Osler Health accepted data as a health care tool early on but ran into roadblocks with an analytics platform. Find out what Osler is now doing to discover actionable insights to meet the needs of triple aim.
Treating tens of thousands of people one at a time takes a great leap in technology. One measure of success is sophistication. When technology becomes really sophisticated, it becomes easy to use.
Since the founding of Osler Health in 2013, our leaders have focused on managing healthcare by endeavoring to use sophisticated technology to make sense of various health care data assets. Founder and Chairman, Dr. Tom Bellavia, recognized physicians couldn’t accomplish population health management or meet the Triple Aim without converting data into usable information. “We had to move from a one-on-one patient model to take care of populations at the same time without losing the personal touch. You could never do that with paper charts and without the advent of new technology,” said Bellavia. We also realized many physicians were confused and overwhelmed by sheer volume of their data and complex reports.
It's hard to take a mountain of data and create actionable, impactful tasks, and then get them into the right hands. Osler has made great progress toward data sophistication.
Ron Manke, Chief Operating Officer and Vice President of Provider Support, explained Osler has 20 quality measures across five contracts covering 86,000 attributed lives. For a while, Osler issued care gap reports based on common measures across payers. They delivered a separate report for each payer. For example, a physician might receive one report listing patients covered by payer A in need of a mammogram and a separate report for patients covered by payer B in need of a mammogram. “So we got rid of all that and said here's one list broken out by insurer - one list of patients who need mammography. Here's one list of diabetics. Here's one list of patients who need eye exams,” said Manke. “That alone has just really improved the physicians’ world so that they can just run down one list,” said Manke.
Making reports actionable
Even with consolidated reports, we realized physicians don’t always have time to dig through results. But we found they do have time to fit a familiar task into their workflow. So we changed the reports. We now include the task they need to perform. That could include scheduling an evaluation of a patient identified as high risk through the use of predictive analytics. What we're really doing is taking this information in these reports and making the doctor more effective. Rather than just seeing a string of random patients who come in, what they're doing is they're treating people who need treatment the most at the right time. If we catch one out of ten that saves us a hundred thousand dollars of acute episode or hospitalization, it is paying for itself in dollars and quality of life.
Need for integrated data, robust analytics
Despite these advances, we encountered limitations in the analysis of our data. “Our previous platform didn't allow us to drill into the specialty care, see site of service or dive deeper into pharmacy cost. The better we got, the more inadequate the platform,” said Manke. To gain a more comprehensive view of each patient, provider, and facility, as well as the entire population and health network, we realized a need to combine clinical and claims data with additional data sources like social determinants of health and behavioral health. We also found we needed advanced analytics to be able to identify opportunities and patterns, confidently predict clinical and financial risk, then prioritize and coordinate the actions physicians could take to improve future outcomes.
To meet these needs, we chose Optum analytics solutions and we are in the process of launching the new platform. Manke says the platform – which is infused with OptumIQ, the unique combination of Optum data and analytics and health care industry expertise – will make a difference. “Now, we will not only be able to see gaps and care, but we will be able to see our high utilizers. We will be able to spot trends and see where money is being spent,” said Manke. We expect Optum analytics solutions to track and deliver information on the outcomes achieved and costs accrued by specialists to help guide referral strategies. We are also looking forward to utilizing the same predictive models and methods that 20 of the top 25 health plans rely on to forecast cost and risk.
“There won’t be discrepancies,” said Manke. “We're going to have exactly what the insurer has and we will be able to deliver that directly to our physician owners so that we perform the best we can in this value-based program.”
We needed something that would scale for the next five to ten years, and Optum was the only platform that we felt could elevate our needs today and keep us in the game tomorrow. This is all about investing in the right patient care proactively by empowering primary care physicians to be clinical managers from their present role as service providers, a giant leap ahead of todays’ fragmented, reactive system. We don’t measure success in dollars saved, we measure it in health crises avoided. Sharing savings with insurers funds the process, and everyone wins.
James Doulgeris is a founder and the Chief Executive Officer of New Jersey-based Osler Health, a physician association (IPA) and accountable care organization (ACO) with 125 primary care physicians in 27 practices at 63 different locations.