark Research PHM Market Trends Report, we thought it would be beneficial to provide a Population Health Management (PHM) primer for those attending the conference in search of what to look out for and what questions to ask. There are a plethora of resources available on the topic, and in fact, HIMSS has neatly packaged PHM conference education and symposium into #PopHealthIT.
PHM has many definitions, the most general of which is “the aggregation of patient data across multiple sources to manage the health of a population.” There are just as many commercially available PHM platforms as there are definitions – those offered by EMR and HIE vendors, those oriented towards payers, and independent solutions facilitating data aggregation, analytics & care management. A holistic PHM solution aggregates clinical, financial, and operational data to provide actionable analytics, enabling providers to improve patient outcomes. The core tenets of a PHM solution include a robust utilization management, care management & disease management infrastructure.
The goals of a PHM program are threefold – clinical proficiency, financial improvement, and most important, patient engagement & outcomes improvement. A successful PHM program is designed to mitigate costs by allocating appropriate utilization of services to efficiently manage and coordinate care, as well as effectively manage and prevent chronic disease. Further, PHM technology is used to analyze the health of a patient population to identify care gaps and initiative delivery of care services. Finally, patient engagement is the most critical aspect of PHM, as patient education and behavioral choices dictate disease prevention and wellness. In addition, a PHM platform should include 12 components and capabilities, as outlined in the Landmark, 12-Point Review of Population Health Management Companies, authored by Dale Sanders, President of Technology, Health Catalyst:
- Registries: Evidence-based definitions of patients to include in the PHM registries
- Attribution & Assignment: Clinician-patient attribution algorithms
- Precise Numerators: Discrete, evidence based methods for flagging patients in the registries that are difficult to manage in the protocol, or should be excluded from the registry, altogether
- Clinical & Cost Metrics: Monitoring clinical effectiveness and total cost of care (to the system and the patient)
- Basic Protocols: Evidence based triage and clinical protocols for single disease states
- Risk Outreach: Stratified work queues that feed care management teams and processes for outreach to patients
- External Data: Access to test results and medication compliance data outside the core healthcare delivery organization
- Communication: Patient engagement and communication system about their care, including coordination of benefits
- Education: Patient education material and a distribution system, tailored to their status and protocol
- Complex Protocols: Evidence based triage and clinical protocols for comorbid patients
- Coordination: Inter-physician/clinician communication system about overlapping patients
- Outcomes: Patient reported outcomes measurement system, tailored to their status and protocol
So, provided with this background, what then should be the burning questions that we ask of PHM solution providers at HIMSS18? Without further ado, here our are top 7:
- What is your data aggregation process and what differentiates it?
- How is alerting integrated into the workflow?
- Is there a restriction on data sources that can be directly uploaded or integrated?
- Are clinical decision support insights integrated at the point of care?
- What patient identification and matching capabilities are available? Is deterministic or referential matching used?
- How are data normalized and validated and how is this integrity maintained over time?
- What methods do you offer for data normalization and nomenclature harmonization?
Visit Galen at #HIMSS18 Booth #8229 to discuss #PopHealthIT EMR & claims data harvesting strategies with our experts.