Question

What are the advantages of the Health First database? What are some concerns about the reliability and predictive validity of the Health First data set?

Case Study:

Central Medical is a multispecialty group practice that has embraced the community-of-practice concept of an ACO. The practice formed an interdisciplinary innovation team to identify how to improve clinical outcomes, maintain a healthy population, increase efficiency, and coordinate care. It comprises 60 physicians and four clinics. Two of the clinics deliver primary care and focus on family medicine, internal medicine, and obstetrics/gynecology. One is a specialty clinic with a multidisciplinary staff devoted to metabolic disorders, and the other (the largest) offers a range of clinical specialties. All four clinics are centrally managed with an integrated EMR, which has the capacity to present clinical information in meaningful and actionable ways, including trend lines for patients, evidence-based clinical guidelines, and integrated treatment protocols. Central Medical has multispecialty teams whose composition is tailored to the needs of the particular illness. The team members include primary care physicians, chronic care nurses, therapists, nutritionists, and health educators. After the start-up period, these teams developed a level of comfort and respect that enables the team members to bring the best discipline-based evidence to support diagnosis and treatment, healthy patient lifestyles, and the total-person concept of patient care. Because of its emphasis on improving patient behavior and knowledge about healthy lifestyles, Central Medical decides to invite patients with specific diseases to join the multispecialty team focused on that illness. Two patients and their respective family caregivers are added to the committee organized to identify and treat high-risk, chronic-care patients. The innovation team identifies the investment in institutional capacity for processing information as a key strategic resource, where knowledge on wellness and health maintenance can be embedded in treatment protocols. The team agrees that the planned strategy's focus should be on quality, safety, efficiency, and alignment of the clinical and financial functions. This approach is consistent with the philosophy and values set forth by the ACO—to coordinate care and address the overall health of patients, not just treat their illness. The patient population is distributed, demographically diverse, and covered by a range of insurance companies with different eligibility criteria and benefit packages. Among the insurance providers is Health First, a large capitation-based plan with more than a million members, including 20,000 of Central Medical's patients. People are generally satisfied with Health First, in part because it enrolls a significant number of Central Medical's patients. However, its mission does not align with that of the practice. Central Medical has an incentive to negotiate higher capitation rates, which will enable the practice to realize a financial return by aggressively managing utilization. Health First is motivated to (1) set lower capitation rates because of the aggressive market, where businesses are willing to change insurers for small differences in cost, and (2) shift the risk to Central Medical. As a strategy, Central Medical enters negotiations with Health First, basing its utilization rates and costs on historical performance and taking a strong position on setting higher capitation rates. The practice believes patients will stay loyal to the clinics because of the high quality of staff and strong patient orientation. Both organizations accept their adversarial relationship, which they consider to be inherent in the healthcare and health insurance industries. Central Medical's innovation team moves forward with developing a strategy for carrying out its mission. It focuses on disease management of complex chronic illnesses, such as type 2 diabetes, as well as accessing and using evidence-based clinical guidelines. The practice discovers from available literature that intensive interventions, such as life coaches, demonstrate a 20 percent reduction in glycosylated hemoglobin (HbA1c) within 6 months for some patients. However, the team cannot justify the cost of adding the staff needed for intensive health maintenance for its sizable type 2 diabetes patient population. This particular population is inherently high risk, although some patients with the same diagnosis use resources at a much higher rate than others. If the team could systematically identify diabetes patients who are at highest risk, it could better focus its intensive maintenance strategy, improve health, and increase efficiency. The challenge is identifying the characteristics of the patients with the highest risk in this high-risk population. These parameters are not revealed in the existing evidence from systematic reviews. Senior clinicians suggest relying on the clinical judgments of individual clinicians; although logical, this approach cannot accurately identify the highest-risk patients because there are complex interdependencies. The team decides to analyze the collective medical records of its physician panel, but the predictive models lack rigor because of low population samples. During a brainstorming session, the team proposes a collaboration with Health First to use Big Data to identify the highest-risk patients on the basis of their rate of resource utilization. From analyzing Health First's population-based enrollment data, the team is able to demonstrate that 1 to 2 percent of all patients with diabetes account for up to 30 percent of the total costs for this diagnostic group. Variables used in the predictive models include total annual prescriptions, unique (disease-specific) annual prescriptions, physician visits, hospital utilization (including emergency services), comorbidities, age, gender, occupation, family composition, benefit coverage, and treatment history. The team concludes that, by deploying a predictive model and a focused strategy, the information system could identify patients from a high-risk population who have the highest risk as well as a range of targeted interventions, such as life coaches and other intensive treatments. One team member says, “Precision medicine from a managed care firm. Who would believe it!”

Answer 1

There are many changes taking place in the healthcare sector. One may therefore ask why are databases important? Simple, it’s essential that proper systems are in place to manage the health data.

Healthcare databases are an important part of running the entire operations. Such systems include labs, finances, patient identification, tracking, billing, payments, among others. The reality is that almost everything runs on a database system and we cannot underscore the importance of technology in healthcare.

Our article below will explore the importance of databases in healthcare.

What are Databases?

In its simplest definition, a database is any record that a practitioner maintains in paper form or on a computer. It does not matter whether it is a sole practitioner or corporate bodies. With technological innovations, medical facilities are leaning towards online transaction processing, thus doing away with paper.

Anything that a medical practitioner collects from a patient forms part of the database. These include encounter forms, discharge forms, or any other registries. The whole purpose then of having a database is to ensure that the information is safe, updatable when necessary, and is easily accessible to anyone who may require them.

With the rapid growth of technology use in the healthcare sector, there is the generation of a lot of data. It, therefore, becomes a requirement that they collate the information for ease-of-use. This will greatly assist healthcare professionals in the discharge of their duties.

Why are Databases Important?

The Healthcare system generates data that requires delicate handling. A patient’s life depends on this information, and it is therefore important for the Healthcare provider to be able to access it in the shortest time possible.

We will explore some of the reasons below.

1. Efficiency

Every time a patient visits a medical institution, there is a lot of information that is collected. Where the patient requires seeing many different practitioners, the diagnosis, procedures, drug prescriptions, or any other intervention, needs to be on record. This process will require the safe storage of data.
Now, imagine a typical day and the number of patients who come to the hospital. Well-designed hospital databases are important for the collection of patient information. It will also assist in achieving efficiency due to the processing of data, thus giving the Healthcare provider relevant information with a click-of-a-button.

The data will require a level of manipulation to make it easier to use. A doctor may, for example, not have time to go through mounds of data when a patient comes in. It, therefore, requires that the information undergoes query, filtering and retrieval using the relevant technology.

2. Exchange of Information

In the case that a patient needs the services of healthcare providers in different hospitals, a system needs to be in a place that helps in the exchange of information. Hospitals need to exchange healthcare data anytime there is a requirement.

It is therefore important that there is function integration through things like patient identification, healthcare access control, and order management services, among others. Technology is essential because standards for the workflow are an important requirement.

3. Monitoring and Improving the Value of Healthcare

Health care database systems provide an important way of monitoring and improving the value of healthcare services. This will result in better well-being for the patients. Healthcare providers find a way of availing information on costs, appropriate and effective treatment, and access to care and the quality of service a patient gets.

Any institution or external group of petitioners can get access to this information for various uses. The data can help in quality assurance and improvement programs for health planning purposes at a regional level. The information can provide important answers about policy issues surrounding reforms in the sector.

Patients can expect better health care, better health, improved efficiency, lower costs and better clinical decision-making.

4. Assessing the Quality of Healthcare

Data for hospitals come from very many sources, including other hospitals, state and regional organizations, Department of Health, federal agencies, among others. The hospital administration discharge information provides valuable data for measuring quality. Such pertinent information includes diagnosis, procedures, length of stay, charges, among others.

Quality experts use hospitals databases to assess healthcare quality. They will consider factors such as:-

• How accessible are the healthcare facilities to the people within the region
• Affordability and timeliness of care
• The barriers to seeking Healthcare
• How appropriate or necessary the services are
• If the Healthcare facilities are following practice guidelines
• Availability of pertinent information to clinicians and other institutions
• Whether the services are appropriate for the identified Healthcare problems
• The use of innovation with regards to healthcare delivery
• Financing of healthcare facilities, among others.

5. Tracking Healthcare Usage

Healthcare databases can give medical providers an important tool for tracking Healthcare use. Healthcare providers, for instance, need to know whether people are getting their vaccinations or not. By having information through the reports, they are better able to tell whether or not this is happening.

By having the ability to track healthcare usage, providers can take care of diseases like influenza, polio, and measles, among others. Eradication of such diseases requires that the patients seek treatment and get the necessary vaccinations.

6. Other Uses

Healthcare databases have a wide range of other uses including:-

• Provision of accurate, up-to-date patient information
• Increase in efficiency due to quick access to records
• Safety of patient information
• Help with diagnosis and prescription. It will help in reducing medical errors
• Improving patient and healthcare interaction
• Assists with documentation and billing
• Reduction in medical facility running costs due to less paperwork and clerical staff

The Healthcare Sector Needs Database Systems

The question; why are databases important, has been the basis of our discussion above. A well-designed Healthcare database system is important for the day-to-day running of the day Healthcare sector. The proper technology will make it possible for the health care providers to collect pertinent information that will improve the quality of care they provide.

Policymakers can also use this information to make reforms in the sector. The sharing of information between and among providers and institutions will also help patient’s access to better care. The medical field is changing rapidly, and there is a higher need for the right technology, information management, and database development. We understand the impact of technology on data management, and you can contact us for more information.