Category: Population Health
July 11 2016
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Contributing authors:
John Bulger, CMO of population health at Geisinger Health System
Amanda Hammel, vice president of IT operations and population health for Memorial Hermann

The following content is a version of a Cerner sponsored article published in the May/June issue of Healthcare Executive Magazine, a subscription based publication by the American College of Healthcare Executives (ACHE), and republished in the Kansas Chapter.

As health care continues to shift to value-based care, organizations are recognizing the need to transform their current care models. Many organizations are finding success employing strategies to more efficiently address the health of the populations they serve—and technology is playing a vital role.

Geisinger Health System, in Danville, Pa., and Memorial Hermann Health System, in Houston, are two organizations using innovative technology to take their population health management strategies further.

Going Beyond Data Collection
As organizations take on responsibility for larger groups of patients, they need to have a more comprehensive understanding of the populations they serve, particularly as health care costs continue to rise and the cost of care is spread more widely across the care continuum.

“Population health management is a realization that there are many different places that impact the cost of health care—it’s not just about the hospital anymore,” said John Bulger, CMO of population health at Geisinger Health System. “There are cohorts of patients you can target to impact the total cost of care for the entire population, and you really have to have good data about the entire population to actually address that.”

Geisinger’s population health management journey has been in process for many years, according to Bulger. With 11 hospitals across two states, one challenge the organization faced was acquiring data it needed from other organizations to successfully care for the larger population it aimed to serve, including its own 510,000-member health plan.

For help with this process, Geisinger partnered with Cerner in 2015 to leverage HealtheIntentSM, Cerner’s population health platform, as one of Geisinger’s management tools. The platform enables providers to access what Bharat Sutariya, vice president and CMO of population health at Cerner, describes as a longitudinal view of individuals within a care population. HealtheIntent provides a broad summary of an individual’s health and helps identify gaps in care and health trends within a population.

"HealtheIntent provides a set of intelligence that is programmed based on the latest knowledge and evidence,” said Sutariya. “We aggregate, transform and reconcile the data across the care continuum on a unified platform, establishing a longitudinal record for each individual within a population and make meaning out of that data. We then identify and stratify the population by running several predictive modeling algorithms to pinpoint gaps in care.”

Gaining Insight on Consumers
When Memorial Hermann Health System launched its accountable care organization (ACO) in 2012, its goal was to improve quality, reduce costs and provide care to a wider population across the Gulf Coast of Texas.

Memorial Hermann’s ACO, which includes 13 hospitals, has been a successful participant in the Medicare Shared Savings Program, posting shared savings payments in performance years one and two, according to Centers for Medicare & Medicaid Services data. Amanda Hammel, vice president of IT operations and population health for Memorial Hermann, said while the team is proud of that success, it cannot be sustained without innovative technology and tools.

“We did not have all the tools and insight into the population we serve to continue to proactively manage that population,” said Hammel. “To truly change outcomes and reduce costs, we needed more detailed data around a patient or person in our population.”

That need is what led the system to work with Cerner and leverage the HealtheIntent platform. “We have aggregated data from more than 20 source systems, providing us a longitudinal view of the patient and enabling us to then put programs in place to better improve care and quality,” said Hammel.

Being able to see the bigger picture of a patient or the entire population enables the system to focus more closely on the consumer and evolve with their changing needs. “No one knows what the final chapter is on population health management,” said Sutariya. “What we know is the direction is pretty clear and that is a shift from a fee-for-service care delivery model to a more accountable, holistic health and care delivery model. Our clients are excited about the opportunity to have a multipurpose, programmable and scalable platform to meet their current needs and enable them to innovate for decades to come.”

See Bharat Sutariya, vice president and CMO of population health, Cerner and Amanda Hammel, vice president of IT operations and population health, Memorial Hermann Health System, present at Cerner Population Health, July 18-20 in Kansas City, Mo.

Bharat Sutariya,VP and Chief Medical Officer, Population Health Leadership

Bharat Sutariya VP and Chief Medical Officer, Population Health Leadership Cerner

@bsutariya

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