The Population Health Management Paradox: Using Data and Technology to Personalize Healthcare

By Sita Kapoor, chief information officer, HealthEC; a HIMSS19 participant

Picture this level of care:

A coordinator checking in with patients regularly to ensure that blood pressure is being monitored, diet and exercise plans are followed, and medications are taken.
Calls from the doctor’s office to arrange transportation.
Text message reminders for upcoming appointments.

This isn’t the future of healthcare. This is healthcare today – a system driven by improved communication and an increasingly holistic view of patients. These approaches are laying the foundation for transformational change as the industry embraces population health management (PHM) solutions and value-based care.

So, what’s behind this personalization of healthcare? Paradoxically, data and technology.

PHM Solutions and Personalized Healthcare

PHM solutions can aggregate and analyze 100 percent of available electronic data and give healthcare organizations across the care continuum insights that were unavailable five years ago. By gathering and analyzing data – clinical, claims, labs, pharmacy and more – then displaying it on easy-to-read dashboard displays, gaps in care are identified.

Efforts of healthcare organizations to close these gaps are driving the personalization of care. By targeting high-risk, high-cost patients and developing personalized care plans, patients are getting the right care, at the right time, in the right place.

Keeping tabs on each patient originates from a phone call or text from a care coordinator who is prompted by a PHM solution to intervene. These simple steps help lower costs and improve patient care.

The beauty of personalized healthcare is its simplicity and scalability. Simple, thanks to the confluence of data and technology. Scalable, because of the ability to incorporate personalized care into value-based contracting.

But the personalized aspects of PHM and value-based care don’t end with the care coordinator communicating with patients. Primary care physicians, specialists and administrators work in tandem with coordinators to treat patients holistically.

How? By leveraging the power of data.

Personalized Healthcare in Action

Caring for Economically Disadvantaged Patients
With a downturn of the gaming industry in Atlantic City over the past years, the area lost thousands of jobs and its citizens experienced a painful economic impact. Many area patients hadn't seen their primary care doctor in years and were presenting to the emergency department (ED) for nonemergency episodes such as headaches, gingivitis and lower back pain.

Shore Quality Partners, a clinically integrated network, sought to understand resource utilization in order to provide personalized healthcare services in the most cost-effective setting and proactively manage illnesses to avoid admissions.

By centralizing data from myriad systems, a longitudinal record across multiple disparate electronic medical records, health information exchanges and claims systems was created. With 240 independent employed and contracted physicians and specialists serving a patient population of more than 40,000 people, the network was then able to apply advanced analytics to evaluate cost, quality and operational metrics across providers and groups, and formulate performance improvement plans.

By orchestrating more cost-effective care, the network achieved remarkable results including:

  • Generating $4.69 million in 2016 shared savings payments across 16,000 patients
  • Outperforming their geographic comparison group by $27.97 per member per month, equal to annual savings of $5.37 million
  • Decreasing spending by high-ED-utilization patients
  • Decreased inpatient utilization rates by 15 percent
  • Increased primary care visits by 3 percent
  • Maintained a 90th percentile ranking nationwide in patient-satisfaction measures

Caring for individuals with Intellectual and Developmental Disabilities
Personalized healthcare can also occur when patients aren’t taking an active role in their own care. Take for example the Alliance for Integrated Care of New York, an accountable care organization (ACO) formed to oversee the healthcare needs of individuals with intellectual and developmental disabilities (IDDs). Using data and analytics through HealthEC’s PHM platform, the organization is tackling fundamental care delivery challenges presented by IDD patients, including the management of care coordination and patient communication.

With approximately 200 physicians and other healthcare professionals caring for more than 6,000 dually eligible Medicaid and mostly Medicare beneficiaries (the majority of whom are IDD patients), measurable results were achieved:

  • Data used to risk-stratify patients resulted in a $2.4 million reduction in total costs
  • Over the first three quarters of 2018, inpatient expenditures fell 6 percent
  • As a result of tele-triage kiosks installed in IDD group homes, ED visits dropped 11 percent and admissions fell 7 percent

Artificial Intelligence, Machine Learning and Advanced Algorithms

Another aspect of technology driving personalized healthcare is how artificial intelligence (AI), machine learning and advanced algorithms are being used to analyze data.

For example, data scientists are testing models that make connections across the healthcare timelines of Medicaid patients. That is, what factors changed between the period when a patient was healthy and when they were diagnosed with a certain condition? How did patients respond to a particular procedure? What types of treatments were given afterward? What were the outcomes?

Alternatively, by blending AI and data analytics, we’ll soon be able to look at a pool of Medicaid patients – for example, 100 people with similar weight, height, body mass index, genetics, etc., diagnosed and treated for heart disease – and analyze outcomes in dynamic ways.

Let’s say of those 100 patients, 50 showed improvement after treatment, 40 didn’t and 10 died. By analyzing every bit of data along the timelines of the 50 patients with improved outcomes – including social determinants of health, medication, changes in diet and exercise – AI can find patterns within care protocols that could be applied to the other 40 patients who did not show improvement. AI could potentially turn around the whole treatment paradigm for Medicaid patients with specific health conditions, not based on clinical expertise, but data. And at the same time, reduce costs.

So, as strange as it sounds, data and technology are driving the personalization of care. And as organizations across the healthcare industry embrace PHM solutions and value-based care, we expect to see personalized health transform the delivery of care.

  • As the growth of population health management and value-based care accelerates, how is your organization positioned to use data and technology?
  • What can your organization do to personalize health?
  • How can your organization incorporate personalized health into value-based contracting?

Want to learn more about personal health management? Join HealthEC’s Sanjay Seth, MD, at HIMSS19 in the Personal Health Experience’s Session PH25, Design a Personalized Care Coordination Strategy, as he takes a closer look at how a population health management solution can help organizations across the healthcare landscape deliver on the promise of value-based care and generate personalized, scalable care coordination strategies that engage providers and patients alike.

Sponsored content. The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.


HIMSS19: Champions of Health Unite

300+ education sessions. 1,300+ vendors. 45,000+ health information and technology superheroes.