Data Will Drive Chronic Care Management Improvements

Chronic care patients often complain that although they have access to a variety of health care specialists to treat their multiple conditions, there is no one monitoring or assessing their health care situation as a whole. Closing this perceived gap enables payers to enhance and expand care management programs in a way that is meaningful to patients and advances health care delivery.

In order to achieve this goal, “we need a patient-centered movement, that allows not only the patient to be informed, but for everyone in their ‘circle of care’ to be informed at the same time,” said Eric Chetwynd, product marketing director for Care and Health Management Solutions, Ingenix.

Empowering patients both to pay closer attention to their health care options and to drive more productive interactions with the health care system are good first steps, according to Chetwynd, who asserts that quality, transparency and measurable data are the keys to progress.

“In order to have a patient-centered system, your doctor should have access to the same basic data about you that the nurse at your health plan would have or that your pharmacist would have,” he said. “With consistent information, everyone can better support you, while delivering services across the health care continuum.”

Multiple factors influence patient tools

A 2001 Institute of Medicine (IOM) report described a quality “chasm” between health care entities, which typically operate as silos, and the needs of patients, particularly those with chronic conditions.¹  “The fact that more than 40 percent of people with chronic conditions have more than one such condition argues strongly for more sophisticated mechanisms to coordinate care,” the IOM stated.

One of six IOM mandates to help bridge the chasm included making health care more personalized and patient-centric. “Providing care that is respectful and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions” should lead to health care that is “safer, more reliable, more responsive to their needs, more integrated, and more available.”²

“Although focusing on the patient may seem like a rudimentary health care objective, the building blocks for patient-centric care delivery have only recently been put in place,” Chetwynd said. “Factors contributing to a patient-focused shift include the rising health care consumerism movement and ̀‘pay for performance’ (P4P) initiatives set forth by payers.”

Consumerism – defined as patients making more informed decisions about their health care utilization, because they are paying a greater share of their health care costs – “has played an important role in increasing demand for aggregated patient and provider information,” Chetwynd remarked.  

“We really need to give patients better tools so they can make intelligent, comparative decisions. For example, who are the highest-quality physicians for their specific condition in a particular geographic area?” he said. “Patients want help making informed choices, and need quality data to answer such questions as: Should I go see this physician? Should I have the surgery? Are there proactive ways to remind me to take steps such as getting a flu vaccine, because as a diabetic I am at high risk for complications from the flu?” he added.

Finding the answers to these questions is not easy because the data points needed to make key decisions often are fragmented across the system. “Getting all of the information in one place is where we need to begin,” Chetwynd added.

Another driver of patient focus, P4P programs, give health care providers “a financial incentive to seek measurable improvements in the health of their patients,” according to the results of a three-year study of seven P4P model programs, released in 2005.³  Many P4P programs call for providers to utilize evidence-based medicine (EBM) approaches, which has helped to level the playing field among providers and give consumers consistently measured results.

Chronic care needs are different

Data aggregation and consumer tools are particularly important to patients with chronic conditions, because they can have multiple health issues spanning several specialties. Indeed, more than 90 million Americans suffer from chronic illnesses, accounting for more than 75 percent of the nation’s (year?) $1.4 trillion medical care costs, according to the Centers for Disease Control and Prevention. Patients with such chronic conditions as heart disease, cancer and diabetes struggle with managing their own care.

Recent studies conducted by Ingenix found that 60 percent of diabetic patients did not take their angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) as prescribed, and that 48 percent of patients with coronary artery disease did not comply with their statin medications.

“There are a number of complicating factors with chronic care patients for which costs are associated,” according to Chetwynd. “Ingenix can get the right information into the room where the patient and physician are meeting for a very limited amount of time, and maximize the impact of that encounter.” 

Ingenix improves interactions with data, tools

To help payers and providers move more quickly toward patient-centered care, Ingenix is targeting four basic areas: (1) gathering patient information from disparate sources, using medical records and claims information; (2) making information actionable by adding value to physician-patient encounters, such providing EBM talking points to physicians and reaching out to patients with information prior to a doctor’s visit; (3) tailoring communication with constituents; and (4) measuring success in a tangible way.

Using Ingenix Impact Provider^™, a Web portal that enables physicians to access patient health history, current status and compliance with care guidelines, providers can improve their relationships with patients, increase quality of care by implementing EBM, and boost performance measurement profiles.

Care management teams can better utilize clinical, risk and administrative member profile information with Impact Pro^™ for Care Management, a multi-dimensional, episode-based predictive modeling and care management analytics solution. “When used by care managers within a payer organization, Impact Pro^™ helps determine which members are in need of a specialized intervention program, which can really benefit chronic care patients,” Chetwynd said.

The Ingenix Impact Consumer^® Web-based application can help plans empower members with access to their own health information, tailored advice on better managing their health care and an integrated approach to managing their families’ health data. To measure success in a transparent way, Ingenix Impact Analysis^™ combines leading-edge decision support technology with proven analytic methods that facilitate information sharing and collaboration among health care entities.

Although in the future electronic medical records are likely to consolidate patient data automatically, Chetwynd said, “Ingenix can help payers take incremental steps – using claims data, lab test results and patient-reported data – to make significant strides in improving care in a comprehensive way today.”

“Payers that address the needs of the whole patient more effectively, implement tools to improve care interactions and communicate directly with patients are all factors in moving toward a new chronic care paradigm,” according to Chetwynd. “When you put high-quality patient information at the center of the circle of care,” he said, “all parties around the circle – consumers, providers and care managers – benefit.”

1. Institute of Medicine, “Crossing the Quality Chasm: A New Health System for the 21st Century,” March 2001.
2. Id.
3. “Pay for Performance Improving Health Care Quality and Changing Provider Behavior; But Challenges Persist,” Robert Wood Johnson Foundation (Nov. 15, 2005).

Be sure to sign up for future issues of Ingenix Innovations, and visit the archive for recent issues.