To solve this problem, Health Catalyst worked with Allina Health in Minneapolis, MultiCare Health System in Washington state, Partners HealthCare in Boston, and Piedmont Healthcare in Atlanta to develop the Health Catalyst Care Management Suite™, healthcare's first patient-centric, end-to-end, mobile-first population health solution. More than simple care coordination, the Health Catalyst Care Management Suite™ enables automation and optimization of all five key elements of the care management process: 1) integrating data from diverse IT systems; 2) stratifying and enrolling patients; 3) coordinating patient care across multiple settings; 4) engaging patients in their own care including creating a social support network for the patient, outside the traditional healthcare delivery system; and 5) measuring the program's performance.
"The fundamental question for population health management today is, 'How can I identify the right patients and engage them so that the resources invested achieve the greatest improvement in outcomes?'" said Dale Sanders, Executive Vice President of Product Development for Health Catalyst. "We call this concept maximizing your Return on Engagement™, a measure that will be an economic imperative for healthcare organizations who are at financial risk for achieving clinical outcomes and value based care contracts. Achieving optimal care for a population of patients begins with identifying the patient on whom you can have the biggest impact, providing optimal care for that individual patient, then repeating that over and over again for an entire community of patients."
Sanders continued, "Population and community health starts by optimizing the care for individual patients. That's what our Care Management Suite™ helps to accomplish. We've spent the last decade accumulating and mining an unprecedented breadth and depth of data on over 100 million patients and their treatment and outcomes. Now we are closing the loop from our analytics back to the care management process for individual patients. We built this system from the ground up, to be data driven, leaning heavily on concepts from Silicon Valley."
A Full-Spectrum Solution for Care Management
To empower the care management process, physicians and care team members need access to data from multiple EMRs and other enterprise IT systems that span the continuum from doctor's offices, hospitals, clinics, pharmacies, payers and patients themselves. Health Catalyst leverages its industry-leading experience in data warehousing to integrate, analyze and make this data available to the right care team members at the right time within the Health Catalyst Care Management Suite™.
Powered by the Health Catalyst Analytics Platform™, the five applications in the Health Catalyst Care Management Suite™ work in concert to help healthcare organizations manage their highest-risk populations:
- Patient Stratification: Current care management solutions deliver static lists of patients who meet certain population health criteria, without actionable information on how to treat them. Health Catalyst's Patient Impact Predictor™ enables identification of people who may fall anywhere along three levels of care management but who are most likely to benefit from specific interventions that have worked effectively in the past for similar patient types.
- Patient Intake: Health Catalyst's Patient Intake tool is built to streamline the process of patient intake and care team assignment. It delivers an efficient way of consolidating and managing multiple lists, collaborating with the physician and reaching out to these patients so the real work of delivering care can be done.
- Care Coordination: It is important that the entire care team, along with the patient, and the patient's family and friends, can communicate through the care management solution to develop relationships that help or encourage patient engagement. Health Catalyst's mobile-first approach enables the care team to go where the patients are: their homes, physician offices, post-acute and long-term care settings. The solution supports all members of the care team including social workers, community resources, care navigators, etc. across multiple EMR systems.
- Care Companion: Most patients have experienced the frustration of not knowing their care plan nor how to become engaged to ensure the plan's success. Health Catalyst's patient engagement tools solve this problem by leveraging smart phones and mobile connectivity. The tools enable secure messaging, assessments, care planning and the associated activities and education that engage patients in collaboration with their care team. Family, friends or caregivers can be invited to share in these plans and communications to ensure patients receive the best care.
- Care Team Insights: Evaluating the effectiveness of population health and care management programs poses a significant challenge for healthcare organizations. But without the ability to assess and adjust these programs, it is impossible to be accountable for the care of patients. Health Catalyst's Care Team Insights tool manages and reports on care management programs using metrics and measures appropriate to Value Based Contracting. Organizations can determine true Return on Engagement—for example, that $17 in savings on cost utilization is achieved for every $5 spent on complex care program.
Patient Impact Predictor™: A More Detailed Look
Among the most important innovations within the new Health Catalyst Care Management Suite™ is the Patient Impact Predictor™, a unique process and technology that dynamically generates portfolios of patients, prioritized by actionable suggestions for risk intervention.
Current care management solutions use claims or EHR data, but rarely both, to stratify patients who meet two criteria: those that are highest cost (with multiple complex conditions); and those posing the highest clinical risk. Sometimes, the patients identified by this approach are high risk but are beyond the ability to intervene and actually change outcomes.
By contrast, the Health Catalyst Patient Impact Predictor™ dynamically generates portfolios of patients, prioritized by actionable suggestions for risk intervention. The solution takes stratification to the next level with advanced client-configurable algorithms and variable weighting that analyze not only claims and EHR data together, but also socio-economic determinants, high-risk medication utilization, acuity of conditions, high-utilization predicted, and HCC scores. This innovative approach uses sophisticated analytics to be able to reveal additional, normally hidden, subsets of patients who might benefit from care management more than some of the traditionally selected high-risk or rising-risk patients.
Explore Care Management Suite in Live Webinar, Nov. 17
For more detailed information, join Dale Sanders and the Health Catalyst product development team for a live Care Management Product Webinar on Thursday, November 17th at 1:00 Eastern. Attendees will view five live demos and participate in a live question and answer session as well. Register for the webinar here.
About Health Catalyst
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 70 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. For more information, visit https://www.healthcatalyst.com, and follow us on Twitter, LinkedIn and Facebook.
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SOURCE Health Catalyst