April 18 2012
Moving beyond episodic care: Managing the health of populations
Earlier today, we announced a
collaboration with Advocate Health
Care, the Midwest’s largest health system and one of the top health systems
in the country, based on clinical performance. Working with Advocate, we’ll
develop models that help predict adverse outcomes before they occur – leading
to earlier interventions and helping to improve the health of Advocate’s
patient population across the continuum of care.
We had a chance to speak with Advocate’s Dr. Rishi Sikka, vice
president, clinical transformation, and Tina
Esposito, director, Center for Health Information Services, about
population health and why it’s an important topic in health care right now, the
goals of this partnership and the impact it will have on their community.
Why focus this partnership on
population health? Why is this topic important right now?
Dr. Rishi Sikka: Traditionally
the American health care sector has focused on episodes of care. As we move into delivering better value,
which means delivering exceptional quality and an exceptional experience as
efficiently as possible while managing our costs, we no longer can manage by
episodes. We have to manage across the continuum of a patient’s experience, not
just the experience in a hospital and focus on a patient’s health throughout
their lifetime. Managing population health is central to solving some of the
fundamental issues the health system in our country is facing.
Tina Esposito: In terms of
best supporting our patients, you have to look at care more holistically,
ensuring that we’re following our patients across care settings and improving
their outcomes regardless of where we see them.
What are the goals of this partnership?
TE: Our goals are to best
leverage the information we have to enhance our patient outcomes. There will be
a key focus around predictive analytics so we can make interventions early and
ultimately improve health outcomes.
RS: The goals are
patient-centric. It’s about improving the care we deliver our patients
throughout the continuum.
How do we move beyond simply
capturing health data in the EHR? How does this project represent the next step
in utilizing health data to drive improvements in health and care?
TE: The goal is to make the
data more meaningful. We’re capturing all this data, but now what we are trying
to do is leverage it to help improve outcomes.
How important is system
interoperability to the success of this project?
TE: Interoperability is
foundational. If the data is not integrated, you are not able to gain the insight
we are in search of, such as understanding the care across the care continuum.
It’s a cornerstone to support modeling and analytics.
Why is it important to capture
information across the entire continuum of care (ambulatory, acute and post-acute)?
RS: For us to really manage
a population’s health, we need to know what’s going on through the lifetime of
the care experience. The only way to understand this is to take away the focus
on episodic care and construct a whole picture of what that patient is going
through. You have to consider their experiences in the hospital, in an
ambulatory care setting and in a post-acute setting. You have to break down
those silos that exist and bring the information together into one place. Once
the data is all in one place, we can work on the analytics and modeling that
will drive improvements in a patient’s care.
What benefits will accurate
predictive models provide in health care?
RS: We hope we can develop
models that predict events before they occur, and that’s really powerful. To be
able to predict a patient who might fall and intervene before they do, to
intervene on a patient who would be readmitted before they are, to predict what
complication a patient might develop from a chronic disease and focus on that
and prevent it from happening, those are all very powerful examples. It allows
a more proactive approach when caring for a patient.
How will this project change the
culture of how you deliver care?
TE: This will help us work
better together to ensure we are addressing population health issues. It’s about
integrating all the venues of care, whether that is the hospital, doctor’s
office or home care.
RS: Patients will see that
we have a dedication to keeping them healthy, and we will have resources and
tools geared towards that ultimate goal.