From ThinkAnthem.com

Effectively utilizing patient health data in delivering care is becoming increasingly important as more healthcare providers are adopting value-based population health management (VBPHM) models. One challenge I see with this shift is that the demands of delivering VBPHM make it impossible for any provider to implement this model of care without the proper tools.

This is especially true for clinicians who have a significant portion of Medicare patients since 7 out of 10 Medicare beneficiaries have multiple chronic conditions and will need more care. A study from a few years ago found that providers could spend about 21 hours a day performing all the acute, chronic, and preventive care required of them if they were responsible for 2,500 patients.

To illustrate my point on how the proper tools can help drastically evolve an industry, I think about the analogy with powered flight.

On December 17, 1903, the Wright brothers successfully piloted the first powered airplane. The plane flew about 20 feet off the ground, at a speed of 8 miles per hour, and a distance of 120 feet. The Flyer – as the Wilber brothers called their airplane – was a relative simple machine: wings made of wood and fabric, an engine, a transmission, and propellers. This 12 second flight only needed one person – Orville Wright – to maneuver the plane during this historic moment.

Fast forward 100-plus years, and we now have fighter jets that speed through the sky at more than 1,000 miles per hour, cruise at altitudes of 50,000 feet, and travel anywhere in the world. But even these sophisticated machines are still piloted by one person.

The big difference is that, with the fighter jet, there are tools and systems in place that process and coordinate a lot of internal data – fuel level, equipment status, etc. – with external data – wind speed, altitude, etc. These automated and sophisticated tools allow the pilot to focus on flying.

Applying this to healthcare, clinicians who practiced the “traditional” approach to care delivery (The Flyers of the world) could do so because there were fewer aspects to this model of care compared to VBPHM. Value-based population health management (the fighter jets of the world) requires accurate, actionable, and timely data for member-centric preventive and wellness program management, patient education, and patient outreach, as well as for meeting regulatory and compliance guidelines.

Healthcare professionals implementing VBPHM must utilize the health information they have about their patients to analyze their health status, understand their care needs, develop appropriate care plans, and identify and close gaps of care.

To do this, they must have automated systems in place to perform many of these functions since doing it manually is resource intensive and virtually impossible.

The real value these systems offer VBPHM is that they help healthcare providers be the pilot who can focus on caring for the patient.

These systems can optimize data collection, storage, analysis, reporting, and utilization of health information to identify the burden of illness and deliver member-centric, preventive care. As with the fighter jet’s instruments that monitor systems inside the plane, successful healthcare practices have information systems in place that can analyze patient data collected during office visits – blood pressure, weight, in-house lab work, etc. These automated systems also help with data collection from outside the practice and synthesize this information (hospital admissions, lab work, patient-reported data, etc.) with the data the practice already has on hand.

These systems flag care gaps so clinicians can come up with intervention strategies to improve care. They can also help providers ensure proper follow through with care plans by generating alerts or lists to tell staff which patients should be called for office visits or medication refills.

By having this level of patient outreach and engagement, clinician will come that much closer to achieving the goals of value-based population health management. Healthcare providers can be more proactive in ensuring proper care and ultimately better health outcomes for their patients. And this level of insight helps clinicians better allocate their practices’ resources to reduce avoidable episodes of care and lower overall cost of care.

Anthem, Inc. and its affiliated health plans support provider groups of different sizes to adopt population based care strategies and help them drive value-based care outcomes. We combine clinical transformation services with an integrated population health technology platform that leverages data from across claims, EMR, and psychosocial and socio-economic areas. The system generates insights across cost, utilization, quality and patient domains. Finally, the platform triggers actions around comprehensive care management, community collaboration, and patient engagement.

Michael Vincent Smith, MD, FACC, FACS, FCCP is the Regional Vice President and Medical Director of Central Region Medicare at Anthem, Inc. Dr. Smith currently oversees Medical Management, Quality Management and Population Health Management for Anthem’s Medicare Advantage, Medicare Supplement and Medicare Part D Plan membership in Indiana, Ohio, Wisconsin, Kentucky, Missouri, Tennessee and Georgia. Dr. Smith is a board-certified cardiovascular and thoracic surgeon and former Chief of Cardiovascular Surgery and Vice-Chairman of Surgery of an academic medical center in Atlanta where he founded the first bloodless cardiac surgery program in Georgia. As the Director of a Cancer Center he also started the first lung cancer early detection program in the same state.