2019-08-20

Can’t My EHR Do This? 7 reasons you need a care management platform

As the move to value-based care accelerates, and as policy continues to provide incentives and requirements to transition away from a fee-for-service (FFS) model, new capabilities are becoming imperative to the way health systems do business. Advanced reporting requirements on cost and outcomes, population health management and patient engagement, data integration and analytics… the list goes on.

What is quickly becoming apparent to organizations that are migrating away from FFS is that an EHR alone cannot meet the needs of healthcare organizations operating under value-based care. We’ve already shared a few reasons why in an earlier post in this series on the limitations of EHRs.

At its core, an EHR is a digitization of the patient chart. It is essential for collecting and storing clinical patient data, as well as coordinating medical billing, but it does not provide the workflow automation or interactivity required to organize around targeted interventions and care planning. It also does not reflect information outside of the clinical setting that is critical for value-based care delivery, such as behavioral health or social determinants of health (SDOH). These are a few highlights, and we discussed several others in the second post in this series on the difference between EHRs and care management solutions.

While many are feeling these limitations in their day-to-day, others might be asking, “Wait… can’t my EHR do this?” Most of the time, it cannot. That’s why health systems must go beyond the EHR to meet the demands of a value-based world. So, what are some of the capabilities a population health care management technology can provide that an EHR cannot?

7 Key Features of a Population Health Care Management Platform

  1. Data Ingestion & Actionable Insights: Patient data is oftentimes locked in multiple siloes across multiple organizations (e.g., payer claims data, various primary care and specialty providers, behavioral health providers). The right technology aggregates data from most, if not all, of these disparate sources, normalizes it and provides the right access to the right people, so that they have it available to them at the right time to make appropriate care decisions. This can even include non-clinical data, such as SDOH, wearables, and behavioral health. As different members of the care team interact with the patient, updates are documented within the solution, creating a more comprehensive record of patient care than what the EHR provides alone.

  2. Patient Stratification: Identification, segmentation and prioritization of high-risk, as well as rising risk, patients is core to successful population health and care coordination. The so-called “magic spreadsheet” is no longer sufficient—health systems need predictive analytics capabilities to create prioritized, dynamic worklists that update as new data is entered into the system. This can be done within a care management platform.

  3. Workflow Automation: Care management solutions are an essential part of making care managers more efficient. It starts with automating care plans based on patient risk and historical patient context. Once a care plan is generated, there is a series of tasks and triggers assigned to members of a patient’s care team to create accountability and transparency into the path forward. In this workflow, everything is customizable to desired best practices and service level agreements, and the initial auto-generated care plan creates efficiencies and empowers care managements to make informed, data-driven decisions to improve patient outcomes.

  4. Role-Based Configuration: Complementary to the role of accountability is a care management platform’s ability to configure to different users. Bringing the right information to the forefront equips providers with the right data at the right time. Role-based configuration also allows organizations to restrict access to only the patients within that provider’s care, which enhances privacy and security while also allowing providers to focus only on the patients that pertain to them.

  5. Patient Engagement: Care manager caseloads are growing at an unsustainable rate. When care managers are required to connect with hundreds of patients a week, they need a tool that enables efficient care coordination—through features like click-to-call automated dialing and custom assessment building. Care managers that are equipped with the right patient-level information at the right time can better engage patients in their care, which is also key to delivering care in value-based arrangements.

  6. Cross-Functional Communication: Care management platforms are also critical to effective care coordination across multi-disciplinary teams. In order to minimize the adverse events important to value-based care (e.g., readmissions, unnecessary ER visits, avoidable inpatient visits), providers must connect and exchange data cross the healthcare ecosystem. The right technology will support easy and secure communication with other providers, specialists, patients and caregivers. This communication and coordination through a care management platform gives the entire care team visibility into a longitudinal patient record, which ensures each party is acting on the best patient information and all are aligned on the path forward.

  7. Performance Management: The transition to value-based care has created an entirely new set of reporting requirements for healthcare organizations. There is MIPS and APMs through the Quality Payment Program from CMS; quality reporting through Star Ratings; general outcomes-based reporting; plus, any other performance metric for population health management. Care management platforms have advanced reporting capabilities that allow healthcare organizations to meet these requirements without much burden on the care team.

Conclusion

If you or your boss has asked the question, “Can’t our EHR do this?” you may have found yourself frustrated when the answer is no. Sometimes, you can enhance functionality through add-ons or web portals offered by your EHR vendor. But none of these supplemental offerings will provide the full suite of features listed above, and if you’re going to purchase an add-on anyways, why not get a full population health solution? We’re certain that the value will outweigh any associated costs.

The technology capabilities of the value-based healthcare organization must empower multi-disciplinary care teams and equip providers, care managers, patients and caregivers with the right information to support the best outcomes.

To learn more about the advanced capabilities of Texture Health’s population health care management solution, contact us to schedule a demo.


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