By Sarianne Gruber
HealthEC gets population health, physician and patient engagement, and the power of data. I visited with Mr. Arthur Kapoor, Chairman and Founder, and Dr. Sanjay Seth, Executive VP, of HealthEC at their headquarters in Piscataway, New Jersey to learn more about their healthcare philosophy and their suite of population health management solutions. Seated across from Dr. Seth, he started the dialogue stating, “We think we are on the cutting edge of technology for population health and value based reimbursement methodologies, and that we can facilitate organizations to accomplish both things. Eventually, we feel that population health and value based reimbursement is going to become the same thing. People may view population health as a clinical aspect and value based in the financial end, but eventually they will tie into each other more closely than it is now.”
Starting with a Claims History
HealthEC had its beginnings as a clearing house. Not being new comers to claims data, they know the basics of cleaning, organizing and resubmitting claims, even knowing how disparate systems process claims. No doubt, HealthEC are experts in handling all the current data standards. The first clearing house business was acquired, and after the restrictive phase finished, they re-entered the market place. “Same time the ACA ( Accountable Care Act ) was released in 2010, we knew that population health as we call it now, or accountable care –tracking large groups of patients– was something that was going to happen. We knew that the powerbase would shift from the payers and the hospitals to the physicians. We saw that coming. So we focused on developing all our technologies and platforms from the physician’s perspective on how can we engage the physician, how can we empower the physician, and all of these things, which factored into designing our platform”, explained Dr. Seth. HealthEC then partnered with NJHITEC, and became the PQRS quality reporting tool for the state of New Jersey, currently over 3,000 physicians. The HealthEC database contains approximately 17 million patients from 8,000 different practices, covering 12,800 physicians. Information includes 12 million admission and discharge summaries from hospitals and practices, with over 46 million claims nationally processed through its systems. There are real-time data feeds occurring from the 25 to 30 hospitals, labs, and plus over 70 different electronic medical records. All the HealthEC data flowing through its systems complies with PHI and HIPAA standards.
Analytics, Care coordination, Patient Assessment: Complete the Population Health Picture
HealthEC went from bringing data from different sources, to creating a longitudinal record for the patient. The next level was to run analytics for financial, clinical and utilization data on that consolidated medical record, and presenting it in different forms. Over 8 labels per entry are applied, so every patient is affiliated with a hospital, with a physician, with a practice, with a payer even the program within the payer, a geographical region as well as tagged with all of his or her diseases. So when you want to come to do the analytics for all the diabetics, a tag exists for all the patients with that diagnosis. You can find all the patients related to this physician as well as an attribution methodology. In today’s environment, you want to improve preventative measures. For example, Mr. Smith may not have seen his primary physician for two years, but goes to cardiologist every day. Yet, this patient didn’t get a flu vaccine. Why? The cardiologist says we don’t do flu shots. That is primary care. But, the patient has never gone to a PCP. The HealthEC Population Health solution can help the organization or physicians decide which practice or provider will be tagged with this patient, and importantly prevent any gaps in care.
Data Analysis and Risk Stratification
Having the data to measure outcomes studies, makes the possibilities limitless. HealthEC can do a study of diabetics on metformin comparing different doses for the past two years, for all female patients between 52 and 53 years of age, and within a given weight range. They can do it because they have all that data. “That is what led us to complete our population health story. We had the ability to handle claims, to aggregate and report on data, to connect to disparate systems, and the ability to build a provider directory of all the providers in an organization, calculate provider attribution. Then we are able to take all the data we have and risk stratify every patient.” voiced Dr. Seth. HealthEC has multiple ways of doing risk stratification with propriety co-morbidity systems, publicly available systems such as Johns Hopkins’ Verisk, as well as HealthEC algorithms. As Dr. Seth explained, risk stratification is the technique that enables you to see what is happening with each patient. If a patient has certain co-morbidities, conditions or illnesses, has been on certain medications, and/or used the hospital or ER so many times, then you can calculate the probability of the amount of dollars that could be spent over the next year on care or the number of ER visits in the next six months. Within those risk groups, you can do the next level of analysis and sub-stratify. “Here is a person, although he is high risk and the diagnosis that is making them spend so much time in the hospital or so much money is stroke, the underlying problem is really diabetes. I should then be managing diabetes not necessarily only managing stroke. So we have that ability to create that second tier or that second level of paying attention. What drives economics and utilization may not be the same thing that should be focused on for care, and we have the ability to do that. Of course, we can track all the quality metrics. The biggest thing we feel is, without the patient or provider being engaged in their own care or in the care of their patients, nothing is going to change. We can have all the technology in the world that we want. But if you don’t engage the patient or the physician we are going to stay status quo,” commented Dr. Seth.
HealthEC® is a leading provider of knowledge, expertise and technology solutions to the healthcare industry to effectively and efficiently manage its community. Its population health management platform provides the flexibility to integrate all of the critical components of a care plan into a single integrated record. From a longitudinal patient record, their platform facilitates care coordination and analytics for payers, providers and employers. Their experience with on-staff physicians guide healthcare organizations in the development and implementation of successful population health management initiatives and ease the transition to value-based reimbursement, to impact cost and improve quality with clear, measurable outcomes. HealthEC® is headquartered in Piscataway, New Jersey. More details about the company and its technology solutions can be found on the HealthEC® website.