The future success of fee-for-value payment models depends partially on the ability of provider organizations to help patients manage their own health.
The idea is that proactive interventions will keep patients healthier and avoid the high costs that arise when a condition worsens to the point of requiring acute care.
Analytics can help providers create intervention programs and track their effectiveness.
For example, by combining data from claims and clinical forms with socioeconomic and care management databases, provider groups can identify high-risk patients.
High-risk patients may need more communication and more interventions. Knowing who they are allows provider groups to reach out to them.
Grace Terrell, MD, is the CEO and president at North Carolina-based Cornerstone Health Care.
Cornerstone uses analytics to inform the work done by its patient care advocate program.
“The program is staffed by trained, certified medical assistants who are able to use analytics tools to identify gaps in care and opportunities for engagement with the patient outside of the exam room,” says Terrell.
The staff member calls patients who appear to have certain types of health care issues and, if necessary, brings them back into the office.
Cornerstone also uses analytics to identify the 30 patients predicted to be sickest for each physician in their practice.
“This list helps our physicians think about those patients not just when they are in the exam room, but more comprehensively. Why is this patient on the list? How can we help this patient?” says Terrell. “When we approach health care like that, it can be revolutionary in a lot of ways.”
To know if a care management solution is truly revolutionary, provider groups can also use analytics to measure the intervention’s effectiveness.
Take five minutes to learn how Cornerstone started its journey from volume to value-based care in this Optum Provider #5in5: Improving patient outcomes: Transformation through analytics.
About the author
Karen Thomas-Smith is vice president of Provider Marketing & Reference Management at Optum. She brings to the role more than 15 years of global experience in the software industry. Karen has shared her unique ideas on corporate culture and leadership in a number of television appearances on Oprah, 60 Minutes and Canada Public Television. Prior to her position at Optum, Karen spent time at Allscripts and SAS.
She holds a bachelor of science degree in business administration from North Carolina Wesleyan College, graduating Magna Cum Laude.