Care Platforms: Integrating technologies and best practices to drive patient-centered, value based care

Brian Justice brian.justice@excellus.com
Matthew Bartels matthew.bartels@univerahealthca.com
Marcos Dachary marcos.dachary@milliman.com

Abstract

Health science information is outpacing the ability of society to embrace this new knowledge and opportunity. New technologies, data sets, and medical research are being released faster than providers or systems can assimilate them into use. Patients get lost in the morass, many life altering interventions are never applied and many critical medical interventions are never introduced to the wanting patient. Technologies and best evidence are too often introduced in a haphazard way, or not at all.

Much of health care is fragmented; interprofessional communication is sporadic and often specialty specific. Patients are not consistently engaged in shared decision-making or active care plans. There is a tendency to treat people as disease sets rather than complex biopsychosocial beings who are living suboptimal lives secondary to their poor health. This dysfunctional model tends to add waste and disrupt value based purchasing.

An ongoing community wide experiment to address these inefficiencies in upstate New York is based on a spine care pathway and platform that allows best evidence and best technologies to be integrated into systems and practices efficiently and effectively. The goal of this program is to meet patient-centered goals by optimizing provider input. The program is assessed by measuring meaningful patient outcomes and episode costs. The Excellus BlueCross BlueShield Spine Health Program is an evolving model that seeks to integrate data, technologies and best practices while creating vehicles for their dissemination into served communities. Examples of special technologies (advanced spinal screening), data sets (value derivatives), clinical evidence (patient reported outcomes) and implementation processes (unique provider training initiatives) that are being introduced and measured will further demonstrate platform utility.

Payers are striving to identify impediments to, and incentives toward, value based care. One example (others will be presented) of technologies being quickly and efficiently incorporated into a care platform is a data search tool, Milliman’s “Waste Calculator,” which mines utilization rates of low value services. Next, Choosing Wisely recommendations specific to these ‘waste’ findings, and their correlating tools created in concert with Consumer Reports, were introduced through the educational initiatives of the spine care platform to quickly disseminate this information to patients and practitioners. Inappropriate care was lessened, unnecessary downstream costs were limited and outcomes improved, all while improving both patient and clinician experience of care.

Data will be presented demonstrating our ACO pilot initiatives have triggered drops in unnecessary opioid prescriptions, emergency department visits, imaging, specialist referral and spinal injections, leading to a decrease in spine per member per month costs of >30%.
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