Orchestrating Value

Population Health in the Digital Age

Pam Arlotto, Susan Irby

• Publisher: Productivity Press
• Year: 2020
• Print ISBN: 9781138367913
• eBook ISBN: 9780429770142
• Topic: Medicine
• Subtopic: Business General

Orchestrating Value: Population Health in the Digital Age focuses on the leadership thinking and mindset changes needed to transition from brick and mortar healthcare to digital health and connected care. The fourth industrial revolution, with convergent disruptions in biology, business models, computer science, and culture, has the potential to transform the healthcare system like never before. Digital health startups, Big Tech and progressive health systems will change the way health and healthcare are delivered to increasingly digitally savvy consumers. This book challenges readers to rethink the role of data and technology in creating and designing the future. Rather than hooking value-based care and population health management onto traditional healthcare business models, it focuses on the emergence of digital ecosystems.

Using the analogy of an orchestra, the book introduces the importance of platforms in the formation of communities and markets with network effects to allow participants to collaborate, create, and innovate. With quotes from healthcare industry leaders and change agents, it helps the strategist understand the three stages of the transition from volume to value. As conductor of the orchestra, the CEO must navigate important leadership pivots to move beyond silo-based thinking.

Finally, the Care Management Platform is described as a new operating model for population health in the digital age. As the next generation beyond foundational EHRs, capabilities such as interoperability, analytics, care management and patient/consumer engagement will fundamentally change the way healthcare enterprises operate and deliver value to customers.

The Care Management Platform III

The big-picture reason that a lot of these tech companies are getting into health care now is because the market is too big, too important and much too personal to their users for them to ignore.

John Prendergass, associate director of Health Care Investment at Ben Franklin Technology Partners, a nonprofit organization in Philadelphia

New Platforms, New Services

As the authors were putting the final touches on this book in late September 2019, Amazon unveiled a virtual care platform, dubbed Amazon Care, to bring telemedicine services to some of its Seattle-based employees. Amazon Care lets users chat, video call, or receive an in-person visit from a Mobile Care nurse seven days a week through a partnership with Washington state-based Oasis Medical Group. The service also offers two-hour prescription delivery for many prescriptions—a service that could potentially be bolstered by Amazon’s $750 million acquisition of digital pharmacy startup PillPack. While Amazon Care is currently restricted to Amazon employees, it seems likely that it’s destined for expansion to the general public, based on Amazon’s decidedly consumer-facing release. And with over 100 million Prime members in the United States alone, the company possesses a solid launching pad for the new service.¹

Indu Subaiya, MD, MBA, cofounder and president of Catalyst @ Health 2.0 and senior advisor to the Healthcare Information and Management Systems Society, indicates: “We’re really excited about new approaches to health with tailored, outcome-based platforms. There’s this phrase ‘health happens everywhere’ which is the idea that providers have to find new ways to partner outside their own walls, because care needs to be delivered wherever people are.”² Multiple value propositions will be addressed through platform-driven business and operating models. Examples are illustrated in Figure III.1.

Figure III.1 Platform business and operating models.

Multiple opportunities exist to reinvent broad swaths of the healthcare industry. Examples include but are not limited to

• Disease treatment and therapeutics: Interventions, treatment, or the management of a specific clinical condition
• Clinical decision support and precision medicine: Augmenting clinical decision making with continuous clinical intelligence, predictive, and prescriptive analytics to support the care process
• Fitness and wellness: Supports healthy behaviors, including fitness, nutrition, and sleep
• Disease monitoring: Remote or wearable technology that provides ongoing data regarding a specific clinical condition
• Clinical trials and research: Enables administration and management of drug discovery, clinical trial management, and other research and development processes
• On-demand healthcare and social services: Delivers immediate or near-real-time health coaching, physician visits, telemedicine, and social support services
• Care management: Supports population health management and value-based care

Platform business and operating models are relatively new concepts to healthcare delivery organizations. As previously mentioned, the journey to high-value healthcare and development of scale in the transition to 3.0: Digital Health and Connected Care has been difficult with traditional healthcare business and operating models as the core. The chapters in this section will present the concept of the care management platform in detail—its definition, history, capabilities, and future as a potential next step along the journey. Readers should use this framework as a guide and should focus on the portions of this section that impact their own situation.

Notes

1. Hendrickson, Zachary. “Amazon Is Piloting a Virtual Care Platform as the Company’s next Big Step into Healthcare.” Business Insider, September 26, 2019. www.businessinsider.com/amazon-piloting-virtual-care-platform-for-employees-2019-9.

2. “Is the Digital Health Bubble Bursting?” HIMSS, September 4, 2019. www.himss.org/news/digital-health-bubble-bursting-health-20-weighs-in.

Chapter 7

The Care Management Platform, Its Layers and Hubs

A care management platform must sit at a level higher than an individual EMR. It must pull data from every system and be the platform where communication takes place.

Russ Staheli, senior vice president, Population Health & Care Management, Health Catalyst

Purpose

To explore the layers of the care management platform (CMP) and to understand how it supports healthcare delivery organizations in their transition to digital health, connected care, and population health management.

In this chapter, the reader will discover

• The definition of care management
• The layers of the CMP, including foundational systems, health information exchange, knowledge management and analytics, advanced care management, and consumer and patient engagement
• The CMP stakeholders and Jobs-to-be-Done (JTBD)
• From electronic health records (EHRs) and portals to care team– and patient-centric hubs

Defining the Care Management Platform

Patients with complex healthcare needs account for a disproportionately high percentage of our nation’s annual medical expenditures. Care management is defined as a range of activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminating duplication, and helping patients and caregivers more effectively manage health conditions. Across the healthcare industry, these efforts have demonstrated potential to improve quality and control costs for patients with complex conditions.¹ Yet, many organizations struggle to scale or break even using traditional healthcare business and operating models.

The CMP meets the definition of a platform business model described in Chapter 6 and leverages the capabilities of clinical integration networks, accountable care organizations, and community population health initiatives. By providing tools, technologies, information, people, and care processes, the CMP supports the interactions of consumers of health and healthcare, their clinical care teams, and other ecosystem stakeholders. The CMP facilitates powerful new value propositions that extend beyond traditional industry boundaries by aggregating core care delivery services across the continuum and connecting key industry partners. The CMP framework² identifies foundational systems (i.e., EHRs, revenue management and practice management systems [RCM], and enterprise resource management systems [ERP]) implemented during 1.0: Brick and Mortar Healthcare. Generally built to support a specific entity or venue of care (i.e., hospitals, primary care/patient-centered medical homes, specialists, post-acute providers, etc.), additional layers are needed to orchestrate value across the platform. These layers include health information exchange, knowledge management and analytics, advanced care management, and consumer and patient engagement, as illustrated in Figure 7.1.

Figure 7.1 The care management platform.

The CMP framework has many implications for the transformation of healthcare. The CMP is

• Focused on the creation of new value, including new answers to old problems, development of new interactions between platform participants, and support of micro-services and experiences.
• Not implemented within one enterprise but enables networks and communities as they address market, specialty, service line, process, and consumer challenges.
• Enabled by the cloud and highly configurable, robust infrastructure.
• Designed to support the convergence of legacy business and operating models found in health plans, health systems, ambulatory care, and other components of the broader healthcare industry.
• Data driven in order to support personalized, evidence-based health management interventions.

While large EHR vendors increasingly provide the data and technology capabilities needed for each CMP layer, no one vendor can provide it all. Many organizations are becoming more open to hybrid strategies that leverage the benefits of stable legacy applications combined with the offerings of e...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• List of Figures
• List of Tables
• Foreword
• Preface
• Acknowledgments
• About the Authors
• SECTION I SETTING THE STAGE
• SECTION II LEADERSHIP THINKING, MINDSETS, AND CULTURE
• SECTION III THE CARE MANAGEMENT PLATFORM
• SECTION IV MAKING VALUE ACTIONABLE
• Index