Population Health – The Integration of Technology & Services

Big data will continue to be an essential element of improving clinical and financial performance for all health care institutions in the future. The ability to include larger and more specific data sets (HIE, ADT, claims, pharmacy, lab, imaging, genomics, etc.) will help institutions pinpoint actionable uses of information to improve care delivery, reduce costs and ultimately improve health outcomes for the patients they serve.

For many institutions, the technology architecture for this endeavor can be expensive and overwhelming, particularly as the integration with disparate data sources are required to effectively manage clinical and financial performance under value-based contracts.

Providers are challenged by stoic, closed EMR’s systems that provide very little in flexibility and integration with third party data sources and applications. Many “bolt-on” population health modules miss the mark on the integration needed to manage across the continuum-of-care and collaborate effectively with care teams outside their own institutions. To effectively address this issue, Providers have turned to enterprise data warehouses and clinical analytics to help data mine their EMR’s to identify critical patient data and stratify their patient populations.

Furthermore, providers must contend with multiple forms and requirements from multiple health plans. Many times, those plans may only have a small membership panel with the physician. The already growing administrative burden is exacerbated when new demands for value-based measurements, quality reporting, MACRA/Mips are added to an already demanding set of workflows.

As providers bring on more risk and organize to manage utilization, an integrated workflow product is essential. Trying to morph an EMR product into an integrated population health platform presents meaningful risks.

Often left out of this discussion is the Payers’ need for improved clinical and financial integration. As payers more closely align and integrate with providers, the ability to position payer integrated care teams virtually and coordinate care across the community of providers is essential. Payers have strong regulatory and financial demands for access to provider encounter data, gaps in care, and quality reporting for HEDIS and STARS. Payers need an active role in the management of the health of their membership.

That’s where Equality Health comes in. At the intersection of the payer and provider integration needs, we offer a comprehensive platform designed bridge the demands across both institutions.

Equality Health is and standalone company, not owned by a Hospital or a Health Plan. Our independence can help organizations share data and insights without giving up any proprietary or competitive intelligence. Our solutions identify, assess, and stratify patient cohorts so that your organization can supplement the role of your care teams, manage your patient population more effectively and efficiently, drive better outcomes, and decrease overall cost.

HealthBI CareEmpower Platform

Automated Transition Care

Effective transitional care management plays a major role in improving population health, maximizing reimbursements and reducing costs for Payers, Accountable Care Organizations, hospitals, physician networks, and Primary Care Medical Homes.

HealthBI has developed an integrated suite of applications that enables health care organizations and health plans to coordinated, manage and monitor patients’ continuity of care anywhere/anytime. This EMR neutral Population Health solution aligns patient-specific transitional care needs with data analytics, customized workflows, care team collaboration and patient engagement tools to efficiently navigate patients from hospitals to ambulatory and community care settings. HealthBI improves your clinical and financial outcomes with easy integration into your clinical workflow to:

  • Deploy effective Technology Solutions for Integrated Care Model
  • Manage & Track Care for Large Patient Populations
  • Aggregate, Analyze, and Report Population Health Data
  • Send Event Notifications and Data to Care Teams
  • Create & Manage Workflows and Care Plans
  • Proactively Engage Providers and Patients
  • Improve Patient Satisfaction Scores
  • Report Care Coordination Quality Metrics

Population Health Data Analytics and Reporting

Health care providers and payers are challenged to maintain quality standards, find solutions to improve financial positions and care delivery models while competing in an environment of escalating costs and increasing demand for care. Payers and providers must access multiple data sources to obtain the ability to view performance indicators, predict outcomes, determine trends and monitor performance.

HealthBI offers Business Intelligence architecture to unify reporting, data analysis and real-time monitoring for your organization. By Tracking clinical key indicators, HealthBI data mining and analytic services will help your organization find and track patients by disease status, risk status, clinical history, lifestyle, community and family needs from both inside and outside of the CareEmpower ecosystem. By connecting with your data sources, HealthBI will find patients with chronic diseases that are best candidates for chronic care management. These patients will then automatically be added to the CareEmpower system and associated with evidence-based Care Flows, based on predefined categories. HealthBI reporting services can provide your organization and provider partners with valuable insight into your Population Health Management performance, results, gaps and more.

Event Notification and Clinical Data Exchange

Many health care providers and health plans are unaware of their patients’ ER visits or hospital admits and discharges. The ability to quickly notify and mobilize the care team can reduce hospital readmissions and avert millions of dollars of spending on preventable hospitalizations.

Event Notification System (ENS) connects, alerts and updates health care providers and payers of patients ADT events and outcomes. The available notifications can also include lab, radiology and transcription results and reports. This approach ensures a quick deployment of the care team and proactive engagement, monitoring and navigation of patients through the continuum of care.

Through integration and processing of HL7 ADT messages, CareEmpower (ENS) provides real-time or daily batch notifications with critical information to payers, private physicians, care management teams, ACOs–alerting them of their members’ acute encounters with participating hospitals.

The Event Notification System can be deployed as a standalone system or as part of the complete Population Health Management Solution. All notifications are delivered via a multi-channel secure messaging platform. The Event Notification System helps health care payers and providers to:

  • Integration with HIEs
  • Create Master Patient-Provider Index
  • Receive detailed notifications of acute care episodes
  • Receive clinical data and reports
  • Be notified of readmissions
  • Quickly deploy a transitional care team
  • Timely execution of care plans
  • Improve patient satisfaction scores
+ Automation

Automated Transition Care

Effective transitional care management plays a major role in improving population health, maximizing reimbursements and reducing costs for Payers, Accountable Care Organizations, hospitals, physician networks, and Primary Care Medical Homes.

HealthBI has developed an integrated suite of applications that enables health care organizations and health plans to coordinated, manage and monitor patients’ continuity of care anywhere/anytime. This EMR neutral Population Health solution aligns patient-specific transitional care needs with data analytics, customized workflows, care team collaboration and patient engagement tools to efficiently navigate patients from hospitals to ambulatory and community care settings. HealthBI improves your clinical and financial outcomes with easy integration into your clinical workflow to:

  • Deploy effective Technology Solutions for Integrated Care Model
  • Manage & Track Care for Large Patient Populations
  • Aggregate, Analyze, and Report Population Health Data
  • Send Event Notifications and Data to Care Teams
  • Create & Manage Workflows and Care Plans
  • Proactively Engage Providers and Patients
  • Improve Patient Satisfaction Scores
  • Report Care Coordination Quality Metrics
+ Analytics and Reporting

Population Health Data Analytics and Reporting

Health care providers and payers are challenged to maintain quality standards, find solutions to improve financial positions and care delivery models while competing in an environment of escalating costs and increasing demand for care. Payers and providers must access multiple data sources to obtain the ability to view performance indicators, predict outcomes, determine trends and monitor performance.

HealthBI offers Business Intelligence architecture to unify reporting, data analysis and real-time monitoring for your organization. By Tracking clinical key indicators, HealthBI data mining and analytic services will help your organization find and track patients by disease status, risk status, clinical history, lifestyle, community and family needs from both inside and outside of the CareEmpower ecosystem. By connecting with your data sources, HealthBI will find patients with chronic diseases that are best candidates for chronic care management. These patients will then automatically be added to the CareEmpower system and associated with evidence-based Care Flows, based on predefined categories. HealthBI reporting services can provide your organization and provider partners with valuable insight into your Population Health Management performance, results, gaps and more.

+ Notification

Event Notification and Clinical Data Exchange

Many health care providers and health plans are unaware of their patients’ ER visits or hospital admits and discharges. The ability to quickly notify and mobilize the care team can reduce hospital readmissions and avert millions of dollars of spending on preventable hospitalizations.

Event Notification System (ENS) connects, alerts and updates health care providers and payers of patients ADT events and outcomes. The available notifications can also include lab, radiology and transcription results and reports. This approach ensures a quick deployment of the care team and proactive engagement, monitoring and navigation of patients through the continuum of care.

Through integration and processing of HL7 ADT messages, CareEmpower (ENS) provides real-time or daily batch notifications with critical information to payers, private physicians, care management teams, ACOs–alerting them of their members’ acute encounters with participating hospitals.

The Event Notification System can be deployed as a standalone system or as part of the complete Population Health Management Solution. All notifications are delivered via a multi-channel secure messaging platform. The Event Notification System helps health care payers and providers to:

  • Integration with HIEs
  • Create Master Patient-Provider Index
  • Receive detailed notifications of acute care episodes
  • Receive clinical data and reports
  • Be notified of readmissions
  • Quickly deploy a transitional care team
  • Timely execution of care plans
  • Improve patient satisfaction scores

Request an Appointment

For more information about Equality Health Network or to schedule an appointment with one of our physician advocates contact us:

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