HIMSS’15: Care Management & Care Coordination Watchlist

In preparation of attending HIMSS 2015 next week, I have been busy finalizing my agenda. It has been a busy week confirming and finalizing meeting times, figuring out what vendors I want to take a more detailed look at, setting up times to meet with some former colleagues, and figuring out what sessions I might want to attend. 

This will be my sixth time attending the annual HIMSS conference and if anything I have learned it is that having a detailed plan before arriving is absolutely essential to getting real value out of attending.  It is quite easy to get bogged down especially in a conference that will have more than 1,300+ exhibitors and 35,000+ attendees spread across the 4 interconnected buildings at McCormack Place in Chicago.

The primary focus though for me at HIMSS this year is going to be focusing on our Care Management and Care Coordination domain. Besides wrapping up some final conversations I am having regarding a forthcoming Insight Report on Care Plans, I am following up some of the initial conversations I had on this topic for the Care Management section of our Population Health Management: Aligning IT Solutions to Strategy report.

Here are some of the ideas and concepts in particular that I am following up with at HIMSS this year in regards to care management and care coordination:

1. Here a care management solution, everywhere a care management solution: Just as ‘population health’ was a buzzword term last year at HIMSS that nearly every vendor featured or spoke about, I anticipate this year it will be care management and care coordination. From our own inquiries, we have identified over 90+ vendors that have some form of care management and care coordination solution. This does not even include some of the startups that are still in ‘beta’ development either. Some of these solutions are more niche-oriented solutions geared around a particular workflow process or event (e.g., discharge planning or referral management). Others are focused on more comprehensive care management activities which are primarily focused on enabling a care team to manage particular groups of patients across various care settings in a community. Given the relative immaturity of solutions in this market, I am going to be taking a look just how vendors are defining their care management solutions and how they are moving from ‘systems of record’ (e.g., registry-oriented solutions) to ‘systems of engagement.’

2. Need for ‘real-time’ data for real-time interventions: Several recent conservations I have had revolved around the need for more ‘real-time’ data in order to act in a more timely fashion to prevent patients who are at high-risk from ending up in a preventable ER visit or hospital admission. At a recent presentation at the 15^th Annual Population Health Colloquium in Philadelphia, Mark Wagar, President, Heritage Medical Systems, went as far as to say that when one of their PCPs receives an ADT (Admissions, Discharge, Transfer) notification that they already missed an important potential opportunity. Heritage Medical Systems represents one end of the spectrum of HCOs in terms of their IT capabilities and ability to consume and act upon data in such a rapid fashion. At the other end are HCOs that are signing up for the MSSP ACO program and not receiving adjudicated claims on their Medicare beneficiaries a full 90-120 days after an event (e.g., hospitalization) has occurred. Literally, unless one of these patients come in for a visit before then, the MSSP ACO likely has little to no visibility into what is occurring with this patient in the interim. One of the things I am looking at is what types of ‘real-time’ data (e.g., pre-adjudicated claims, ADTs and results delivery) are being utilized to facilitate care management efforts and how they are being consumed and utilized by care management IT solutions.

3. Data, data everywhere, nor any data insight to drink: Even for HCOs that have invested considerable time, energy, and resources to aggregate clinical data from EMRs and claims, they are struggling to put together a ‘360 degree view’ or ‘longitudinal patient record’ view at the point-of-care that allows the various members of a care team to easy and efficiently find the ‘insight issues’ for a particular patient. Given that HCOs often have limited numbers of nurse case managers/coordinators, this is causing a challenge for these HCOs to effectively manage broader numbers of chronically-ill patients as they expand their care management efforts to larger portions of their patient population. There is also a lot of talk about getting data into the EMR in the physician’s office but even a prominent EMR vendor admitted to us recently that they are having many of the same issues on how to present the most pertinent ‘insight issues’ in a succinct fashion within the individual patient record within the EMR. I am going to be looking at how care management solution vendors are presenting summary level information on individual patients within an individual patient’s record including their care plan. I am interested to see how different types of ‘insight issues’ are being presented to various types of care providers via different methods (e.g., mobile, tablet, desktop).

4. Care management that actually includes the patient and their caregivers: One of the issues that has emerged as I have been researching the current state of provider longitudinal care plans is that they are generally missing a key stakeholder – the patient and their caregivers. Despite supposedly being the key focus of the care plan, it has been surprising to find just how disintermediated patients and their caregivers are from their actual care plan in most cases. In many cases, patients and their caregivers cannot even access the actual care plan itself even in a read-only capacity. I am interested to see at HIMSS is how care management and care coordination vendors are involving the patients and care givers including beyond just providing them with basic access to their own care plan.

5. Role of others in the care management process: For all of the talk about the shift to provider-led care management, there is still an important role for payers in this process for several reasons. Payers have extensive experience with care management, they have the actual claims data that providers still need to get a holistic view of their patient population, and in most many cases are offering money and/or additional services to assist providers in their care management activities especially in commercial ACO arrangements. Additionally, several payers including United Healthcare, Aetna, and Humana, have made a number of IT acquisitions over the years that they are either offering or selling to HCOs.

   Another key area that I am going to focus on is what home health, post-acute, and behavioral health IT vendors are doing to enable care management activities especially in regards to the issue of being able to receive and send out clinical summary documents including care plans. The status quo largely seems to be that even if these provider entities are owned by HCOs and have adopted IT solutions, they can consume only limited amounts of information electronically. Most transactions are still done via the old reliable fax machine or even paper document transfers. I will be stopping by some of the leading vendors to see what progress they are making and how care plans are being utilized by some of IT vendors in these provider settings.

You Tell Us: What are you looking forward in the care management and coordination space this year especially at HIMSS?

• How much progress will care management vendors make this year moving to ‘systems of engagement’ that also include the patient and their caregivers?
• What role are payers going to play in this process and are their care management IT solutions going to have increased provider adoption and actual utilization?
• How successful are care management solutions going to be in both getting critical information in a timely-enough fashion for care teams to act and presenting insights on patients in an efficient manner to the proper care team member?
• How much progress is going to be made to incorporate post-acute, home health, and behavioral health facilities into provider-led care management efforts?
• Thoughts on the numerous startups that are trying to penetrate this space?