What will it take to control healthcare costs and provide better patient care?
When Dr. Don Hall launched Wellsource nearly 40 years ago, he already knew there was more to managing healthcare costs than just looking at biometrics and claims data. As the wellness industry has evolved, more organizations recognize this approach to manage healthcare costs and patient outcomes.
Instead of just looking at claims or biometric data, information technology solutions may hold the key to improving population health management, says Dr. Adrian Zai, Clinical Director of Population Informatics at Massachusetts General Hospital.
He recently spoke at the Big Data and Healthcare Analytics Forum hosted by the Healthcare Information and Management Systems Society.
In 2016, healthcare costs in the United States will surpass $3.2 trillion, according to a National Health Expenditure report. To put that in perspective, it means healthcare now costs about $10,000 per person. And rising costs are expected to continue.
So how can we reverse the trend, or at least keep costs from rising?
“When an organization only looks at healthcare claims or biometric data to evaluate population health, the data doesn’t account for other lifestyle factors that could lead to chronic disease and higher healthcare costs,” says Wellsource Director of Health and Research Dr. Joe Raphael. “A comprehensive health risk assessment that evaluates lifestyle behaviors and socioeconomic influences is one way to identify health risk factors that go beyond the typical approach used in the industry. This gives a more complete picture of an individual’s health.”
And Zai agrees. Part of the problem linked to controlling healthcare costs may be linked to the outdated model for managing population health. Many organizations still rely on claims and biometric data to manage population health. But it’s not an accurate representation for true population health.
“One of the big tasks that we had to deal with [at Massachusetts General Hosptial] is to really get away from how population health used to be defined by payors,” says Zai. “Payers really encompass about one-third of the population we’re responsible for. So changing how we define population health was critical.”
At Massachusetts General, expanding the definition of population health to include people with no insurance, and people covered by employer health plans, private health plans, Medicare, and Medicaid, has provided a more accurate picture of population health and helped drive changes in how care is provided.
“By doing this, we’ve been using predictive analytics very significantly in many ways,” says Zai
For example, the expanded view of population health data has helped Massachusetts General identify:
- Patients most likely to get readmitted within 30 days
- Critical care patients with a primary discharge of heart failure
- Likeliness a patient will not show up for appointments
You can't find this information in biometric data or healthcare claims. But it’s helped Massachusetts General make significant changes to improve patient care and efficiency for healthcare providers.
And it’s an indicator that leveraging information technology and data analytics may be the key to improving population health management.
What data does your organization use to measure population health?