In what ways is technology powering population health initiatives?

Healthcare organizations are striving to more effectively manage the health of defined populations. This includes more effective diagnosis and management of chronic diseases, anticipating adverse health outcomes and redirecting resources for early intervention, with the goals of improving outcomes, reducing disparities and lowering cost. Technology plays a huge role in supporting these efforts.

Maybe the most frequently discussed initiative today is making use of data to gain insights about patients. The amount of data (e.g., clinical, administrative, behavioral health) gathered by healthcare organizations is enormous and growing. Analytics, artificial intelligence and machine learning, for example, are making it possible for providers to identify patients who are at risk for readmission or at greater risk of a hospital acquired condition during their hospital stay. Using this information to help prevent a patient from readmitting or developing a hospital acquired condition could result in better health outcomes for patients and reduced costs for the system. Advances in computing power and advanced software applications will be crucial leveraging for these data sources.

As the healthcare system continues moving towards value-based care and value-based payment models, how do you see technology playing a role here?

These concepts – population health and value-based care models (i.e., where reimbursement to providers is based on quality of care provided and patient outcomes, with consideration of costs) – are very similar and closely linked.

With the proliferation of accountable care organizations, and with health systems taking on more responsibility for patient outcomes and costs through risk-sharing contracts, I think the potential for analytics will be critical. That is, health systems and providers will need tools to help identify high-risk patients and then employ that knowledge to engage in effective outreach and to focus resources where they are needed most.

Another way that technology will support value-based care models is through tools and solutions like telemedicine and remote patient monitoring. These allow hospitals to extend care to the home, offering patients and care teams greater flexibility and more continuous and personalized care while potentially decreasing healthcare costs through reduced hospitalizations. Rather than staying at an inpatient facility, patients with long-term conditions can keep in contact with their care teams and exchange information from home using remote tools and services. This is especially beneficial to patients in rural areas or with limited access to care. Providing continuous, real-time monitoring of a patient’s health situation, using resources more efficiently, and better engaging patients and families can improve patient satisfaction and contribute to the overriding goals of both population health management and value-based care models.

What success stories have you observed recently that exemplify some of these concepts related to population health and technology that we’ve just discussed?

One success story at the health system level comes from our collaboration with Sharp Healthcare.

We worked with the health system’s clinicians and the rapid response teams to use data to help identify patients who were at risk of sudden decline. We brought a data science team together with Sharp, Cloudera and ProKarma. We looked at two years’ worth of data from patients who had serious events in the hospital, identified the factors that led to those events, and developed predictive models to produce a patient risk score for this type of population. Sharp now has the ability to predict with an 80 percent accuracy rate whether or not a RRT call will need to be made in the next hour. The ability to predict patient decline an hour before it happens can enable Sharp to intelligently place medical emergency teams (i.e. RRT) at key points in the hospital and intervene before it becomes life threatening.

What steps should a healthcare organization take to prepare for the future – i.e. “future-proof” their organization – to deliver population health in the most meaningful way?

Start by making the right investments in people, process and technology. Engage with technology and finance industry leaders who have had success in building powerful analytics teams. Build the right processes that include data management and governance, that help foster tight alignment between clinical and business stakeholders, and that help adapt existing workflows through effective change management.

Lastly, on the technology side, build the right environment. That includes addressing the four different layers that make up the technology environment:

• The infrastructure layer — the compute, storage and networking that helps hospitals ingest, store and process very large data sets;

• The data layers — where data sources are combined into one environment and access is provided to those who need it;

• The analytics layers — which support different types of frameworks and give you flexibility to incorporate new tools and collaborate; and

• The application layers — which provide the visualization needed to bring results and actionable insights to life.