Quality Congress: Onsite clinics help drive population health
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Rai, during his presentation, shared his strategies and successes for building an accountable care organization (ACO) using automated population management for the 200-strong physician organization.
To paint the picture of the current environment, Rai shared statistics that between 1999 and 2009 health insurance premiums rose 131 percent while general inflation rose 38 percent and wages rose 28 percent. Additionally, through analysis of a panel of 2,500 patients, the average time to manage that panel is 24.8 hours per day. “It’s depressing because the population theoretically is not getting any healthier,” said Rai.
Looking towards how to look at population and health outcomes, Prevea reviewed the core principles of the patient-centered medical home, including:
- Superior access to care;
- Patient engagement;
- Clinical information systems;
- Care coordination;
- Team care; and
- Feedback.
“Care is getting more complicated,” said Rai noting that organizations can’t “shove patients off the cliff” when they leave the provider’s doors and hope they come back. Rather, care needs to involve more of a closed-loop process.
“How do we manage the patients we aren’t seeing?” questioned Rai.
Prevea audited its own charts to go beyond the encounter and identify/engage patients in recommended care, automate the care management process and extend the reach of the care team beyond the office to reach the ultimate goal of improved care.
Using an IT partner to mine nine years worth of data, Prevea defined noncompliance and set to using an automated telephone call to tell noncompliant patients limited to certain modalities like hypertension they need to visit their provider. Even though the HIPAA-compliant automated calls were rolled out in November during an election year three years ago and at dinner time, Prevea received few complaints and a bevy of money/visits within six months for their efforts, reported Rai, adding that letters were sent out ahead of time to patients that phone calls were down the pipeline.
It’s not often a provider can improve quality and make money at the same time, said Rai. For hypertension patients, successfully called patients were twice as likely to have both a chronic visit and a systolic blood pressure result record in the EMR, Prevea’s data found. Additionally, hypertension patients successfully reached by the phone call were about 40 percent more likely to have a chronic visit. Taking this real world example, Prevea set to use automated principles to fuel its ACO efforts to engage more patients past the initial hypertension launch.
Rai and colleagues posed the question, “Who is the target population of the future?” and came with a resounding answer: Employers. Repackaging their efforts to employers, Prevea offers on-site medical clinics to help cut the employer’s health plan costs for physicians and ER visits, while reducing absenteeism associated with minor illnesses that go untreated.
These services include, but are not limited to, on-site clinics, clinical programming, fitness programming and education. Operations of the on-site clinic are at cost for the employer averaging $5,000 of cost savings for the employer daily. “By helping employers save money themselves by engaging them and doing wellness education, not only are we helping the employers save money, we’re doing the right thing by making the employees healthy,” Rai told CMIO and added that, on average, when Prevea works with employers, almost 60 percent of their employees don’t have a primary care physician yet.
According to Rai, this manages the employer’s population and locks the employers in as faithful to the paradigm. “You want the employer to be your partner for the next 10 to 20 years,” Rai said. “To do that, every partnership needs a win-win situation. Our win is the downstream. Their win is the median savings of primary care expenditures and a healthier population.”
This true, sustained partnership is important for business and a population’s health when viewed with a lens focused on long term goals, according to Rai.
Looking towards the future, Rai is looking to services to expand population management using data and build out medical home on wheels and offer on-site screening programs based on the organization’s risk factors.