Value based care models are increasing the need for more population health and healthcare analytics
The need to analyze the health outcomes of a group of individuals, including the distribution of such outcomes within the group becomes more necessary to help make better decisions on quality of care. The groups that are will have the most data available are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors.
Population Health aims to improve the health of the population, while recognizing that health outcomes are heavily dependent on multiple determinants of health, including medical care, public health, genetics, behaviors, social factors and environmental factors.
Scope of PHMS
Telliant systems Population Health Management System [PHMS] component, congregates clinical details from EHR, in a decision supportive form, where it can be utilized for better care for patient in health organizations.
All the clinical details of a patient are consumed by PHMS, grouped using a BI tool [Power BI], in turn helps in treating patient in groups and track the health behaviors of patient who falls in high risk categories. PHMS assist an organization to participate in Accountable Care Organization [ACOs] or in other Value based / Pay 4 Performance [P4P] incentive program in the upcoming years.
PHMS has two major sub systems performing Configuration and Pop-Health Analysis. Each Sub Systems has its own fragmentation’s and functions. It is described in below in brief.
Configuration module takes care of Incentive metrics rule creations, Patient Filtering rules, Risk analysis structural rule [of health data], PMPM [Per Member Per Month] cost analysis configuration to be a part of ACO [Accountable Care Organization]. Creating user specific rule permits personalized decision making for health care professionals.
Pop-Health Analysis module plays substantial role in PHMS by analyzing the clinical details using the personalized rule configured by user and deliver the outcome in the form of recommendations along with the graphic representation, aiding professional healthcare practitioners to take better decisions.
Summary of PHMS
Clinical Information process
Clinical and Claim details of patients can be pulled from HER of an organization. PHMS will work as an independent web component, where only analysis and recommendations are the deliverables, no clinical details will be stored anywhere, so as to ensure HIPAA compliance.
Patient Filter, Risk Analysis, PMPM [Per Member Per Month] rules configured in rules engine will be used as a basis for analysis of Clinical details. The clinical details extracted from EHR will be filtered depending up on the need of health professionals to take better decisions. The filtered patient clinical details will be represented graphically [ any suitable form] with the help of BI tool [say Power BI].
PHMS receives the Patient filtered details, with the created rule as basis, it will analyze and segregate the patients. To one side the improvement in care quality plays its role in deriving the metrics, the reduction in cost of care equally plays significant role in the derivation of metrics the other side. PMPM [Per Member Per Month] cost analysis need to be communicated along with risk details to the ACO for incentive participation. Cost analysis will be made using the claim details along with organizational cost incurred.
Recommendation sub-system utilizes the risk analysis outcomes along with BI tool outcomes to recommend the treatment for segregated patients depending up on the clinical parameters, specialty,