Population Health Management Analytics to Meet ACO Compliance

Population Health Management Analytics Software is needed by large health systems that serve tens of thousands of patients annually, coordinate multiple primary care clinics, and prepare to become accountable care organizations (ACOs). They report that compliance has gone up by almost a third and that the time doctors spend on data collection and records maintenance has been significantly reduced. Compliance with Meaningful Use (MU) standards and Physician Quality Reporting System (PQRS) requirements also can be achieved. Why is the strategy of these large healthcare systems so successful?

More health systems pay their attention to accountable care organization models as a possibility to cut costs and make care quality better. Here the value-based care approach is used, where the government funds and rewards ACOs for putting quality ahead of quantity in their medical procedures.

A successful transition to an ACO model is possible if the health system ensures that primary care standards are met with excellence and achieves quality goals. It also needs to focus on prevention, coordinate patient care for groups/individuals, and carry out data on patient satisfaction, revenue, costs, and other important info in an optimized data collection process.

However, organizations may lack specialized tools and advanced analytics based on data to pinpoint high-cost patients, boost care quality, make reporting process easier, and allow providers of primary medical care to spend less time on data collection and more time with patients.

Healthcare organizations can turn to healthtech vendors to get data analytics solutions. Custom medical software development companies like Belitsoft can develop products such as Population Health Management Analytics software for healthtech Software-as-a-Service (SaaS) startups (assisting them with PoC and MVP development, creation of a SaaS Data Collection and Reporting platform, cloud migration, etc.).

Challenges to Stakeholders to Resolve While Managing Population Health

The essence of the value-based approach is patient-oriented, efficient, and high-quality care. A health system can follow it if its potential of electronic healthcare records (EHRs) is realized. It’s also important for the health system to have a strong primary care base, i.e., whose outpatient clinics effectively manage patient groups.

The majority of all healthcare costs are spent on just five percent of clients.  Because healthcare organizations fail to comprehensively identify these people and offer them targeted prevention and high-quality medical care, their utilization increases, i.e., people visit doctors more often and overuse expensive medical services.

Providing services only when a patient sees a doctor is a narrow approach to population health management. Primary care providers (PCPs) face the urgent task of implementing care delivery proactively.

However, if an organization expands its patient panel of primary care providers through a proactive approach to population health management, it may face a new challenge. Association of American Medical Colleges (AAMC) says that in the next ten years the industry can be short by as many as eighty-six thousand doctors.

Not enough staff makes it hard for doctors to grow their panel of patients while keeping care quality high and fulfilling their job responsibilities. A doctor can only examine a small number of patients in a day, as they are forced to spend time collecting info about each patient and adding it to the electronic healthcare records. Medical professionals may feel that productivity suffers. They are not patient-focused but rather focused on a list of items to check off. The reason is that clinics of primary care may lack care teams where each team member works at the highest level of their qualifications and license.

In addition to individual patient care, population health management also suffers. Doctors have to review dozens of individual reports (which they may not have even prepared) and try to piece together the whole picture of the health of an individual patient and the entire group.

Healthcare companies need to monitor compliance with regulatory standards and doctors’ performance measures. Medical staff are forced to coordinate their work with the IT team when compiling a report, if data is monitored and reported separately from each other. It takes a long time, there are delays, and the team cannot quickly obtain the needed data and correct errors. Health systems need an app that conveniently and safely combines clinician standards and measures developed by the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services (HHS), and others.

It becomes more difficult to meet performance and regulatory indicators without special software, when the new clinics are added to the clinical network and the number of patients increases meaningfully.

Features of Population Health Management Analytics Software

Valuable data and advanced analytics tools help health systems create patient care policies that are value-based. They also enable organizations to carry out primary care analysis to optimize population health management.

These tools operate on a single source of truth — the healthcare enterprise data warehouse (EDW). Using EDW, the healthcare system may boost better care delivery efforts across the entire organization. Population Health Management Analytics App based on the EDW platform helps customers monitor and understand step-by-step improvements. Also, they are useful for:

• Pinpointing and adding to a patient’s medical record info about a procedure or treatment received at another healthcare facility. Demonstrating this data for a doctor in charge.
• Tracking near real time data on primary care dashboards and tracking compliance for each patient individually over the target period to ensure necessary treatment and follow-ups are scheduled.
• Analyzing the whole patient care initiative during care process stages such as the number of clinic appointments, inpatient admissions, recovery periods, readmissions, etc.
• Adding the patient satisfaction data into the app to evaluate how optimized processes and managing of population health impact the patients’ experience.
• Monitoring composite measures, measures for chronic conditions, disease prevention, and medication control.
• Tracking doctors and regulatory performance measures.

Organizational Steps for Care Delivery Optimization

Primary care clinics should make practice reorganizations to build strong and capable care teams. Each team consists of a physician and other members with whom the physician can share responsibility for patient care and perform only his or her professional duties.

Project managers are encouraged to create long-term, collaborative teams that work together to find points for care improvement and incorporate evidence-based practices into the care process.

The team consists of specialists from different fields — physicians, quality specialists, analysts, technologists and experts in Lean methodology. Team members transform data from enterprise data stores into valuable insights and integrate them into work processes.

The Lean experts should create value stream maps to measure the workflow. They are recommended to examine the process from A to Z and work with other team members to determine opportunities for how the process can be improved. They should also work with the workgroup to clarify the maximum level of responsibility for each care team member and understand how best to integrate EHR and analytics technologies into the process.

Primary care centers are encouraged to appoint medical assistants to collect patient data on behalf of doctors and pass it on to doctors to save their time in examining the patient. 

Advantages of Applying the Population Health Management Analytics Software

With the automation of external reporting and regulatory compliance improvement, healthcare organizations move beyond basic analytics through the stages of using advanced analytics to manage population health. They highlight significant improvements in compliance driven by incorporated near real-time reporting for measures of clinician and regulatory performance. Among the reported achievements are the following:

• Staying compliant with Meaningful Use (MU) standards and Physician Quality Reporting System (PQRS) requirements.
• Regular data collection and analysis allow PCPs to see trends in sustainable, rather than one-time increases in compliance for preventive care interventions (e.g., cancer screening, seasonal vaccinations, etc.).
  Employees of a medical organization can see both summary measures for an entire group of patients and individual indicators for each patient.
• Doctors save dozens of hours on performing documentation and can spend them on solving patient problems thanks to the new reporting process. 
• The IT team can also focus on analysis, rather than gather data from multiple sources manually, format it, and combine it for reports.

Role of Custom Healthcare Software Development Organization

Data analytics firms can collaborate with software development companies like Belitsoft and avail their skilled abilities in developing and deploying data analytics platforms and apps. The software assists clients in carrying out analysis of actual performance measures, spotting areas for improvement and streamlining processes. So that clients know which areas they need to fill up with their own improvement tasks.

Via integrated data platforms large datasets from different sources (lab systems, EMRs, billing systems, etc.) are able to be gathered, stored, organized, and examined. Platforms are useful for the following:

• Specific processes of workflow automation: cleansing, standardizing, and normalizing.
• Scaling adaptable data stores and apps functionality for the smooth addition of new outpatient clinics to the network.
• Building dashboards, reports and visual representations via analytical tools.
• Complying with HIPAA and other important healthcare regulations with the help of  data security algorithms.
• Integrating machine learning and AI into analytics.

Companies that provide medical software development services could build specialized analytical apps like Population Health Management Analytics for:

• Integrating externally available state performance averages or internally established benchmarks in case the former are not available, to assess the performance of the care team.
• Visualizing patient level and population level compliance measure summary (weaknesses in the care process, interventions, missed or upcoming treatments, and so on).
• Adding an unlimited number of measures and choosing specific measure filters to find the patients who have missed appointments or abnormal values.
• Visualizing lists of patients needing future care and those behind schedule on their treatment and need to be called.
• Showing scheduled procedure reminders and missed / delayed procedures with the help of graphical visuals and reports.
• Reminding for upcoming treatments within the target period.
• Viewing overdue treatments, upcoming treatments and items outside of control limits related to all patients.
• Summarizing items outside of control targets.
• Demonstrating changes in results over time, and the most current metrics.
• Monitoring compliance with PQRS requirements and MU standards.

If you are searching for expert advice in HL7 interfaces, data platforms, workflow engineering, and development within the cloud (Azure, AWS, Google Cloud), data analytics, on-premises or hybrid environments, and data infrastructure, you can turn to Belitsoft.