The Future of Care – Population Health as a Service

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By Lisa Pettigrew, Industry General Manager, Global Healthcare

As the United States edges towards population health management models of care, CSC is investing to create a first of type Population Health Management “as-a-service” solution in another country. This solution will help support and manage the care and care logistics for a population of over 200,000 “health consumers.”

We are focused on enabling population health – working with clients to co-create new workable business models. Models that will serve the needs of their members, their patients, and their consumers in more appropriate ways, and which can deliver better outcomes.

Better outcomes for everyone – better healthcare, better quality of life, better economic outcomes with reduced and avoided costs. We hope the approach might also boost health literacy and encourage a focus from all healthcare stakeholders around prevention and early intervention.

Across the United States, there are a great number of pilots, prototypes, and new innovation business units being established at healthcare providers, payers, and within accountable care organizations. These pilots and prototypes are being implemented at the biggest and most prestigious academic medical centers and also at the smallest, lowest-cost regional healthcare centers that serve Medicaid and underprivileged populations.

Anecdotal and intuitive outcomes from coordinated care and population health initiatives are reported as very positive, but it is perhaps too early to be able to look for any longitudinal and peer-reviewed research and evaluation outcomes.

But we all know the current models of healthcare delivery have to change.

At CSC, we are investing to commence this journey with some of our boldest clients. We have planned a trajectory from basic services to enable population health with a strategy to scale in both size and sophistication. We will learn from the data collected and the experiences of the patients, physicians, and care givers.

CSC’s Patient Care Coordination Center

At CSC, we are implementing a health population management service by creating and operating a Patient Care Coordination Center (PCCC).

The PCCC is designed to coordinate care logistics for over 200,000 consumers in a health economy, focused on several key chronic health conditions including diabetes and dementia.

So, what’s involved in operationalizing a health population management service?

  • We start with acknowledging there is no one perfect solution, no one perfect provider, no one-size-fits-all answer. Together with our client, we have designed a solution that brings all relevant patient data across multiple care pathways in a health economy into a hub and manages the patient journey across various health providers in their health cycle. We are also working with our client to design new models of care, which require new commercial models and an ecosystem of clinical and technology partners to provide the right blend of the right care and care support for the population.

What are we setting up right now? Some of the features of our first stage include:

  • The PCCC is clinically led, with physician-led clinical governance.
  • A nurse-led call center handles the end-to-end care logistics for patients with particular chronic conditions. This involves assisting and coordinating the next step in a patient journey and ensuring the supporting documentation (electronic or otherwise) accompanies the patient.
  • The call center triages and routes calls based on physician-governed care pathways and business rules and includes escalations to physicians where required
  • CRM-style patient relationship management for viewing patient details and managing the scheduling of patient logistics.
  • Clinician portal and decision support.
  • Patient analytics to track “missing” events and actions to drive quick follow-ups and help keep patients “on track.”
  • Single point of management for referral review and management, and signposting to clinical services / alternatives to hospital and appropriate deflection.
  • Full digital telephony / unified communications fully cloud based.

The PCCC is patient-centric and spans across and complements the work of multiple acute-sector provider organizations. The PCCC is changing the location of care, focusing on the patient and the best locations for the patients to interact with their physicians and the health system.

And what’s coming next?

The next stage of care coordination evolution will involve:

  • Considering existing and additional disease focus areas with a view to improving clinical pathways and patient journeys.
  • Introducing biometric monitoring with telehealth devices for selected and appropriate conditions.
  • Social media integration.
  • Evaluating the use of cognitive computing for predictive insights.

To find out more; come and see us at #HIMSS15 – CSC Booth #631

 

Comments

  1. Patient Care Coordination Center is certainly the way to go now! But my question is, a significant number of patients we have are senior citizens. How do you think it’s going to benefit them?

    Like

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