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Analytics – An Integral Part of Care Management Success

by Matt Guldin | September 15, 2016

Last week, I attended the 3rd Health Analytics Summit (HAS). This was my first time attending an event that now attracts over 1,000 attendees. Providers were well represented at the event with nearly 80 percent of the attendees coming from various provider HCOs.


While Health Catalyst focuses on analytics, my observations were largely focused on the care management related aspects of the conference. Here are some of the main impressions from the event:

Line between analytics and care management has blurred further: In our Care Management Market Trends Report, there were some analytics-focused ratings criteria with ‘Risk Identification and Stratification’ being the most straightforward analytically-oriented criterion.

More HCOs though are moving beyond simply importing a risk score from a claims-based risk grouper solution as explained in our Insight Report on the topic. They use this as a starting point, utilizing other data types (mainly clinical and utilization data) to define their own proprietary risk groups including sub-groups within high-risk patients.

Additionally, HCOs are leveraging analytics to measure the effectiveness of their care management programs ‘early and often’ – instead of waiting 9-12 months to examine clinical and cost-based outcome measures.  They are also looking at more implementation and process-based measures to assess program effectiveness of particular care plan elements before expanding them to other patient types.

New data are ‘sexy’ but existing data issues consume lots of bandwidth: One of the first poll questions asked was which new data sets were the attendees most interested in for analytics-related projects with the top 3 being: social determinants, patient-reported outcomes, and external demographic data (e.g., credit scores). There was not much difference between the three although most of the conversations I had or heard really focused on the gathering additional social determinants of health especially related to the patient’s home after discharge and what resources were available to a patient.

But clinical data quality and to a lesser degree claims data still remain the biggest issue. HCOs are spending 30-40 percent of time on this single issue during the first several months of a project. Combine this with a multitude of varying and ever-growing value-based performance (VBP) measures, it is no wonder that incorporating additional new data sets into various analytic initiatives is challenging.

Provider-led care management adoption reaching a tipping point: One of the more difficult things to determine is just how many HCOs have actually put a care management program in place in their outpatient settings. There are several different ways we have heard HCOs define this but the most standard definition is having care teams headed by an outpatient nurse care manager who actively manages some percentage of an HCO’s patients through a care plan.

At the Partners HealthCare session on their care management strategy, which Health Catalyst has licensed the IP of, nearly two-thirds of the respondents indicated they had a high-risk primary care management program already in place at their HCO. The conference attendees likely represent some outliers but it would not surprise me if the actual adoption rate for care management among hospital-based HCOs is already at or exceeds 50 percent by early 2017. This number is likely considerably lower in rural settings, community hospitals, or among physician-based HCOs.

There is not some clearly-defined threshold in which an HCO decides to put in place a care management program but the two most useful anecdotal metrics seems to be: number of primary care lives under value-based reimbursement programs (VBR) (est. >15 percent of primary care lives) and percentage of total revenue in VBR arrangements (est. >20-25 of total HCO revenue).

HCOs actually engaging in longitudinal care management for a cohort of patients: While more HCOs have put in place care management programs, the overwhelming majority of these programs are not truly long-term, continuous care management programs. Instead, the vast majority of them are based around enrolling a patient for a finite duration of <30 days, <90 days or <120 days.

This should not be surprising given that HCOs are rationally responding to the measurement periods of various VBP programs most notably the Hospital Readmissions Reduction Program (HRRP) program from CMS. Partners Healthcare detailed how they are engaging in care management for a cohort of high-risk patients from several different payer types including Medicare Advantage, Commercial, Managed Medicaid, and their own employees and dependents.

If provider-led care management programs are going to bend the cost curve, continuous care management including palliative care for end-of-life patients is going to be necessary. Simply focusing on inpatient admission rates is going to be insufficient given early ACO results. The question is how many HCOs have the financial and clinical resources, geographic coverage, and economies of scale to accomplish this lofty goal especially in regions where there is considerable patient churn (e.g., +20% annually).

Broader integration is key for care management: Time and time again access and timely integration with behavioral health services is becoming a critical issue for the success of care management programs. Partners Healthcare reported that nearly 40 percent of their patients in care management program had at least one behavioral health issue. This is not uncommon and several other HCOs have reported to us that 30-50 percent of their patients have at least one behavioral health issue beyond something that can be treated by a primary care provider (PCP).

It is critical that when these patients come in for an office visit to their PCP or seek access to behavioral health services that these resources are available in-person or via a telehealth consult. Other additional areas that are coming up as being critical to provider care management programs for high-risk patients, are tighter integration with substance abuse, pharmacy, and palliative care resources.

Most attendees at the Population Health Summit indicated their HCOs were in the early to middle stages of integrating analytics across their organization with varying degrees of success. Attendees overwhelmingly felt these efforts were having overall positive effects on quality even if ROI remains challenging to determine. Most surprisingly, attendees self-reported that adaptive leadership and culture was the highest-scoring attribute in Health Catalyst’s recently-released Organizational Improvement Readiness Assessment with analytics and best practices being the lowest scoring attributes.

What stuck with me though was just how pervasive analytics are to not only defining the foundational requirements for a care management program but the crucial role they play in helping to set up, refine, and support a care management program over time. Unless a care management program is using analytics to actively measure ‘early and often’ and using this feedback to effectively optimize care management processes, results will be limited.

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