Full Clinical Snapshot – Unifying Data for Population Health
In today’s dynamic healthcare landscape, seamless access to comprehensive patient data stands as a cornerstone for informed decision-making and optimal patient care. However, the reality often falls short of this ideal, particularly with off-the-shelf medical systems. These systems, while functional, lack the capacity to aggregate data from other systems and merge it in a readily accessible format.
When clinicians engage with patients, there’s an array of medical data that needs to be considered for effective patient outreach. Patient demographics, diagnostic results, treatment history, programs they’re enrolled in, contact preferences, etc., are all data that influence how the clinician reaches out to the patient.
Care management plays a crucial role within health plans, serving as a proactive approach to coordinate and optimize healthcare services for members, particularly those with complex medical needs or chronic conditions. Care management programs contribute to improved health outcomes, enhanced member satisfaction, and cost-effective healthcare delivery within health plans. Care Management programs can vary from plan to plan, and include functions of Patient Advocacy, Coordination of Care, Chronic Disease Management, Preventive Care, Medication Management, Risk Assessment and Stratification, Transitional Care, Behavioral Health Support, Health Education and Coaching, and Utilization Management.
Estimates suggest that health plans may allocate 10% of their administrative budget to care management efforts, although these figures can vary based on factors such as the size of the plan, the population it serves, and the specific care management programs implemented. Ultimately, health plans allocate a significant portion of their budget to care management initiatives, recognizing the value of proactive healthcare coordination in improving member outcomes and reducing overall healthcare costs.
Having a holistic, 360° clinical view of a member’s overall health has become a critical tool in realizing the potential of improving member outcomes and realizing the ROI from this critical investment in care.
Impact on Clinical Workflow
Data integration and interoperability are significant challenges within off-the-shelf care management systems. Off-the-shelf medical systems can seem attractive to healthcare providers, offering a range of functionalities within an easily implementable, ready-to-use platform, however, because these medical systems are often built to accommodate a wide range of functions, they can be limiting for performing more specific roles.
Clinicians responsible for delivering high-quality care face obstacles when attempting to access pertinent patient information. They must conduct exhaustive searches to find the medical data they need. This inefficiency not only hinders the clinicians’ ability to deliver timely care but also introduces the risk of oversight or misinterpretation of vital medical data.
The fragmentation of medical data across various sources only increases this challenge. Without a cohesive system in place, finding the necessary data becomes a hunt through multiple medical systems. To this point, reports indicate that 60% of health systems receive duplicate, incomplete, or junk data.
Clinicians in Care Management functions often rely on the premise of the “next best action” to determine the most appropriate course of action for a patient’s care at any given time. This data-driven approach requires unifying relevant patient data from various sources, including electronic health records (EHRs), medical claims, member benefits, engagement data, etc. Furthermore, using predictive analytics and decision support tools can greatly assist clinicians in making data-driven “next best actions”, like reaching out to patients through channels they like to engage with.
The Need for a Solution
In light of these challenges, there emerges a critical need for innovative solutions that bridge the gap between disparate medical data sources and streamlined clinical workflows. By leveraging advanced technologies and data integration frameworks, healthcare organizations can empower clinicians with seamless access to comprehensive patient information, thereby enhancing diagnostic accuracy, treatment efficacy, and overall patient outcomes.
10Pearls Health partnered with a leading national healthcare payer to develop Member 360°, a system that consolidates all patient data sources to present it in a way that is truly beneficial for clinicians. The solution relieves healthcare professionals from spending time navigating through different platforms and allows them to focus on providing thoughtful and effective patient care.
Approaching the Problem with Agility
To ensure the success of Member 360°, we followed an Agile development methodology, conducting routine group meetings to gather continuous feedback during the development process. By working closely with the clinicians, we developed a strong understanding of their day-to-day challenges and the data that mattered most to them. There were several instances where these feedback sessions resulted in new features that were implemented in the system. This collaborative approach allowed the clinicians that would be using the system to feel more connected to the solution, while also empowering us to create a platform that truly met their needs.
Developing User-Centric Solutions
Understanding the difficulties that come with migrating to a new software – like training, workflow disruptions, and ensuring a positive user experience, we prioritized making the system transition as seamless and frictionless as possible for the clinicians.
Lowering the Barriers to Entry
When designing the Member 360° interface, 10Pearls Health implemented single sign-on authentication for users, allowing them to authenticate once and gain access to all authorized resources without needing to re-enter their credentials. With single sign-on, the adoption process was made drastically smoother for clinicians, reducing the typical frustrations that come with transitioning to a new platform and enhancing their overall user experience.
Pinpointing the Right Data
The original system in place had hundreds of fields of data. When speaking with the clinicians, we learned that most of their work focused on 10 of these fields.
Keeping in mind time and budget constraints, as well as ease of adoptability, 10Pearls Health worked by the 80/20 rule, first focusing on providing the most pertinent data that allowed clinicians to gain a functional view of the patient. This included demographic data, health and wellness programs the patient is enrolled in, health metrics the patient has logged as part of those programs, claims data, immunization records, social determinant of health (SDOH) scores, benefits information, lab results, member scores, and encounter history.
From there, clinicians could utilize the other medical systems to access any supplemental information they needed for the patient.
Designing for Streamlined Adoptability
Working closely with the clinician team was integral to the interface design process of Member 360°. Because we were coming into this process to create a more useful and functional software for clinicians, we wanted to ensure that our new system lived up to that expectation. Through extensive collaboration, we collected valuable feedback and insight, providing us with a thorough understanding of their needs, operations, and the system’s utility within their distinct roles.
After having a comprehensive understanding of their workflow and preferences, we were able to iterate on our learnings and create user interfaces that were easier to work with and increased productivity.
Conclusion
The Impact on Patient Care
Member 360° drastically improved user experience for clinicians utilizing the platform. Finally, clinicians had access to all the medical data they needed in one place and didn’t have to waste time scouring different systems for basic information. This increase has had a direct effect on operating expenses.
Over 10% reduction in administrative costs
By providing clinicians with a large scope snapshot of patient-critical data, they were able to dedicate more time to creating meaningful outreach experiences and delved deeper into patient data to identify gaps in care, allowing them to develop more comprehensive intervention programs and solutions for patients.
Member 360° has instilled confidence where clinicians once felt doubt.
They trust the app. They trust the data. They know that it’s going to be more up to date than other locations and easy to find what they need right away."
Starting with 100 individual users and growing to 2,500 unique users and counting, the value of Member 360° continues to be recognized by clinicians and healthcare providers nationwide.
The Scalable Value of Member 360°: A Dashboard for Decision Making
With the ability to capture vital patient data, Member 360° has the power to serve as a reliable source of truth for healthcare professionals in their daily tasks. It offers far more adaptability and scalability than off-the-shelf solutions that require users to operate within a strict system infrastructure with no valuable customization capabilities.
At its core, Member 360° is an optimization function that unifies member-critical data in an actionable dashboard. This versatile solution wields the potential to be leveraged across various healthcare roles and departments. Member 360° addresses a large gap in the market by offering a simple, centralized clinical dashboard, empowering clinicians to focus on creating more effective and streamlined patient care experiences. Any healthcare entity managing a patient population like Accountable Care Organizations (ACOs) and healthcare providers in a value-based care (VBC) arrangement are fundamentally incentivized to achieve their goals of improving patient outcomes, enhancing patient experience, and controlling healthcare costs. A data-driven, actionable member view is key to improving clinical workflow and delivering on the promise of improved member care and ROI.
Looking Ahead with 10Pearls
In navigating these challenges, partnering with a seasoned healthcare consulting and technology partner can offer a pivotal advantage. At 10Pearls, we provide strategic healthcare consulting, product innovation, and software development services to empower health providers and payers to provide industry-leading patient care.
We are passionate about leveraging cutting-edge technology to advance clinical innovations, transform operations, improve patient outcomes, and reimagine patient experiences. From innovative digital therapeutics to scalable telemedicine practices, we have a deep expertise in helping health partners navigate industry complexities and facilitate the implementation of simple and effective solutions.
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