Assessing the Growing Market for Condition Management Solutions

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Watch lead analyst Brian Eastwood’s webinar that accompanied the release of this report:

Increasing pressure to control rising healthcare costs related to chronic conditions has led the industry to begin exploring the use of mobile apps, devices, and other digital interventions that help patients manage the symptoms of these conditions. Interest is understandably higher among the stakeholders responsible for paying for care than it is among those who deliver care, but the growth of value-based care (VBC) models is expected to drive greater adoption among provider organizations.

Selling to these stakeholders forces vendors to prove both clinical efficacy and return on investment (ROI) for their solutions. It also forces vendors to demonstrate ease of use and improved efficiency, as user adoption evaporates in the absence of these qualities. While this has presented hurdles, it has also forced the condition management market to mature quickly, with dozens of clinically proven solutions on the market:

 

This report examines the market forces driving current adoption of these technologies, looks at what we expect the future to bring, and provides profiles for a select set of market leaders (listed below). As the march to VBC continues, convergence between payers and providers will shift these solutions closer to the point of care. Learn what has made these companies stand out from the pack and what to think about when planning to implement your own condition management programs.

Vendors Profiled: AbleTo, Canary Health, Glooko, Lark, Livongo Health, Noom, Omada Health, Propeller Health, Twine Health, Wildflower Health

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“Chilmark were one of the first industry watchers to recognize the importance of population health and are still one of the most sophisticated in their apprecition of what is going to be needed to transform health and care.”

-Former SVP of PHM at Cerner

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Watch the corresponding webinar summarizing some of the report’s key findings below:

Building on the 2014 and 2016 editions of this report, Chilmark returned to the market this year to assess critical changes in vendor solutions and how well they map to provider needs. Notably, analytics solutions and care management applications are more tightly linked now and show promise for moving analytics-derived insights closer to the point of care. Analytics applications are also becoming more user friendly — an opportunity for differentiation previously identified in the 2016 edition.

What remains the most important driver underlying the strong growth in data analytics is the move to alternative payment models, commonly referred to as value-based reimbursement (VBR). Future financial success in the VBR realm requires healthcare organizations (HCOs) to effectively manage risks, utilization and costs while concurrently improving quality and optimizing outcomes.

This year’s report provides in-depth profiles on 17 of the leading analytics vendors in the market today. All solutions profiled have the capability to co-mingle claims and clinical data. While Chilmark noted last year that EHR vendors are well positioned to incorporate analytics into their EHR solutions, vendors of all types have promising analytics solutions both in terms of product vision and capabilities. The report also includes major changes in vendor solutions compared to those from last year’s report.

Vendors Profiled: The Advisory Board Company, Allscripts, Arcadia Healthcare Solutions, athenahealth, Inc., Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Epic Systems Corporation, Forward Health Group, Geneia LLC, Health Catalyst, HealthEC, IBM Watson Health, MCIS, Inc., Optum, Philips Wellcentive.

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Tackling Prior Auth: New Solutions to Address Provider-Payer Friction

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Watch lead analyst Jennifer Rogers’ webinar that accompanied the release of this report:

PA solutions are on the cusp of a breakout moment, partially driven by both the growing adoption of value-based care (VBC) arrangements, as well as sophistication of new enabling technologies, including APIs, NLP, and AI. A new PA model is emerging that promises to deliver mutually beneficial results for providers and payers with far less pain, better integrating CDS, claims, and order workflows at the point of care.

With the dubious honor of being one of the thorniest pain points in provider-payer collaboration, and sitting at the start of the revenue cycle, PA is a logical starting point to establish greater provider-payer convergence. Chilmark Research projects that this new evolution in PA technology will serve as a petri dish for greater forms of convergence that will then spread to other VBC strategies.

This report answers the following questions:

  • How is PA evolving for providers and payers alike, given the growing expansion of VBC adoption?
  • What is the current state of pharmacy and medical PA technology and process?
  • Who is innovating in this space to improve the provider-payer experience and clinical and cost outcomes?
  • What should healthcare organizations (HCOs) consider as they decide on a solution?
  • Where do significant gaps remain that HCOs will struggle to fill?

Vendors Profiled: Accenture, athenahealth, Availity, Change Healthcare, Cognizant, CoverMyMeds, eviCore, MCG, Partners Healthcare, Surescripts, ZipRad

Cost: $2,750 (Discounts for qualified provider organizations. Email John for details.)

 

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Driving Speed to Value: Three Approaches to Population Health Management

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Watch Jennifer Rogers’ free webinar on this report, reviewing the specific example of the Marshfield Clinic Health System and their subsidiary, MCIS:

This report delves into three case studies of different population health management strategies, examining the clinical and technology models. This research project is intended to increase PHM speed to value, helping to identify optimal health IT (HIT) enablement. This report combines the findings from these case studies with additional primary and secondary research to distill common themes and provide recommendations for other HCOs considering or already deploying a PHM strategy of their own.

The approaches taken by our three case study HCOs to PHM highlight a stark contrast in PHM strategies and technology models.

  • Trenton Health Team: Community collaborative and health information exchange that relies on a single-sourced HIT vendor;
  • Partners Healthcare: Large regional health system that has taken an extremely broad build-and-buy HIT portfolio approach;
  • Marshfield Clinical Health System: Vertically integrated health system that has developed and deployed a proprietary electronic health record and PHM integrated technology platform.

Recognizing there will never be a one-size-fits-all model that generates positive outcomes across all metrics, there is much to be learned from these early adopters that have been implementing PHM strategies for five or more years.

Report Length: 30 pages

Report Cost: $795 (Discounts for qualified provider organizations. Email John for details.)

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Watch Matt Guldin’s free webinar on this report, sharing some of the research highlights:

As healthcare in the United States has evolved toward a model of value-based care (VBC), so, too, has the concept of care management evolved. No longer is care management limited to the high-risk patients who require high-touch care interventions. Healthcare organizations (HCOs) are increasingly broadening the reach of care management to include the rising-risk population: Those in danger of developing a preventable chronic condition such as Type 2 diabetes or hypertension due to any number of health, lifestyle, genetic, or environmental factors.

Care management vendors are now starting to align around a core care management process: Identify patients, create care plans, communicate care plan goals and tasks to patients, monitor patient progress, and alter care plans as needed. Across the market, vendors are differentiating in the more nuanced parts of the process: How patients are identified, where care plans come from, how well patients are engaged, and how much of the care management process can be automated.

In last year’s seminal report on this market, vendors were focused on comprehensive and longitudinal care coordination. This has fallen out of favor with provider organizations due to costs and evasive return on investment. Providers are now focusing more directly on episodic programs directly tied to Medicare reimbursements, such as 30-day readmission penalties or 90-day bundled payment programs.

This report provides a comprehensive review of more than 25 solutions available today to meet the various needs of provider organizations pursuing care management strategies. It also examines for the first time the potential for patient relation management (PRM) and condition-specific solutions to help HCOs engage with patients and achieve ROI in their care management programs. Reflecting the market’s emphasis on episodic care, the report’s vendor rankings focuses on core care management functionality and places less emphasis on a solution’s care coordination features.

Current and prospective vendors of care management solutions will find this report valuable, as will providers and payers looking to buy or replace a care management solution. Consultants, investors, patient advocates, conveners, and others will all benefit from this in-depth report.

Vendors Profiled: Allscripts, athenahealth, Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Enli Health Intelligence, Epic Systems Corporation, Evolent Health, Geneia LLC, GSI Health LLC, Health Catalyst, HealthEC, IBM Watson Health, Lightbeam Health Solutions, Medecision, Optum, Philips Wellcentive, Inc., Salesforce.com

Report Length: 118 pages

Report Cost: $6,000 (Discounts for qualified provider organizations. Email John for details.)

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The Patient Will See You Now

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This month’s Domain Monitor is a little bit different. We recently read through Dr. Eric Topol’s latest book, The Patient Will See You Now. Over the past few years, Topol has become a “crossover” figure between our insular world of health IT and the more mainstream media. Today he is a widely respected thought leader in the area of digital medicine. In his latest book, he explores the myriad of changes happening to the traditional delivery of medical care, fueled by advances in consumerism, technology, science, regulation…and the list goes on.

While Topol is certainly a visionary, his thesis leaves out some obvious real world considerations about tractability, adoption, usability, health literacy, and more, which ultimately amounts to a sort of a prophetic evangelization of a high-tech future rather than a field guide to the present.

This book is not a roadmap for health executives, nor is it a blueprint for technologists or scientists. That being said, Topol does serve up a complete (if at times off-topic and/or esoteric) survey of the new consumer landscape in healthcare and medicine, along with the market drivers, roadblocks, technologies, and other factors involved. All in all, Topol’s overview of these complex topics is comprehensive, rife with detailed examples of companies, technologies, and concepts throughout.

What follows here is a high level summary of some of the major issues in this book, along with our overall take on Topol’s findings. We have also provided a quick “Executive’s Guide” for those interested in Topol’s work but without the time to pore through the entire book.

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Making the Most of the CCM Code

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One of the most buzzworthy topics at the recent HIMSS conference was CMS’ new CPT code for chronic care management (CCM). The code will pay providers and care teams $43 PMPM for the non-face-to-face time they spend managing complex, chronically ill patients’ health. Scaled across patient panels and office practices, this represents no small amount of potential new revenue. Yet, the billing requirements accompanying the new payments are complex and comprehensive, with considerable implications for workflow, documentation, IT customization,patient engagement, and more. This month’s domain monitor provides a high level outline of the new CCM code, a breakdown of the major challenges practices face in billing for it, and some early signs of how the health IT industry is responding to the opportunity with new solution capabilities.

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Watch Brian Murphy’s webinar on this report sharing some of the research highlights:

In the past, messaging-based and document-centric models of health information exchange helped healthcare organizations (HCO) coordinate resources across networked communities of clinicians to enhance care delivery. This report concludes that such approaches have reached the limits of their effectiveness. The advent of value-based care is driving the need to assess risk for a population and effectively manage that risk across a distributed clinical care delivery network. This requires far richer, diverse information flows across a greater diversity of market participants.

In early 2014, Chilmark Research’s groundbreaking research on CNM (Free Report: Migration to Clinician Network Management) uncovered an industry undergoing massive transformation at a rate that outpaced the vendor community’s ability to deliver solutions. This gap between industry needs and vendor products has widened since then, in part because most products are tied to an approach and a technology stack that does not take advantage of modern development and integration ideas.

The vendors profiled are deeply committed to making healthcare data more broadly available and useful around the healthcare system. Since our last CNM Market Trends Report these vendors have evolved their offerings to include more data types supplying a wider range of applications. Social and behavioral data is being incorporated and supplied to the point of care and for risk profile development and predictive analytics. Patient-reported data from wearables and devices is also being gradually incorporated into product plans. Most vendors also want to make this data available for new computing capabilities such as predictive modeling, machine learning, and cognitive computing.

The technical approach advocated in this report involves leaving health data closer to where it was created and making it available to a range of diverse applications and users via APIs. Organizations should also be able to provision data based on application need. This approach, widespread outside healthcare, represents a more effective way to supply and consume data. It also offers a better way to accomplish development and integration goals. Such an approach will better support value-based healthcare and simplify what has evolved into notoriously complex implementation and maintenance efforts.

Vendors Profiled: Allscripts Healthcare Solutions, Inc; CareEvolution; Cerner Corporation; Epic Systems Corporation; InterSystems Corporation; Medicity (Aetna); Orion Health; RelayHealth.

Report Length: 60 pages

Price: $6,000 (Discounts for qualified provider organizations. Email John for details.)

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