Dr. Mark Wendling wears several hats in health care, but one topic he is most passionate about these days is care coordination and its role in transforming the industry.
Wendling is executive director of the Lehigh Valley Physician Hospital Organization Inc., a preferred provider organization that uses data from Populytics of Allentown to coordinate care. Populytics is a subsidiary of Salisbury Township-based Lehigh Valley Health Network, while the Lehigh Valley Physician Hospital Organization is affiliated with LVHN.
Populytics provides population health management through data analysis. It has data from health insurance claims and combines that with clinical data from medical records, Wendling said.
“What this data analysis does is identify the patients in need of preventive care or ones with chronic illnesses,” he said.
Wendling and other industry officials said care coordination means that physicians, nurses, hospitals, insurance companies and pharmacists involved with a patient’s care come together to communicate and share information about the patient. Care coordination is intended to improve a patient’s quality of care, reduce health costs for the patient, improve efficiencies in the industry and eliminate unnecessary hospital stays, testing and services.
“Our analytics team is building receiving fields and processing data information, interpreting explanation of benefits” and analyzing data from medical records and medical visits, Wendling said.
The data are formatted into tables, charts and reports that can be reviewed by the Populytics’ team of analysts.
“The work Populytics does cascades down to individuals and physicians, shows the patients that are in need of services and looks at various levels of specificity such as a group of people with heart failure or diabetes,” Wendling said.
WORTH THE CHALLENGES
Carol Michaels, administrator, care coordination with Populytics, said its analysts create patient registries that are consistent across health care agencies.
There are several challenges, including learning and interpreting different electronic systems, trying to get everyone onboard with the new system and away from old practices, and finding the appropriate professionals to analyze the data.
“It is not a perfect system,” Michaels said. “It doesn’t reveal everything about the person, but if we are able to check off all the boxes, we are able to flag” a situation or specific patients that require the most assistance.
REDUCES READMISSIONS
Wendling said that with care coordination, a patient leaving the hospital after being admitted, perhaps one with multiple health issues, has less of a chance for readmission.
Care professionals work with the patient, scheduling follow-up appointments, checking if the patient is taking the correct medicine and able to get transportation to appointments.
“We need to make sure a patient with multiple health issues is not taking duplicate medications, that there are no drug interactions with the different medicines they are taking and that there is no duplicate testing being done on this patient,” Wendling said.
“Doing those things significantly lessens the chances for a readmission to the hospital.”
COST CONTROL
Carl Seitz, president of Lehigh Valley Business Coalition on Healthcare, said he views care coordination as a way to control the rising cost of health care.
Care coordination “includes all of the activities that are done to assure that an individual maintains the best state of health after an acute illness or continuously with a chronic disease,” said Seitz, whose nonprofit organization represents more than 200 employers who seek to provide access to quality, affordable health care to their employees.
“It involves everything from making sure the patient has transportation to doctors’ visits, confirming the patient has the right medications, education on a disease and providing a handoff to the next caregiver.”
According to Seitz, focused and frequent care management is necessary for a person with multiple chronic illnesses and no at-home caretaker. In addition, a person newly diagnosed with asthma, for example, may initially need outreach visits or calls until he understands his diagnosis and to prevent flare-ups.
ELECTRONIC MEDICAL RECORDS
Wendling said one of Populytics greatest resources has been the electronic medical record system such as Epic. The Populytics team often uses the information in Epic to do its analysis.
The electronic medical record is able to record data from medical visits and claims information, manage prescriptions, keep a record of test results and X-rays and coordinate videoconferencing with a patient who has questions for his doctor.
Anthony Matrisciano, spokesman for Highmark Blue Shield in the Greater Lehigh Valley, said care coordination is “conducted on both the payer and provider side with the intent to improve quality of care, reduce duplication of services, reduce unnecessary utilization including emergency visits and hospitalizations and to reduce high costs overall with the health care industry.”
PROS AND CONS
Matrisciano said there are advantages and disadvantages to care coordination.
Positives include improvements in preventive care and general health outcomes of members, a marked reduction in health care costs, decrease in complications associated with chronic health conditions, early detection of health concerns and issues and better collaboration and management in the health care system.
He said the downside can be duplication in coordination efforts between providers, having to navigate and learn different electronic records systems, poor integration of data systems and the unwillingness of insurance members and patients to take a more involved role in managing their own health.
CULTURE CHANGE
Michaels said she sees the pros and cons of care coordination, but that it leads to better management of a patient’s care by preventing poor outcomes, working with the patient so he can self-manage his care and building and creating a new model that will make a difference in one’s care.
“We are connecting the dots and putting the patient at the center,” she said. “We are talking about a culture change.
“They will have greater access to services and hopefully be contacted before they even need the care.”
