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fter terrorists slammed a plane into the Pentagon on 9/11, ambulances
rushed scores of the injured to community hospitals, but only three of the 3 From Accountable Care
patients were taken to specialized trauma wards. The reason: The News: Patient Identity
hospitals and ambulances had no real-time information-sharing system.
Management Key to ACO
Nineteen years later, there is still no national data network that enables the health
Success, COVID Response
system to respond effectively to disasters and disease outbreaks. Many doctors
and nurses must fill out paper forms on COVID-19 cases and available beds and 5 Cambia Health Solutions
fax them to public health agencies, causing critical delays in care and hampering
the effort to track and block the spread of the coronavirus. Launches Journi - Powered
by Data, Innovation and
“We need to be thinking long and hard about making improvements in the data-
reporting system so the response to the next epidemic is a little less painful,” said People
Dr. Dan Hanfling, a vice president at In-Q-Tel, a nonprofit that helps the federal 6 LexisNexis Risk Solutions
government solve technology problems in health care and other areas. “And there
will be another one.” Joins Patient ID Coalition in
There are signs the COVID-19 pandemic has created momentum to modernize
Support of a National Unique
the nation’s creaky, fragmented public health data system, in which nearly 3,000 Patient Identifier
local, state and federal health departments set their own reporting rules and vary
greatly in their ability to send and receive data electronically. 7 Welltok Uses Data to Predict
Risk and Drive Flu Shots
Sutter Health and UC Davis Health, along with nearly 30 other provider
organizations around the country, recently launched a collaborative effort to speed 7 SCAN Health Plan
and improve the sharing of clinical data on individual COVID cases with public Leverages AI Based
health departments.
Predictive Models to Improve
But even that platform, which contains information about patients’ diagnoses and
response to treatments, doesn’t yet include data on the availability of hospital
Identification of High Risk
beds, intensive care units or supplies needed for a seamless pandemic response. Members
The federal government spent nearly $40 billion over the past decade to equip 8 CDC's NCHS Releases Most
hospitals and physicians’ offices with electronic health record systems for improving Recent Decennial Life
treatment of individual patients. But no comparable effort has emerged to build an
effective system for quickly moving information on infectious disease from providers Tables
to public health agencies.
In March, Congress approved $500 million over 10 years to modernize the public health data infrastructure. But the
amount falls far short of what’s needed to update data systems and train staff at local and state health departments,
said Brian Dixon, director of public health informatics at the Regenstrief Institute in Indianapolis.
The congressional allocation is half the annual amount proposed under last year’s bipartisan Saving Lives Through
Better Data Act, which did not pass, and much less than the $4.5 billion Public Health Infrastructure Fund proposed
last year by public health leaders. ( continued on page 2 )
Care Analytics News COVID Data Failures Create Pressure for Public Health ….. continued from page 1
Care Interventions Edition
(formerly Readmissions News) “The data are moving slower than the disease,” said Janet Hamilton,
August 2020, Volume 13, Issue 8
executive director of the Council of State and Territorial Epidemiologists. “We
need a way to get that information electronically and seamlessly to public
ISSN 2166-255X (Electronic)
ISSN 2166-2568 (Print) health agencies so we can do investigations, quarantine people and identify
hot spots and risk groups in real time, not two weeks later.”
National Advisory Board The impact of these data failures is felt around the country. The director of the
Amy Boutwell, MD, MPP California Department of Public Health, Dr. Sonia Angell, was forced out Aug.
Founder and President, Collaborative 9 after a malfunction in the state’s data system left out up to 300,000 COVID-
Healthcare Strategies, Lexington, MA 19 test results, undercutting the accuracy of its case count.
Molly Joel Coye, MD, MPH
Chief Innovation Officer, UCLA Health Other advanced countries have done a better job of rapidly and accurately
System, Los Angeles, CA tracking COVID-19 cases and medical resources while doing contact tracing
Thomas R. Graf, MD and quarantining those who test positive. In France, physicians’ offices report
Chief Medical Officer, Population Health patient symptoms to a central agency every day. That’s an advantage of
and Longitudinal Care Service Lines having a national health care system.
Geisinger Health System, Danville, PA
Brian Jack, MD “If someone in France sneezes, they learn about it in Paris,” said Dr. Chris
Professor of Family Medicine, Boston Lehmann, clinical informatics director at UT Southwestern Medical Center in
University Medical Center, Boston, MA Dallas.
Martin S. Kohn, MD, MS, FACEP, CPE,
FACPE, Chief Medical Scientist, Care
Coronavirus cases reported to U.S. public health departments are often
Delivery Systems, IBM Research, missing patients’ addresses and phone numbers, which are needed to trace
Hawthorne, NY their contacts, Hamilton said. Lab test results often lack information on
Cheri Lattimer patients’ races or ethnicities, which could help authorities understand
Director, National Transitions of Care demographic disparities in transmission and response to the virus.
Coalition (NTOCC), Little Rock, AR
Last month, the Trump administration abruptly ordered hospitals to report all
Josh Luke, PhD, FACHE
Founder, National Readmission COVID-19 data to a private vendor hired by the Department of Health and
Prevention Collaborative, Author, Human Services rather than to the long-established reporting system run by
Readmission Prevention: Solutions the Centers for Disease Control and Prevention. The administration said the
Across the Provider Continuum switch would help the White House coronavirus task force better allocate
Harold D. Miller scarce supplies.
Executive Director, Center for Healthcare
Quality and Payment Reform; President The shift disrupted, at least temporarily, the flow of critical information needed
and CEO, Network for Regional to track COVID-19 outbreaks and allocate resources, public health officials
Healthcare Improvement, Pittsburgh, PA said. They worried the move looked political in nature and could dampen
Mary D. Naylor, PhD, RN, FAAN public confidence in the accuracy of the data.
Marian S. Ware Professor in Gerontology
and Director of the NewCourtland Center An HHS spokesperson said the transition had improved and sped up hospital
for Transitions and Health, University of reporting. Experts had various opinions on the matter but agreed that the new
Pennsylvania, School of Nursing, system doesn’t fix problems with the old CDC system that contributed to this
Philadelphia, PA
country’s slow and ineffective response to COVID-19.
Jeremy Nobel, MD, MPH
Medical Director, Northeast Business “While I think it’s an exceptionally bad idea to take the CDC out of it, the
Group on Health Boston, MA bottom line is the way CDC presented the data wasn’t all that useful,” said Dr.
Bruce Spurlock, MD George Rutherford, a professor of epidemiology at the University of
President and Chief Executive Officer, California-San Francisco.
Cynosure Health Solutions, Roseville, CA
_____________________________ The new HHS system lacks data from nursing homes, which is needed to
ensure safe care for COVID patients after discharge from the hospital, said
Publisher - Clive Riddle, President, MCOL Dr. Lissy Hu, CEO of CarePort Health, which coordinates care between
hospitals and post-acute facilities.
.
A
ccountable Care Organizations are playing a critical role in supporting their communities in the face of the
pandemic. ACOs have diverted significant tools and resources to identify high-risk populations, expand
telehealth services and provide post-acute care management for COVID-19-positive patients.
• The lynchpin of ACOs is every provider is responsible for a defined assigned patient population.
• The provider is accountable for the spending and outcomes of those members regardless of the patients’ pre-
existing diagnoses, their socioeconomic challenges or when and where they seek care.
• This creates a very strong incentive for providers to take an active role in managing patients and redirecting
individuals to the most appropriate, cost-effective facility or service for their needs.
But fragmented and siloed health IT infrastructure can often prevent efficient communication within the ACO. Many
providers still lack insight into clinical risks and gaps in care for their own patients. And because patients are free to
visit providers outside of the ACO at any time if they wish, it can be difficult to identify and control activities that take
place in other settings. To overcome these challenges, ACOs need to understand their members’ clinical status, their
potential health risks and the spending patterns that go along with them.
The journey to shared savings begins by developing complete visibility into an ACO’s attributed population. A
comprehensive patient identity management strategy is one of the most important components for success
Creating confidence in an attributed patient’s identity
Even within the same provider organization, duplicate records and outdated information are commonplace, with some
healthcare systems experiencing error rates in the double digits. The ACO environment can magnify those problems
dramatically. Participants may be using completely different electronic health records and other health IT tools to
manage their patients – and each of these systems may have a different way to generate medical records and share
information.
• For example, at the two ACOs participating in South Carolina’s Care Coordination Institute, providers use more
than 40 different EHRs and clinical data systems.
• During an initial assessment, CCI found more than 300,000 duplicate records in need of reconciliation.
• Some same-source systems had duplication rates as high as 80%.
After CCI deployed an Enterprise Master Patient Index to jumpstart its patient identity management program, the same-
system duplicate record rate dropped to 0.2% in most cases and just 3% within the network’s largest EHR environment.
This drastic reduction in duplicate records allows the ACOs to feel certain about the number of patients they are
serving, the health of each individual and the spending associated with their beneficiaries.
It also helps ACOs be sure that they are getting the correct credit for their clinical and financial improvements without
being penalized for gaps in care that have actually been closed.
Collaborating within and across organizational lines
Providers must work effectively with their ACOs partners, but they will also need to communicate with an untold number
of other organizations in the larger healthcare community. “ACO leakage,” or the rate at which patients visit providers
outside of the ACO, is a major problem for most groups. Up to 50% of patients may be out of network, contributing to
higher costs per beneficiary in Medicare ACOs.
ACOs have little control over these patterns, which has been a point of contention for many years. However, ACOs
tackle this problem by using an EMPI platform to accurately integrate data from external entities into the correct patient
records. In addition to preventing the duplicate record rate from rising again, this strategy helps ACOs account for
trends in out-of-network utilization. (continued on page 4)
© 2020, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission. page 3
4 Care Analytics News August 2020
Patient Identity Management Key to ACO Success, COVID Response ….. continued from page 31
Providers with visibility into healthcare utilization may be able to suggest more cost-effective care alternatives to
patients, such as making an appointment with a primary care provider instead of heading to the emergency room for a
lower-level complaint.
Clarity around the entire scope of patient activities will also support more effective care management.
In ACOs, primary care providers often act as the “quarterbacks” of patient care and take on the central role in care
coordination and chronic disease management. ACOs that equip PCPs with patient identity management tools that
present internal and external utilization data will be in a better position to manage patient well-being in an informed and
comprehensive manner. The result is a better opportunity to reduce avoidable spending and improve quality while
ensuring that patients can make empowered choices about when and where to access care.
Taking the next steps into personalized, accountable care
The ability to confidently and consistently track individuals across multiple clinical organizations can support the next
phase of value-based care: integrating socioeconomic insights into the clinical care environment. For many patients,
regular screenings and chronic disease management need to be accompanied by broader efforts to address the social
determinants of health.
• Social determinants – including transportation access, food and housing insecurity and interpersonal
relationships – play a significant role in patients’ ability to follow care plans and maintain their well-being.
• Further, COVID-19-related illness is higher in areas with greater socioeconomic challenges.
ACOs are increasingly designing targeted interventions for these issues, such as increased use of telehealth visits,
working with rideshare companies to provide non-emergency medical transportation or connecting families with food
banks, housing resources and other support services. With clear insights into members and their activities across the
clinical and non-clinical environments, ACOs can allocate their limited resources most effectively to reach even more
individuals in need. Getting ahead – and staying ahead – of the health issues and socioeconomic circumstances that
impact outcomes depends entirely on knowing as much as possible about an ACO’s attributed population on a detailed
level.
As value-based care initiatives become more popular in Medicare and the commercial insurance environment, providers
that wish to take advantage of these opportunities should consider starting with a foundation of reliable patient identity
management. ACOs that adopt an effective patient identity strategy will be better prepared to adapt to the challenges of
COVID-19, provide proactive care, foster better outcomes for their patients, control spending – and ultimately reap
financial rewards for their participation in value-based care.
Cidon is CTO at NextGate, a global leader in healthcare enterprise identification. Visit nextgate.com.
COVID Data Failures Create Pressure for Public Health System Overhauls ….. continued from page 2
The Digital Bridge platform also allows the agencies for the first time to send helpful treatment information back to
doctors and nurses. About 20 other health systems are preparing to join the 30 partners in the system, and major digital
health record vendors like Epic and Allscripts have added the reporting capacity to their software.
Sutter hopes to get state and county officials to let the health system stop sending data manually, which would save its
clinicians time they need for treating patients, said Dr. Steven Lane, Sutter’s clinical informatics director for
interoperability.
The platform could be key in implementing COVID-19 vaccination around the country, said Dr. Andrew Wiesenthal, a
managing director at Deloitte Consulting who spearheaded the development of Digital Bridge.“You’d want a registry of
everyone immunized, you’d want to hear if that person developed COVID anyway, then you’d want to know about
subsequent symptoms,” he said. “You can only do that well if you have an effective data system for surveillance and
reporting.”
The key is to get all the health care players — providers, insurers, EHR vendors and public health agencies — to
collaborate and share data, rather than hoarding it for their own financial or organizational benefit, Wiesenthal said.
“One would hope we will use this crisis as an opportunity to fix a long-standing problem,” said John Auerbach, CEO of
Trust for America’s Health. “But I worry this will follow the historical pattern of throwing a lot of money at a problem
during a crisis, then cutting back after. There’s a tendency to think short term.”
This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent
service of the California Health Care Foundation.
T
he global COVID-19 pandemic has forced both people and employers to evaluate how health care is accessed
and delivered, from the need for telemedicine and behavioral health services to real-time data driven solutions.
Cambia Health Solutions is addressing the evolving physical, behavioral and financial needs people face each
day with the introduction of Journi – the next major milestone in the company’s vision to deliver a seamless,
personalized health care experience for people and their families. Journi is a new health platform powered by data,
innovation and people, which Cambia says is “built to ensure personalized, simple and better care for all.”
Journi is currently available to organizations that deliver health and wellness benefits to their employees in Oregon,
Washington, Idaho and Utah, with plans for nationwide expansion in the coming months. This new health platform
puts people first to address their unique needs by bringing family health and well-being support, prescription
management, health insurance and other benefits together in one place. This integrated health solution is powered by
intelligent, data-driven technology that in one platform delivers:
• Personalized, real-time access to address pressing health care questions via nurse chat and video; detailed
health and medication histories; and medication safety, efficacy and cost information.
• Intelligent navigation with advanced AI technology that enables users to find an in-network provider, easily
view and understand health benefits and manage health and wellness choices for themselves and their family
members.
• 24/7 access to Care Guides available via chat or phone to schedule medical appointments, coordinate
prescriptions, deliver emotional and behavioral health support, and address COVID-19 related questions and
concerns.
• Financial tools and dashboards to track deductibles and out-of-pockets for everyone on the health benefits
plan, provide cost estimations for treatment, and support via Care Guides to address insurance billing
questions.
• Whole-person health and well-being, including access to health coach services for nutrition, well-being goals
and mental resilience; personalized insights and suggestions based on health history; access to employer-
sponsored programs and services such as Employee Assistance Programs (EAP), retirement savings
accounts and wellness programs.
Journi layers in existing employer-sponsored health and well-being benefits, digital care tools and a diverse care team
to elevate value, increase utilization of benefits and improve return on investment. Journi’s reporting package gives
employers the ability to drive stronger engagement, better outcomes and lower organizational costs, all while meeting
employees where, when and how they need support. Journi’s features can be accessed via a mobile app, mobile chat,
and phone. For more information visit journi.com.
In a statement, Mark Ganz, Cambia Health Solutions Chief Executive Officer comments that "Journi changes the
game. From this day forward, how people access, engage and interact with health care will be different. As technology
continues to reshape the world we live in, Journi sparks an evolution that brings forth a more personalized,
compassionate experience for people and their families. As COVID-19 magnifies the gaps in our health care system,
Journi is perfectly timed to bring together the fragmented experience. Designed over several years by deeply listening
to people and engineered to put the individual at the center, Journi offers support that revolves around the unique
needs of each one of us in sickness and in health, when and how we need it most.
Cheryl Pegus, Cambia’s Consumer Health Solutions President and Chief Medical Officer adds that "today’s health
care solutions must provide access to not one, but all points in a person’s health and well-being journey in a way that
is easy to understand and use. COVID-19 pushed employee health to be top of mind for employers as they find
themselves taking on greater responsibility for employee well-being, behavioral health and ongoing, preventative care.
Journi combines data, technology and the unique human experience to deliver personalized care and unlock
actionable insights to help people get the care they need, when and where they need it. We believe Journi, which is
designed to be health-literate and culturally appropriate, can ultimately result in cost savings and a healthier, more
productive workplace for employers."
© 2020, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission. page 5
6 Care Analytics News August 2020
L
exisNexis Risk Solutions has joined Patient ID Now coalition to support accurate patient identification and ensure
that patients are accurately matched to their health information across care settings and platforms. Patient ID
Now is a coalition of healthcare organizations representing a wide range of stakeholders committed to advancing
through legislation and regulations a nationwide strategy to address patient identification.
The Patient ID Now coalition seeks to remove section 510 from the Labor-HHS-Education appropriations bill, allowing
HHS to work with the private sector to develop a nationwide patient identification strategy – including adoption of a
Unique Patient Identifier – to improve patient care. The founding members of the Patient ID coalition are the American
College of Surgeons, AHIMA, CHIME, HIMSS, Intermountain Healthcare, and Premier.
Through LexisNexis® LexID for Healthcare, LexisNexis Risk Solutions uses automated matching to assign unique
identifiers to patient records to link together records for the same patient – allowing healthcare organizations to reduce
duplication of records and increase interoperability among disparate EHR and other healthcare systems. LexisNexis
Risk Solutions partners with healthcare organizations to cleanse and match patient records to ensure safe patient care
and smooth workflow, helping combat the industry’s interoperability challenges.
A lack of widespread operational principles as well as limitations in processes – such as human error and demographic
changes – result in inaccurate patient identification. As more data is generated and shared, duplicate patient records
and mismatches result in multiple challenges for the healthcare industry.
From a safety perspective, patients can receive incorrect diagnoses, treatments, or prescriptions when their healthcare
information is spread across multiple files, or misfiled in the wrong record. From a workflow perspective, providers are
muddling their way through often incomplete or incorrect patient records, leading to compromised decision-making and
wasted resources.
Furthermore, data integrity is essential as the healthcare industry continues to move toward value-based care because
it is foundational to enabling preventive strategies, social determinants of health (SDOH) applications, and population
health management.
Sharing patient information – the right information – across healthcare organizations serving the patient hinges on
having a correct and complete patient record for each patient, which will protect patient safety, reduce costs, increase
program efficiency, help prevent fraud, and ensure better patient experience. It also means that when a patient requests
their own record, they will have more confidence that their healthcare provider is maintaining a complete view of their
medical history.
In a statement, Erin Benson, Senior Director, Market Planning, at
“Patient ID Now has determined LexisNexis Risk Solutions commented that “Patient ID Now has
determined that a nationwide patient identification strategy is critical
that a nationwide patient
for the healthcare system at large to be able to better assure patient
identification strategy is critical safety throughout the patient’s entire care journey. We support that
for the healthcare system at mission for the benefit of patients and providers and offer our
expertise and solutions to help solve the challenge.”
large to be able to better assure
patient safety throughout the For more information about Patient ID Now coalition, visit
https://patientidnow.org. To learn more about LexisNexis LexID for
patient’s entire care journey.”
Healthcare, visit https://risk.lexisnexis.com/products/lexid-for-
healthcare
W
ith the risk of the flu and coronavirus looming, experts are advising that more people get vaccinated against
seasonal influenza – and do it soon. Welltok, a consumer activation solutions company, has a long track
record of identifying people more susceptible to contracting the flu virus and activating them to get a flu shot.
The company is already starting seasonal flu shot outreach for a large national pharmacy this week.
With symptoms similar to COVID, minimizing the infection and spread of the flu is critical to avoid further strain to our
health system. An influx of flu-related hospitalizations could potentially overwhelm healthcare workers and hospital
capacity. Protecting everyone from influenza is important to decrease risk of COVID infection too.
Welltok is working with participating pharmacies, health plans, hospital systems and employers identify and reach the
people that have a need or interest to take action. The company’s social determinants of health data and predictive
models reveal that factors such as car ownership, political party affiliation and household composition can be early
indicators of a person’s flu risk. To engage, educate and activate consumers, Welltok delivers targeted
communications using a multiple channel strategy that includes text messaging, emails, social posts, automated calls,
web, direct mail and more.
One nationwide retail pharmacy chain is doubling its flu shot reminders over last year with Welltok, issuing hundreds of
thousands of automated voice calls to customers, prompting them to get flu vaccines and sharing information for doing
so safely. Welltok also manages outreach for a national health plan across multiple communication channels with a
proven success rate of reaching nearly 90% of the individuals targeted with chronic disease. Of those contacted, 56%
reported receiving a flu shot.
The Centers for Disease Control and Prevention (CDC) recommends a flu vaccination for everyone six months of age
and older, with rare exceptions. Vaccination is particularly important during the 2020-2021 flu season for groups who
are at higher risk for complications from flu as they are often at higher risk for COVID-19 too. Getting vaccinated can
reduce flu illnesses, doctors’ visits and missed work and school, as well as prevent flu-related hospitalizations.
Influenza vaccination is particularly important for older people, pregnant women, people who are immunocompromised,
and others with chronic conditions who are more vulnerable to serious flu complications.
In a statement, April Gill, senior vice president of market solutions at Welltok noted “many people may be reluctant to
visit a doctor’s office or health clinic for a flu shot, making it even more important to proactively educate consumers
about all the options available. Flu outreach campaigns with personal, multi-channel engagement will be essential to
broadly reach people at risk about the importance of getting the shot in September/October and where to get it.”
S
CAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage health plans, today announced
the first phase launch of artificial intelligence (AI) based predictive models designed to improve health outcomes
and inform benefit and service design. This implementation will improve SCAN’s ability to identify high-needs
members and provide tailored interventions to help avoid or reduce hospitalizations.
With symptoms similar to COVID, minimizing the infection and spread of the flu is critical to avoid further strain to our
health system. An influx of flu-related hospitalizations could potentially overwhelm healthcare workers and hospital
capacity. Protecting everyone from influenza is important to decrease risk of COVID infection too.
As a part of the first phase implementation, SCAN and KenSci, a system of intelligence for healthcare, have launched
explainable AI models for healthcare, enabling SCAN to identify members at risk of Hospitalization for Potentially
Preventable Complications* (HPC) as well as those eligible for Nursing Facility Level of Care (NFLOC). The platform
provides SCAN with insights, proactively identifying members potentially at risk for specific disease states allowing for
early interventions. In addition, SCAN is using machine learning (ML) techniques that are routine across consumer
applications but new to healthcare in helping identify gaps in care to improve the management of chronic conditions. In
a statement, Josh Goode, SCAN CIO commented “at SCAN our goal is to support our members at every stage of their
journey and utilizing advanced technology, such as AI, enables us to do so on a much more proactive basis.”
© 2020, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission. page 7
8
w w w . C a r e A n a l y t i c s N e w s . c om
I
n the August 7, 2020 National Vital Statistics Reports, the CDC's National Center for Health Statistics, National
Vital Statistics System period life tables for the United States, based on age-specific death rates for the period
2009–2011. These tables are the most recent in a 110-year series of decennial life tables for the United States.
During 2009–2011, life expectancy at birth was 78.60 years for the total U.S. population, representing an increase of
29.36 years from a life expectancy of 49.24 years in 1900. Between 1900 and 2010, life expectancy increased by 42.88
years for black females (from 35.04 to 77.92), by 39.21 years for black males (from 32.54 to 71.75), by 30.15 years for
white females (from 51.08 to 81.23), and by 28.26 years for white males (from 48.23 to 76.49). During 2009–2011,
Hispanic females had the highest life expectancy at birth (84.05), followed by non-Hispanic white females (81.06),
Hispanic males (78.83), non-Hispanic black females (77.62), non-Hispanic white males (76.30), and non-Hispanic black
males (71.41).