Health IT Summit: Intersecting ACOs and population health management

BOSTON—The first step to population health management is knowing your patients, said Adrian Zai, MD, PhD, MPH, clinical director of population informatics at Massachusetts General Hospital’s (MGH) Laboratory of Computer Science and instructor in medicine at Harvard Medical School. Zai, who developed population tools that later were purchased by Partners Healthcare, spoke during the iHT2 Health IT Summit on May 13.

“The attribution model is critical to managing patients,” he said. The first step is developing algorithms based on clinical data, problem lists and claims information to identify high-risk patients.

Determining which primary care provider (PCP) is responsible for these patients can prove difficult. Patients may be registered with PCPs but have never have seen that clinician. "It’s a big problem,” he said. To address this issue, MGH utilizes real-time scheduling data to better match providers with patients.

“Clinical care is messy. Data are messy,” said Sean Kelly, MD, VP, CMO at Imprivata and emergency physician at Beth Israel Deaconess Medical Center. “As we build IT systems, vendors adjust and we have a whole set of workers not used to going into homes." In the meantime, “the elephant in the room” is the lack of PCPs to take on appointments set up by care coordinators. “There are not enough PCPs, and if patients can’t get appointments, they end up in the ER.”

Often an organization participates in both the Managed Shared Savings Program and fee-for-service, so a challenge arises in “trying to run two businesses at the same time,” said Zai.

Terry Carroll, PhD, CIO at Dartmouth-Hitchcock in New Hampshire, said he is trying to reframe the system so it can handle any payment model. Many Dartmouth-Hitchcock patients are from Vermont, which is moving toward a single-payer system, so the organization needs to construct a delivery system in the context of all the payment models going into the system, he said.

Regardless of payment model, “You need to have population management, to make sure the network supports the needs and make sure the business supports the needs."

In other efforts, Carroll said the organization is working with a blood data collaborative that is mining data for more personalized care, and it has hired a data management services company that help “use resources go upstream to better manage population health.”

“The dilemma is always 'should I take money or take care of health?' Once we decided to take care of health, we brought together a group of physicians and empowered them to decide how to run the business," said Shafiq Rab, MD, VP, CIO at Hackensack University Medical Center. From there, “we started doing things that are proactive instead of reactive.” For instance, care coordinators with tablets worked with physicians to identify and provide outreach to high-risk scorers.

The hardest part remains coordinating all the data together, he said.

Looking to the future, Carroll cited an Economist article that stated that in the next decade, 50 percent of everything will be automated. “To me, that means we need to step back and rethink our framework,” he said. Reworking the workplace so clinicians and departments are truly integrated and working in a way that is relevant to the task at hand is crucial.

“I was disappointed walking the HIMSS floor and finding nothing relevant to what we’re doing,” Carroll said, referring to the February conference. The EMR needs to move to the background, and providers need business and clinical signals and sensors to derive true value from health IT.

If not, “we’ve mortgaged money on EMRs that really aren’t giving us what we need,” he said.