AI is hyped, but big data, social determinants may have a bigger impact

The shift to value-based care often has C-suite executives wondering how best to support the transition, while ensuring a solid return on investment in the long term. And the key to improving care value is to ensure an organization has the right tools to support patients throughout the care cycle.

To Sheela Ramamurthy, VirtualHealth chief client officer, organizations need to focus on the most vulnerable care populations to make the biggest impact. And while there’s a lot of hype around artificial intelligence and robotics, the tools that run in the background will make the greatest impact on those care populations.

“Solutions that bring data together to address whole-person care not only bridge gaps in both care and services, but help patients stay healthy and out of the hospital or emergency room,” said Ramamurthy. “Actionable insights provided through care management technology help ensure patients with the greatest needs get timely access to services.”

Organizations need to consider various avenues when choosing the best approach for their members’ health, explained Ramamurthy. That will include “configurability, cloud native compliance and revenue optimization.”

“As such, the value proposition of a care management platform is directly tied to its ability to support a ‘whole-person’ patient view,” she said.

One piece of this equation is accurately capturing diagnostic and procedure codes, Ramamurthy said. But organizations also need to layer other critical components like social determinants, while “analyzing and manipulating data and identifying social services and resources.”

“Simply put, organizations must have a means of efficiently aggregating data on the individual level and proactively acting on insights,” said Ramamurthy.

Leveraging social determinants

The role of social determinants cannot be overstated, Ramamurthy said. To achieve health equity, organizations need to address the economic and social conditions that directly influence the health of its communities.

Poverty, unequal access to healthcare, lack of education, racism and stigma all play into this, said Ramamurthy. A Population Health Management report found behavioral and socioeconomic factors can determine up to 60 percent of an individual’s overall health.

“It becomes clear that organizations must look beyond medical or behavioral factors to address the whole person,” said Ramamurthy.

But capturing social determinant does more than improve patient health: It’s critical for cost reduction. Ramamurthy said one health organization saw a “10 percent reduction in healthcare costs between people who were successfully connected to social services versus those who were not.”

“The savings equated to more than $2,400 per person annually,” she said.

To get there, these factors need to become a more common consideration of care planning.

“Reducing the resource burden of impactful population health initiatives is not easy,” said Ramamurthy. “In the past, care management platforms have struggled to provide the flexibility needed to address specific health and population nuances to enable the deep analysis needed to truly impact outcomes.”

“That’s one reason it’s vital to overcome challenges associated with multiple legacy components through a single integrated platform that incorporates clinical, behavioral and social data streams,” she said.

By using a value-based platform, an organization can pool information from intelligent and responsive workflows that let care teams efficiently find and bridge care gaps, said Ramamurthy. These platforms can improve the rate at which patients receive care and prevent costly ER visits and hospitalization.

“This approach is particularly critical to support the nation’s most vulnerable patients — the developmentally and intellectually disabled, low-income and elderly,” Ramamurthy said. “The primary goal of any care management technology investment is to improve the health and cost burden of member populations.”

“In terms of ROI, this means that health organizations must be able to tie bottom-line improvements to tangible outcomes such as reduced hospitalizations and high-cost interventions, or the consumption of fewer medications,” she said.

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