"You want to look at those patients who are in the ambulatory [setting] all the time and understand how they become part of the ambulatory metrics. You also want to focus on those with diabetes, and to follow the patients with high blood pressure to make sure that these patients aren't developing worse problems," says Hopkins. "You need to look at all the data, but getting it can be a bit challenging."
Armstrong agrees that information sharing isn't usually due to a lack of willingness, but disparate IT systems. At the beginning of their PHM program, QualChoice was tracking patient populations manually and providing monthly progress reports (with month-old data) to the providers. Not an ideal scenario for those hoping to catch patient problems in the early stages. To help aggregate data for comparison and improve care-related communications between the payers and providers, this year QualChoice installed an integrated care management system from Trizetto.
QualChoice is hoping the new system, which automates the process of managing members' chronic illnesses as well as the continuum of care including case, disease, and utilization management, will allow it to use clinical resources more effectively, explains Armstrong.
"As we pioneer our program, we have to help the practices get accurate, on-time information about the patients," he says. "This [technology] delivers information about the members so that we can all spot the gaps in care. You can see when a patient is admitted and discharged; you can coordinate labs and put flags in the system. Now we can get the providers the information in real-time, so we can all work better together."
For CFOs, charged with protecting the financial best interests of their organizations, it's vital to recognize the role PHM can play in cost reduction efforts. Only by working together can the different entities of the healthcare industry reduce costs, achieve healthy balance sheets, and foster a healthier population.