Information technology is radically changing business models by making it possible to measure things in a way that was never before possible. One industry undergoing radical change is health care.
“Today, most health care services deal with utilization practices,” says Raza Pasha, M.D., interim chief medical officer of Altus Accountable Care Entity (ACE). “However, we’re introducing value-based medicine, including a more robust preventative model, to reward efforts and keep patients healthy, rather than simply treating pathologies.”
Altus ACE (part of the Altus Health System network), is positioning itself on the leading edge of value-based medicine. It hopes to revolutionize the industry by putting data to work in ways that would have been impossible only a few years ago—and making the resulting information actionable.
The Houston-based accountable care organization (ACO) strives to deliver value-based services to Medicare and Medicaid patients by leveraging a partner firm, Virtual Health, to implement cross-EMR (electronic medical record) integration and real-time collaboration across interdisciplinary care teams, including those outside the physician’s office.
By utilizing Virtual Health’s data-driven population health management platform, Altus ACE will introduce a broad-based set of tools spanning the entire health care continuum. This includes dashboards and alerts that allow the organization to proactively manage both clinical and behavioral needs for a diverse and complex population.
Replacing Ineffective Legacy Systems
The approach relies on a variety of information technology tools and solutions, including clouds, APIs, business intelligence and predictive analytics. The end goal is to replace ineffective legacy systems and information silos with a single value-based ecosystem that revolves heavily on analytics and metrics.
“We have introduced an entirely new layer of technology that sits atop an electronic medical record,” Pasha explains. “One of the problems with EMRs is that a lot of the data that doctors enter is hidden and inaccessible. The ability to pull data in a more comprehensive way changes everything.”
For example, Medicare Advantage programs have different requirements for diabetes patients than Medicare ACA programs. Altus ACE has designed its system to connect to electronic medical records and pull the appropriate data for the plan. If the system identifies a medical issue, such as a patient not obtaining a specific test that’s required, it can alert a physician, who can then take action and follow up with the patient.
“This type of tracking and flagging has not been available in the past,” Pasha says. “Moving forward, the health care system must do a better job of keeping an eye out for patient populations and subsets of these groups.”
To be sure, Altus ACE’s strategy of dispensing value-based care means understanding data and relationships in far more detail and greater context. This would include the primary and secondary diagnoses, what medications a patient takes, what allergies the person has and more, he explains. It also translates into understanding how medical outcomes intersect with behavioral issues, social factors and different communication approaches.
“There is a whole array of issues and factors that extend into medicine but also go beyond the doctor’s office,” Pasha points out. “The goal is to make health care more efficient and cost-effective, while delivering the best possible results for our patients.”