Toward Accountable Payment

Update from the Symposium: Harnessing Data and Analytics for Population Health

Our final panel of the National Population Health Symposium addressed what is perhaps the newest uber-question in health care: how do I harness data and analytics to drive my population health efforts? Attendees were lucky enough to hear from the country’s first chief technology officer, Aneesh Chopra; the national coordinator for health information technology at HHS, Dr. Farzad Mostashari; the CEO of MHMD Memorial Hermann Physician Network, Christopher Lloyd; and the executive director of the Greater Baltimore Health Alliance, Colin Ward.

Dr. Farzad Mostashari

Dr. Mostashari—the Symposium’s funniest panelist—started by pinpointing providers' greatest challenge making changes in health care: "finding the signal for the noise." Health care data has proliferated rapidly, and different stakeholders value different metrics; providers struggle to identify metrics that are easy to track and universally respected.

Dr. Mostashari offered some sage, if unexpected, advice to providers: “Focus on what kills people.” (Dr. Lisa Bielamowicz gave similar advice earlier this year.) Specifically, he pointed to the “ABCS” of care management: aspirin, blood pressure, cholesterol, and smoking cessation.

Dr. Mostashari also challenged the providers in the room, asking, “how many of you can make a list of your patients?” He pointed out that as panels grow (and as patient movement between providers increases), this task grows harder—not to mention actually making an impact with these patients. According to Dr. Mostashari, diabetes patients who do not take a statin have a 50% higher death rate in three years than those who take one. Kaiser Permanente has gotten 9 out of 10 diabetes patients to take a statin; the average provider succeeds with just 4 out of 10 patients. 

His recommendations for turning this trend around are easier said than done. There are three steps:

  • Get them to come in
  • Don't let them leave without a prescription
  • Get them to take the pill

According to Dr. Mostashari, as challenging as this is, it is the single best approach to transforming patient outcomes.

Memorial Hermann Physician Network

Chris Lloyd spoke from his perspective as the leader an organization with significant experience operating as an ACO, and he told attendees that as you get deeper into population health, your data needs only grow more intense.

With data both in very high demand and increasingly complex, IT governance plays an important role in managing and harnessing these data. Lloyd told attendees that organizations must develop clear protocols for what data is available, who has access to it, and how that data is disseminated. These guardrails include both qualitative protocols, which each organization must develop in concert with its needs, and technical things like firewalls and encryption mechanisms. This is as important for securing physician buy-in as it is for complying with HIPAA.

Greater Baltimore Health Alliance

The Greater Baltimore Health Alliance has made a name for itself by tracking one of the most challenging metrics out there: where are patients now? According to executive director Colin Ward, so often we lose data on which provider a patient saw last, whether they’ve been admitted or discharged, and where they are at this moment. This lack of knowledge can prevent providers from taking the crucial steps to avert an ED visit.

GBHA’s central product is called Chesapeake Regional Information System for Our Patients (CRISP), and it enables regional providers in and around Baltimore to track patients through the system of providers.

Through CRISP, transition coordinators now have the ability to follow up with patients and direct them to a primary site of care before the patient winds up back in the ED. CRISP has helped simplify the process of managing at-risk patients, and has connected the network of Baltimore providers in service to these patients.