Tech-Enhanced Coordination: Using Data-Driven Approaches in Alternative Payment Models
The AHEAD Model is a pioneering initiative aiming to reshape state and regional health systems through a Total Cost of Care (TCOC) approach. The Making Care Primary (MCP) Model, a 10.5-year multi-payer initiative, builds upon the successes of previous models like Comprehensive Primary Care (CPC), CPC+, and Primary Care First (PCF), as well as the Maryland Primary Care Program (MDPCP). MCP elevates primary care services and sets the stage for a high-performing health system.
These innovative models, driven by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, hold immense potential for leveraging evolving technologies and harnessing the power of data analytics to drive significant improvements in the health of state populations and the reduction of healthcare costs.
Leveraging Evolving Technology
The AHEAD and MCP models' success depends on an interoperable data infrastructure that supports the seamless collection, sharing, use, and aggregation of individual and population-level data. Technologies that will play a pivotal role will be those that easily integrate with existing platforms and scale, such as:
Telehealth and Remote Monitoring. The COVID-19 pandemic provided a clear value proposition for how these tools enable providers to deliver care remotely, improving access for underserved populations and facilitating proactive management of chronic conditions as demonstrated by Oak Street Health.
Artificial Intelligence (AI) and Machine Learning (ML). AI/ML models analyze robust levels of healthcare data to identify patterns, predict outcomes, and personalize treatment plans.
Health Information Exchange (HIE). Evolving HIE platforms and Health Data Utility (HDU) models facilitate seamless information exchange between state agencies, payers, providers, community partners, and the public. Core to these platforms is technology that ensures relevant patient data is accessible across healthcare entities and coordinated across multi-disciplinary providers.
Harnessing Data Analytics
Data analytics catalyzes success in AAPMs, enabling providers to derive actionable insights and drive decision-making. Critical opportunities for the AHEAD and MCP models include:
Care Coordination. Coordinated care is essential for improving patient and/or individual outcomes and reducing unnecessary healthcare and human services utilization. Data analytics can facilitate care coordination by providing insights into patient transitions across care settings, identifying gaps in care, and facilitating communication among care team members.
Population Health Management. Data analytics platforms aggregate and analyze population-level data to identify trends, disparities, and areas for improvement in healthcare delivery. These insights provide a shared understanding of the unique needs of populations and enable upstream efforts that implement targeted interventions to improve health and reduce social disparities.
Risk Stratification and Predictive Modeling. Advanced analytics techniques, such as risk stratification and predictive modeling, identify high-risk patients who may benefit from intensive care management. By prioritizing these individuals for interventions, providers can prevent adverse events, reduce hospitalizations, and lower overall healthcare costs.
Social Drivers of Health. Providers can readily use data analytics platforms to identify social risk factors and tailor interventions accordingly. Evolving health and social care information technology solutions have the potential to serve as dynamic hubs that can readily collect and aggregate data across disparate systems to generate real-time insights. These technologies are leveraging artificial intelligence and machine learning models for advanced analytics that track patient engagement with health and social services and provide insights into patients’ health and digital literacy and the extent of adherence so that providers can customize care plans around their needs and preferences.
Conclusion
Technology is a powerful catalyst in pursuing health equity, offering unprecedented opportunities to bridge gaps, address disparities, and ensure that healthcare resources are accessible to all. The new AHEAD and MCP models represent a paradigm shift in healthcare and hold immense potential for transforming healthcare delivery and improving population health while reducing costs. By leveraging technologies such as telehealth, AI, and HIE and harnessing the power of data analytics, providers, states, and payers can drive meaningful improvements in care quality, outcomes, and efficiency. As participating organizations embrace this innovative approach, they can harness the power of information to enhance care coordination, support health equity, and ultimately improve the overall health outcomes of their populations.
About
Karen Marie Joswick is the CEO and Founder of Benevolence Health and serves as a national thought leader on value-based care and health system operations. Her passion is to accelerate the quintuple aim and improve health, not just healthcare. Her areas of expertise include global budgets, contracting, compliance, population health analytics, and quality improvement. She is the former enterprise vice president and Chief Value Officer for Nemours Children Health and has senior system roles at the University of Maryland Medical System, UM Quality Care Network, and Transform Health MD. She is on the faculty at Jefferson University in the College of Population Health and serves as a strategic advisor to innovation accelerators.
Evelyn Gallego is the CEO and Founder of EMI Advisors and a national expert in health and social services data interoperability. She is a results and mission-driven leader with 20+ years of experience optimizing health, high-tech, government, and non-profit organizations. Evelyn provides specialized expertise in digital health interoperability and health policy, focusing on aligning regulatory, technical, and process improvement requirements to enable the effective adoption and use of technology. Evelyn is the co-founder of the Gravity Project and an active board member for IHE USA and United Community, a non-profit community-based organization in Fairfax, VA. She also serves as adjunct faculty at George Washington University.