The Partners Healthcare Center For Connected Health deployed analytics tools to examine and classify patients coming through the system from 2010 through 2015. Using a technique called an acuity pyramid, the executives placed patients into three tiers and found big opportunities in the largest group, which it had not previously focused as much on, according to Partners’ senior director of connected health innovation Kamal Jethwani.

Four percent of patients fell into the top tier of the pyramid. These patients required the most care and were the most expensive to treat. Doing an exceptional job managing these patients offers the potential to save quite a bit of money. Forty-five percent of patients fell into the bottom tier of the pyramid. These patients cost the least amount per patient to care for. Still, because of the sheer number of patients here, the total costs are significant.

The remaining 51 percent of patients, the majority, fell into the middle tier of the pyramid. These patients have chronic illnesses or mental health issues, for example, that are fairly well managed but perhaps not extremely well managed.

Here’s the twist: Partners learned a valuable lesson in population health management from this middle-tier.

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“When you look at 2015 in a static fashion, you will gravitate toward working with the sickest at the top of the pyramid, many hospitals do that,” Jethwani said. “If you look at the pyramid in a static manner, you think, if I can just get these patients better, I can save a lot of money. But when you look dynamically from year to year, a lot of the patients at the top ultimately fall down into the middle bucket and a lot of patients in the middle bucket go to the top. So even though working on the top 4 percent of patients makes sense for this year, it makes no sense for next year. The question becomes: What if I could intervene with the middle bucket this year so they do not wind up in the top bucket next year?”

The team examined cost data from 2010 through 2015, studying the same cohort of patients going through the health system, and compared what happened with patients from one year to the next.

“We showed how these patients moved from one risk level to another risk level over the years and the financial consequences,” Jethwani explained. “That led us to understand that we needed to focus on the middle tier, which untreated can lead to spending a lot of money. We needed to divert our attention toward better management in the middle bucket. These are people with longstanding chronic illnesses, people with mental health issues, people who have had two or more chronic illnesses for five years who are fairly well managed but not well managed.”

As the healthcare organization starts thinking about strategies to take better care of the chronic illnesses of patients in the middle tier of the acuity pyramid, the better the organization gets at treating these illnesses and, subsequently, the lower the chance middle-tier patients will shift to the top tier and become more expensive patients in the years ahead, he added.

“Interventions by the organization here enable patients to take better care of their chronic illnesses and stay well controlled and well managed so you prevent them from becoming more expensive,” Jethwani said.

Jethwani will discuss the acuity pyramid and other population health strategies at the HIMSS and Healthcare IT News Pop Health Forum in April in a session entitled “Bringing the Power of Predictive Analytics to the Highest Cost Patients.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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