Shared by Dr. Jerry Osband, Former Chief Medical Officer for EXL and Member of the Impresiv Health Executive Advisory Board
Population health management (PHM) can significantly enhance clinical, financial, and administrative outcomes by improving care coordination and fostering patient engagement through effective economic, care support, and technology processes. A well-executed PHM program is designed to reduce healthcare costs while optimizing clinical outcomes.
As part of Impresiv Health's ongoing series on PHM basics, we've discussed foundational concepts and data acquisition and stewardship. This review will delve into identification and stratification (ID&S) strategies, which are crucial for identifying and categorizing candidates who would benefit most from impactful care coordination programs.
In the early use of PHM programs, ID&S capabilities relied on traditional data sources for consumer and population recognition for engagement. Initially, claims files, laboratory results, basic health assessments, and pharmacy information were integrated into the original software programs or even on spreadsheets to develop risk assessments for those at the greatest potential for high-cost care and/or higher utilization for in-patient hospitalization and ER visits.
Basic risk scoring and stratification outputs were not integrated into care management software, nor was there a risk-based 360-degree member view. These first-generation ID&S scores were contributory to resource-intensive telephonic engagement strategies with low percentage enrollment and engagement in PHM programs.
Low participation reflected the lack of socio-economic, care barrier information or readiness to change insight included in the scoring analysis. The resulting ROI in initial programs was difficult to determine, and key success metrics demonstrated low participation among identified members.
To take full advantage of newly developed PHM programs, healthcare organizations need to move from the initial risk scoring to state-of-the-art analytics and reporting for full ID&S functionality. As described in our previous blog, data acquisition needs to incorporate not only claims, pharmacy, and lab inputs but also in-depth assessments, digital device data, EHR integrations, social determinants of health, personalized barriers to care information, and health equity evaluations.
Now, using AI and machine learning tools, new software applications can synthesize highly personalized insights into real-time scoring to identify members at various risk levels of interventional need and adjust the scoring to reflect the “engagement impactability” of the potential participant(s). Impactability is a measure of the participants’ interest in program motivation and readiness to change while incorporating hierarchal factors in reducing barriers to care to expedite interventions and outcomes.
The resulting scoring insights should not be used solely as an API function. The output should be fully integrated into care management software and CRM platforms for care coordination and gaps in care closure. The software analytics scores should provide more definitive insights into digital communication preferences to direct interventional services, appointment scheduling and program benefits.
Impactability scores inclusive of SDoH and Health Equity information will significantly improve health care organizations use of care management resources and enhance overall program involvement by those at risk.
The ongoing complexity of data analytics and reporting for ID&S will only increase, especially as AI and MLR functionalities evolve, social determinants become more relevant, and digital communications and EHR integrations become commonplace. Healthcare organizations will need to evaluate technologies that provide state-of-the-art PHM risk scoring. Impresiv Health can help your organization evaluate and implement risk scoring for ID&S and impactability by thoroughly evaluating the status and future needs for an effective PHM program.
Get in touch with Dr. Jerry Osband, part of our Executive Advisory Board: josband@impresivhealth.com