In a way, population health combines the best in modern medicine with the best in premodern medicine. We’re not talking about merging proteomic advances with the bleeding of foul humours. Rather, to grasp the value of population health, consider the small-town doctor making house calls a century or so ago – or at least an idealized notion of him.
He had known his patients since he had delivered them. He knew if a patient who came in with a bad cough also had diabetes or had slipped off a ladder a few years back and had never been quite the same. He knew, in short, the sum total of everyone in town’s medical history. He could combine that knowledge with his medical acumen and come up with a fitting response to whatever the ailment for the patient at hand was – or at least as fitting as the medical standards of the day allowed.
Population health aims to inject the deep perspective of a small-town doctor into the modern medical context. Though the name hints otherwise, the individual patient is population health’s big winner.
Population health empowers customized, appropriate, context-rich care right when it’s needed. To enable that today, when countless patients move among doctors, hospitals, clinics, specialists, pharmacies and insurers, one needs some analog to the small-town doctor’s accumulated knowledge. It’s called data, and UCHealth is taking a huge step toward putting untapped troves of data to work for patients, doctors and the health care system in general.
That step involves bringing payer claims data – data that clinics, hospitals, pharmacies and other health care providers send to insurers when they want to be paid for products and services rendered – into clinical decision making using a newly acquired software package called Stratus. In the coming months, 36 UCHealth primary care clinics will start using Stratus, developed by Boston, Mass.-based Best Doctors, Inc.
What does Stratus have to do with the small-town doctor of old? UCHealth already has an acclaimed electronic health record, called Epic. With Epic, providers get an instantaneous, detailed view of an existing patient’s medical history as it unfolded from anywhere within the UCHealth system’s many clinics and hospitals. But Epic is not magic. It may not present the full history of a patient that, say, recently moved to Denver from Topeka – or changed jobs (and insurers) locally, or aged into Medicare and switched doctors. There are lots of ways patient data can evade Epic.
Claims data fills the gaps
Health care experts have long recognized that payer claims data would be a good way to fill out a patient’s history and improve care. It was a matter of collecting it all and presenting it in meaningful ways – given massive transaction volumes and diverse data formats, a massive undertaking. Stratus proved it was up to the task during the federal Comprehensive Primary Care Initiative (CPC), in which three UCHealth clinics participated. (Stratus’s extension to 33 additional UCHealth, CU Medicine, and Associates in Family Medicine primary care clinics is part of CPC’s follow-on Comprehensive Primary Care Plus (CPC+) program.)
“With claims data, you have a truly full view of everywhere the patient went, every service they received, every diagnosis they were given,” said Charles Baumgart, MD, UCHealth’s chief medical officer for population health. “That’s why claims data from payers is, at this point, very key data.”
Stratus amasses claims data from seven Colorado insurers (Anthem Blue Cross and Blue Shield, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Rocky Mountain Health Plans, and UnitedHealthcare). The data will not be perfect. Unlike a patient record in Epic, which updates across UCHealth the moment a clinician adds to it, there’s a time lag that can extend 90 days or longer, Baumgart said. There’s also less detail than in Epic. With claims data, he said, “You get a diagnosis and a billing code,” whereas the Epic record contains details such as blood glucose levels, lab results, blood pressure, even economic, social or transportation issues that can impact care.
So the goal, says Baumgart, is to combine the depth of Epic with the breadth of Stratus, all from within the Epic system UCHealth clinicians know so well, thereby offering richer context for treating each individual patient over time.
“It is indispensable to getting away from episodic care,” Baumgart said.
What’s more, Stratus’s ability to access troves of data across insurers promises new ways to improve care for certain patient populations – population health’s calling card. Baumgart gave the example of a clinic whose patients are visiting emergency departments more than would be expected. Through Stratus, a physician can request the diagnoses associated with those visits, and then narrow them down to conditions such as colds, urinary tract infections and skin infections which, if treated properly in primary care clinics, can keep people out of emergency departments and inpatient rooms. The clinic can then reach out to these patients to understand what led them to emergency care and explain how the clinic can help them better manage their health.
Stratus is no more magic than Epic, of course. First, its success will depend on the hard work of systems integration and sifting through ores of raw data to deliver the informational gems a nurse or doctor in clinic a) wants and b) can quickly apply to better care decisions for patients and populations of them. Second, the clinics themselves must adapt so as not to waste Stratus’s potential bounty. Otherwise, Baumgart said, “It will make for a great dust collector.”
Jean Haynes, UCHealth’s chief population health officer and the driving force behind bringing Stratus to UCHealth, isn’t about to let that happen. There’s too much to be gained: providers win better insights into each patient’s medical status and history and can also spot health trends in the aggregate; patients avoid unnecessary tests and procedures and enjoy more tailored care, she said.
“This enables us for the first time to have an aggregation of claims and clinical data for our patients and providers at the point of care, period,” Haynes said. “I am passionate about this.”