• Background
  One of the largest healthcare providers in the United States.
• Challenge
  Our client needed an approach for the proactive healthcare management of high-risk populations. They identified the ability to consistently and accurately link patient information from multiple facilities as a key requirement.
• Solution
  Leverage Initiate software with its robust probabilistic matching algorithm that manages patient identities.
• Results
  Technology innovations. Measurable improvements in patient care. Increased operational efficiencies. Lowered costs.

One of the largest not-for-profit healthcare providers in the United States, well known for delivering high quality healthcare services including preventive-care programs, faced the need to lower costs while improving quality. They needed an innovative approach to manage the care of senior citizens. Clinicians have too many patients to see, too few resources to handle proactive healthcare programs and no automated way to inform when their patients might be heading toward serious health problems. The organization recognized the solution to the problem required a health management versus a care delivery orientation. The implementation of their program called for new processes, new technology and new information.

Traditional clinical data repository applications did not address the proactive requirements for managing health. As a result, medical records could be fragmented, difficult to find and contain inconsistent patient information. In addition, the facility-specific manner in which our client’s patients were identified posed significant barriers to creating a comprehensive view of the patient.

To develop effective capabilities for managing per-member financial/medical risk, they needed to deliver the right care at the right time in the right location, achievable through three mission-critical objectives:

• Coordinate care services effectively to improve outcomes and member satisfaction.
• Understand the health risk of each member, segment, and risk profile of the entire population.
• Anticipate and correct member problems consistently, effectively and affordably.

Essentially, our client’s ambitious agenda posed totally new requirements for managing health plan member identities: proactive management of healthcare for high-risk populations.

After extensive evaluation of dozens of technologies, the organization chose Initiate software to work in concert with its existing data systems. Initiate software is critical for linking patient information from a wide range of organizations, a necessary step in managing the health of at-risk plan members.

Integrating comprehensive member-specific information, such as their health risk assessment profile with current medical “event” data, is necessary for implementing proactive care initiatives. Continuous monitoring of at-risk members, through managing data integration on a daily basis, facilitates identification of potential problems before they undermine the quality of life for the member and turn into high cost, resource intensive interventions. Initiate software provides a seamless comprehensive view of the patient, forming the framework that supports the client’s care management application. By linking health plan member information from a wide array of sources, including high-risk medical events, member health surveys, hospitals, pharmacies, labs and health plans, a comprehensive view of the member is provided. Time-sensitive, patient-centered program interventions are supported by the flow of important information to nurse coordinators to alert them when patient situations warrant. In our client’s environment, each piece of real-time data is tagged and automatically flows through each of the other applications in the system.

The Initiate solution. Managing the identities of health plan members and patients is key to population management. Knowing which members will benefit from medical interventions, allowing caregivers to track their care history and minimizing redundant or inappropriate testing also enables better care across the board. These care management programs are supported by the information workflow that can only be provided by a service-oriented architecture with an EMPI providing a comprehensive patient indexing system. At the core of our client’s service technology environment is the enabling capability to identify patients and healthcare providers consistently and accurately.

Linking identities across multiple systems and platforms. Initiate software provides high-performance, real-time linkage of patient information using data from a large number of systems representing different technologies and data capabilities. It addresses critical data integration issues, creating patient-centered views by matching duplicate records and linking records. To manage complexity and enable a high-volume solution, patient information is left where it is in each application, and all relevant data for matching records is reached by using Initiate’s technology.

Sophisticated probabilistic algorithms link records. Initiate  software compares the available data items from different records to determine their similarity. The similarity or likelihood that the records represent the same member is scored using probabilistic techniques. This approach provides the greatest possible accuracy in creating comprehensive views of the patient. Initiate’s solution-enabling capability provides both flexibility and accuracy for our client without sacrificing high performance.

Furthermore, this high performance creates even greater value because the scalability of Initiate’s technology will handle the client’s increasing volume for years to come. And, since functionality is layered on top of existing systems, the client can take advantage of new features offered by Initiate software without having to replace legacy systems.

Using Initiate software, the organization has a service-oriented architecture that enables economical healthcare management – concurrently reducing utilization and increasing patient satisfaction. These operational efficiencies have decreased unnecessary inpatient bed days by 8.7 percent, urgent bed days by 17.5 percent, and total inpatient admissions by a significant 25.2 percent.

Complete access to patient history and information supports an early warning system that prevents major surgeries, re-hospitalization and decline in patient health, while continuous data monitoring ensures that follow-up is performed as ordered by the care provider. In solving the care management requirements for our client, Initiate has created an innovative, proactive approach to managing the healthcare needs of high-risk patients. This is an “industry first” with important consequences for the care delivery process.