Why Precise, Tailored Patient Registries Lead to Cost-Effective Care Management Programs

Why Precise, Tailored Patient
Registries Lead to Cost-Effective
Care Management Programs

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Patient Registries
One of the hottest topics on
industry blogs and publications
today is evidence-based care
management programs.
Physicians and their assistants,
nurses and nurse practitioners,
and other mid-level professionals
all want to improve outcomes.
When the Centers for Medicare and Medicaid Services
(CMS) recently announced it would begin paying roughly
$42 per patient per month to physicians for managing the
care of Medicare beneficiaries the topic got even hotter.

Patient Registries
The CMS announcement
validated the benefit of care
management as part of an
overall population health
management (PHM) strategy.
Healthcare can no longer afford
to be reactive.
Providers must apply more
proactive interventions, such as
patient education, nutrition
counseling, telephone outreach,
and self-monitoring devices.

Patient Registries
What about patients not falling
under the CMS program?
Providers participating in account-
able care or value-based contracts
should invest in care management
as a way to reduce their overall
utilization.
By building a precise tailored
patient registry providers can
improve outcomes while reducing
cost of care.

Challenges of Building Patient Registries
A registry is simply a collection of
standardized data about a well-
defined patient group who share
similar clinical conditions.
Good registries provide care
management teams a focused set
of patients to work with.
Care management programs have
traditionally been operated by
insurance companies, and usually
focused on high-risk patients only.

These programs have proven
effective at improving care and
reducing cost, but have two
distinct shortfalls:
• They don’t have access to the
rich data of patients’ electronic
health records.
• There is often a meaningful time
delay (i.e., 30+ days) between a
clinical event and the payer’s
awareness of that event.

Take the example of a care
management program for
asthma patients.
The payer can see from the
diagnosis and procedural codes
on claims, which patients were
diagnosed as having asthma
and which ones received
breathing treatments.
The payer also knows which
patients have filled their
Albuterol prescriptions.

The best predictor of risk that a
payer has is the cost of care
provided for that patient.
Unfortunately, cost is a lagging
indicator of clinical risk.
Traditional care management
programs often struggle to
identify rising risk patients where
they can make the biggest
clinical and financial difference.

Hospitals and health systems
that use an enterprise data
warehouse (EDW) can create
far more precise definitions of
which patients to include in the
care management program.
Critical to the success of any
population health management
initiative is the ability to
categorize patient populations
into high, low, and the ever-
important rising-risk groups.

A precise, tailored patient
registry can include patients
with specific breathing issues.
The registry can include
patients where the radiologists’
impression of their chest x-ray
includes bronchial thickening.
It can also stratify asthma risk
based on the results of a
pulmonary function test, or by
patients yet to fill prescriptions
for inhaled or systemic steroids.

The more precise and tailored
a healthcare organization can
make these patient registries,
the more they will be able to
ensure they are focusing their
limited time, money, and
resources where they will do
the most good.

Measuring the Effectiveness of a Care
Management Program
Being able to quantify the ROI of a
care management program is
critical to its effectiveness (and
continuation).
There are three basic methods
used to measure the effectiveness
of a care management program:
1. Randomized control design
2. Historical or intent-to-treat design
3. Matching comparison design

Management Program
Randomized control design
Normally the best option as it
allows the most precise contrast
between creating or not creating
an intervention.
With this method the organization
builds a precise, tailored patient
registry, selects a portion of that
group to receive an intervention
and then compares the results
between the two groups.

Management Program
Historical or intent-to-treat design
With this approach, the organization
can lay out the criteria of people
selected for care management.
Then compare them to past patients
with similar conditions who were not
part of the program and measure
the difference between the two.

Management Program
Matching comparison design
This is the least desirable method,
but sometimes necessary.
In this situation the organization
uses the precise, tailored patient
registry to look for patients from
one employer who isn’t participating
in the care management program
and matches them to another that
is using the program.

Ensuring Measurement Precision
The accuracy of any of these
methods will improve when
candidates are drawn from a
precise, tailored patient registry.
The more accurately the provider
can determine which patients
should be asked to participate, the
better the measurements will be.

Ensuring Measurement Precision
If an organization includes patients
previously documented with asthma
symptoms in asthma trials, it may be
difficult to determine whether they are
improving costs and outcomes.
By focusing on the sickest patients,
and the level right below them, the
organization will gain a better sense
of whether the care management
program is having an impact on
reducing ED visits and inpatient
admissions/readmissions.

The Future of Care Management
We are in the midst of a
transition from payer-led care
management to provider-led
care management.
Providers have access to the
rich, real-time data about their
patients that is instrumental in
stratifying risk and setting up a
population health management
initiative for success.

The Future of Care Management
Precise, tailored patient
registries help accurately
quantify the value of a care
management program and
ensure that a healthcare
organization’s limited time,
money, and resources are
focused where they will deliver
the greatest benefit, both to the
patients and to the bottom line.

More about this topic
Precise Patient Registries: The Foundation for Clinical Research & Population Health
Management Dale Sanders – Senior Vice President, Strategy
How do you use patient registries to track specific diseases and diagnoses and ensure
appropriate care? Health Catalyst
ACO Success Requires Precise Patient Population Definitions
Luke Skelly – Health Catalyst
Population Registries Kick-start Rapid-cycle Clinical Process Improvement
Health Catalyst
From Care Management to Population Health Management (Executive Report)
Brent Dover – President, Health Catalyst
Link to original article for a more in-depth discussion.
Why Precise, Tailored Patient Registries Lead to Cost-Effective Care
Management Programs

For more information:

Jared Crapo joined Health Catalyst in February 2013 as a Vice President. Prior to
coming to Catalyst, he worked for Medicity as the Chief of Staff to the CEO. During
his tenure at Medicity, he was also the Director of Product Management and the
Director of Product Strategy. Jared co-founded Allviant, a spin-out of Medicity, that
created consumer health management tools. In his early career, he developed
physician accounting systems and health claims payment systems.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com

Why Precise, Tailored Patient Registries Lead to Cost-Effective Care Management Programs

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Why Precise, Tailored Patient Registries Lead to Cost-Effective Care Management Programs