Population health insights

Scaling care management while activating patients and providers

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Jun 05, 2018

The more we work with health systems on integrating technologies fitting their needs, the more we understand the core elements of successfully merging scale, cost and quality.


And it’s no surprise that success requires a balance of technology and stakeholder buy in. And by stakeholders I mean patients and providers.


Care management is the blueprint for success. The strategies within it are what is the right process and how will it scale. How will it; not how can it or should it. As systems expand their footprint or join an ACO, for example, scaling care management is required, additional patients need to be activated and providers should not fear either.


And in this era of cost and quality, all patients – regardless of condition – need to be identified, stratified and reached out to.


Doing this effectively – and this is where provider buy-in or activation is key – means a focus on workflows and visualization at the point of care. That’s how data management can turn into actionable insights toward proactive and preventive care.


Within the care management process, there’s key elements to pursue:

  • Leverage a centralized approach – It’s hard to scale without it.
  • Automatically see patient alerts, care or coding gaps and payment model assignment within the EHR during appointments – read more about this integration here.
  • Fine tune and own referral management – here’s more on helping patients find quality care throughout their continuum that can be tracked and coordinated toward repeating best practices upon follow up care or the next visit, while impacting the system’s financial sustainability as well. Here too provider workflows can be enhanced.

Why not close care gaps before they become care gaps, and give providers more automated and workflow-centric tools with data insights sharable with care team members.


Sounds easy, right? Well, it is a process, and again I’ll emphasize a centralized approach. As we aggregate data from disparate EHRs within a health system, risk stratify patients, set up alert algorithms and outreach, it’s common for us to conduct about five billion data transactions per month.


That means finding a technology partner with a lot of experience, and yes, one that has its own ability to scale.

Scaling patient activation

For the patient, multiple outreach mechanisms are needed along with assigned care managers. To really activate patients to take a more direct approach to levels of self-management, home health solutions matched to those needs and individual conditions are a growing core approach.


Home health is taking on many forms, with each approach offering connected data to the provider and care team. This is also how care management can scale.


Remote monitoring, telehealth and in-home medication adherence are emerging examples we are also integrating into health systems. Technology that can scale in the office must also scale in the home or at other delivery sites, and make data available.


If you’re watching the policy/incentive trends, you know that patient-generated health data, application programming interfaces and third-party apps are moving toward mandatory capabilities within CMS ambulatory and hospital rules, and within ONC interoperability roadmaps and its impending data blocking rule. At the same time, Apple is integrating EHR data into consumer devices, and hospitals are being told to find ways to make EHR data available to patients upon discharge.


Offer financial incentives to all assigned beneficiaries who undergo qualifying primary care services.

Telemedicine as common ground

Scaling care management can help merge with patient and provider activation. Telehealth is a good example.


Surveys show us that patients are willing, and likewise providers are too, as long as they can get properly reimbursed.


Reimbursement is expanding, and tipping points are nearing. And if the entire landscape of telehealth benefits and reimbursements are reviewed, there’s plenty to be encouraged about.

  • The same Bipartisan Budget Act will allow Medicare Advantage plans to offer telehealth as a covered benefit, though beginning in 2020.
  • Beginning in 2019, former originating site rules for ESRD and stroke telehealth take hold and provide a visit fee.
  • At this writing, there are more than 50 bills in Congress addressing the opioid crisis. A common denominator is expanded telehealth. Similarly, there are separately a dozen or so bills percolating specific to telehealth expansion.
  • This year also saw expanded telehealth reimbursement codes within the CMS physician fee schedule, though still limited by originating site restrictions. New areas include counselling for lung screening, psychotherapy, interaction complexity, health risk assessment and CCM assessment/care planning.

From ground zeros to comprehensive

Once these essentials are configured to provider workflows and efficiencies – and to patient needs lending to activation – health systems can seek ways to expand data points and delivery structures to bring in other care management resources and processes.


Other specific and scalable processes can incorporate social determinants of health or value-based insurance design models, be it for rising risk populations, keeping the healthy, healthy, or of course for chronic care management.

As a vendor partner that offers very specific technology solutions to meet very specific needs, or as one that can provide a comprehensive, end-to-end platform, we’ve seen that scaling care management and activating providers and patients are obtainable, sustainable goals.


Goals that will continue to lend toward making internally strategic and ROI-driven inroads into value-based care models regardless of payer.

About the author

Niki Buchanan
Niki Buchanan, 
General Manager & Business Leader, Philips
Niki Buchanan is General Manager & Business Leader for Philips PHM. A dynamic and versatile healthcare executive, Niki uses her distinctive customer satisfaction and product optimization methodology to lead improvements across the Health IT spectrum.

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