More performance-based contracting means more responsibility for population health management for provider organizations. The challenge? Rapid management decisions are central to successful population health management. And this requires integrating clinical, financial, and administrative data in ways that distill information to provide insight for management. This is a data system that goes beyond a electronic health recordkeeping system – adding a data analytics platform and decision support tools. (For more, see Decision Support In The Emerging Pay-For-Value World: An Essential Element Of Market Place Success and No Decision Support Tools? You’re Not Alone).
Two weeks ago at The 2015 OPEN MINDS Strategy & Innovation Institute, in the session, Best Practice Population Health Management: Achieving The Triple Aim By Moving Decision Support To Provider Organizations, I had the opportunity to learn more about two existing applications of decision support tools to population health management.
The first was the Improving Medication Prescribing and Outcomes Via Medical Education (IMPRxOVE) program, in Manitoba, Canada – which is focused on the reduction of the inappropriate use of prescription drugs. The program’s use of decision support tools was presented by Dan Chateau, Ph.D., Research Scientist & Assistant Professor, Manitoba Centre for Health Policy, University of Manitoba. The program reviews Drug Program Information Network (DPIN) pharmacy claims data to evaluate the quality and appropriateness of the prescriptions. Potentially risky prescriptions trigger an audit-and-feedback-based mailing intervention with the prescriber. That intervention was found to influence physicians to have better prescribing practices and limit the number of physicians that engaged in really poor prescribing practices.
The second case study was the use of decision support in the management of East Carolina Behavioral Health. The session, presented by Michael E. Smith, MD, Chief Medical Officer and Jackie Fedash Beck, Medicaid Contract Manager, outlined how East Carolina Behavioral Health (now known as Trillium Health Resources) uses decision support tools to push clinical management information to their providers. The decision support tool, Care Management Technologies’ ProAct Tool; allows forecasting and predictive measures for agency planning; monitoring of evidence-based practices; monitoring of fiduciary investments to insure appropriate utilization of Medicaid monies; and monitoring of internal benchmarks and productivity.
Dr. Smith and Ms. Beck noted this had led to decreased cost of services (by utilizing the appropriate service), decreased hospital and ED admissions by utilizing predictive measures, enhanced consistency, and better care quality.
The use of decision support tools at the provider organization management team level will increase – by necessity. The question will be what management teams have organized their existing data in ways that provide competitive advantage. For more, check out the white paper, Decision Support In The Emerging Pay-For-Value World: An Essential Element Of Market Place Success, by Care Management Technologies (CMT).