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Klas Healthcare Research Paper

Many healthcare organizations have tested the waters of population health management with pilot projects and a few payer contacts, and some of these organizations are ready to dive in deeper, but are population health management vendors ready as well? At this point, no one vendor has both breadth and depth to meet all needs for all types of healthcare organizations, according to a new KLAS report.

For the population health management vendor performance report, researchers gathered feedback from 278 providers about their experience using population health management solutions. The KLAS study focused on asking participants to rate their vendors against two criteria: 1) the ease with which customers can establish and maintain data feeds and, 2) the quality of the resulting aggregated data.

The report evaluated fully-validated vendors’ population health management products in areas such as ease of module integration, vendor adaptability, and the number of data feeds utilized to generate population health insights. The report compared the products of fully-rated companies such as The Advisory Board, Cerner, Epic, IBM Watson Health, Optum and Philips Wellcentive, as well as those of preliminary vendors including Aetna, Caradigm, Conifer Health Solutions, McKesson and Medecision.  With regard to the major electronic health record (EHR) vendors Cerner and Epic, the scores for their PHM solutions fell in the middle of the pack, and, in a several key areas, ranked behind companies such as Enli, i2i Population Health and IBM Watson.

With regard to preliminary vendors, Health Catalyst earned a preliminary performance score of 91.0 out of 100 in the report. KLAS research director and lead author of the report wrote, “Their solutions are scored highly in meeting the needs of clinicians at the point of care and in meeting the needs of care managers/coordinators and program administrators. Their preliminary KLAS performance score of 91.0 makes them the highest rated preliminary vendor in this study.

One of the broad findings from the report is that currently no vendor is meeting the mark for all types of customers. The researchers noted that, in less complex environments, Enli and i2i Population Health satisfy multiple PHM roles. “Cerner and IBM Watson Health bridge the data needs of both program administrators and care managers. Allscripts and Philips Wellcentive streamline workflows for care managers and clinicians using EMRs at the point of care. Advisory Board, athenahealth, Optum, and Valence have difficulty keeping up with complex needs of larger customers. EMR vendors are holding on to their customers and tempting best-of-breed users as development progresses,” Hunter wrote.

Hunter also noted that when KLAS began research on population health management (PHM) solutions in 2013, providers were in the early stages of learning about value-based care. “Instead of taking on significant risk, many focused instead on pilot programs, often with their own employees as test subjects. Understanding how to adapt their organizations was top priority, so they invested selectively in PHM solutions and often favored manual or homegrown systems. Patient data was being gathered, but providers were still learning more about the data than from the data they collected,” he wrote.

Hunter further noted that now, three years later, the grace period is ending. “Pressure from CMS, commercial insurers, and competing health systems means value-based care is no longer optional. Facing more payer agreements, larger patient populations, and higher-risk contracts, providers are entering value-based care ‘production mode’ and raising the bar for PHM solution vendors.”

As outlined in the report, healthcare providers are reporting three rising priorities in their vendor selections:

  • High-quality patient data with which they can reliably make decisions. Both time and money are short, so data feeds must be easy to build and maintain.
  • Broad functionality that meets the needs of multiple roles, from back-office analysts to clinicians at the point of care. Providers want more capabilities from fewer vendors and integration that ensures PHM tools work well together.
  • Flexible vendors that know how to partner and can quickly adapt their service and software to meet providers’ rapidly changing needs.

The KLAS report also compares the products of fully-rated companies such as The Advisory Board, Cerner, Epic, IBM Watson Health, Optum and Philips Wellcentive, as well as those of preliminary vendors including Aetna, Caradigm, Conifer Health Solutions, McKesson and Medecision.  KLAS preliminary vendors had fewer than 15 unique provider organizations providing input to the research, while fully-rated vendors had 15 or more organizations responding.

Among the highlights of the report, researchers found that data aggregation is in low gear as no vendor has proven capable of building data feeds easily and at scale. “Enli and i2i Population Health make aggregation simpler for providers with a few (or fewer) EMR feeds. Valence Health handles more feeds, but greater effort is required of customers, Hunter wrote. “Philips Wellcentive strikes a balance thanks to broad experience and a proactive data management strategy that pairs data experts with individual customers.”

Hunter also noted that early feedback from a handful of Health Catalyst, HealthEC, and Arcadia Healthcare customers looks promising.

For population health initiatives, providers often need to combine data from a variety of sources. Regarding this capability, Hunter noted in the report that claims data continues to be a challenge. “Among fully rated PHM vendors, athenahealth, Optum, and Philips Wellcentive have the highest percentage of customers merging both clinical data from EMRs and claims data from payers. Cerner customers commonly aggregate from payers and non-Cerner EMRs. Epic users are in the early stages of doing both. Claims data is a universal challenge, even for payer experts Advisory Board and Verscend (previously Verisk),” he wrote.

The performance report also gauged vendor flexibility to adapt to evolving needs. “Philips Wellcentive provides strong guidance, Enli delivers quick turnaround on requests, and Cerner closely collaborates with customers of the still-emerging HealtheIntent solution suite,” Hunter wrote. “Some Optum and Verscend (previously Verisk) users say slow development has them spinning their wheels. Some Explorys and Phytel customers say IBM’s acquisition is impacting service, echoing former Humedica users who are now with Optum.”

Sepsis detection and treatment is taking a big step forward as providers increasingly utilize surveillance and monitoring technology available through electronic medical records (EMR) vendors and third-party providers, according to a new report by KLAS Research.

Of 95 providers interviewed who are employing sepsis solutions, 69 percent reported improved outcomes—with up to a 50 percent drop in mortality, while 23 percent said it was too early in deployment of the technology to have reportable results, the KLAS researchers wrote. Providers also reported improved outcomes in terms of reduced treatment costs, length of stay and readmissions. 

Up to half of hospital deaths are due to sepsis, according to research published in The Journal of the American Medical Association (JAMA), KLAS analyst Kody Hansen, who co-authored the report with KLAS analyst Jon Christensen, said in an official statement.  

Hansen also sees the advancement of sepsis technology as representing a broader evolution of health IT. “In essence, the clinical decision support (CDS) market is transitioning from passive point solutions to active intelligence—making data valuable and actionable at the point of care,” Hansen said. “A few new vendor solution areas are coming to fruition according our analysis, including what we deem Clinical Process Improvement (aimed at reducing care variation and promoting compliance) and Enterprise Clinical Surveillance (focused on overall patient status, including deterioration and multi-factorial condition analyses).”

Further, Hansen said KLAS’s analysis found that sepsis served as a microcosm of how HIT is beginning to truly effect the triple aim of healthcare delivery. “KLAS is committed to reporting on how vendors are demonstrating ROI, clinical outcomes, and cost reduction related to sepsis and CDS in general. In regard to sepsis, our data—and numerous scholarly publications in the industry—indicate that vendor solutions in general are making a difference today, no question.”

According to the report, adoption of Cerner’s and Epic’s sepsis technology is higher than all other sepsis solutions combined, with customers of both reporting improved outcomes, including mortality reductions. The report quotes an IT director as saying, “We have been using (the Cerner sepsis) product for seven months with excellent results.” “The protocols and criteria are very inclusive and thorough. Reducing septic shock and sepsis is very beneficial to us and our patients. The solution has reduced length-of-stay numbers, mortality, and readmissions,” the IT director also stated. While Cerner’s sepsis solution is easily deployed, Epic users report the need for significant in-house effort for implementation and integration into workflows. Use of sepsis solutions by other EMR vendors lags, though MEDITECH recently developed a solution for sepsis, the KLAS researchers wrote.

Because most EMR vendors lack easily deployed sepsis solutions, some providers are looking to other sources, the researchers found in their analysis. Infection control and surveillance vendors such as Wolters Kluwer and VigiLanz are perceived as most focused. “(Wolters Kluwer’s) POC Advisor pulls data out of our EHR to an engine with all of these rules and then shoots alerts to mobile devices,” the research report quoted one CMIO. And, the CMIO further said, “We are giving needed information to providers at the point of care no matter where they are. We get more of a real-time perspective verses the retrospective chart reviews that we would get three to six months later.”

KLAS researchers also found that Health Catalyst and LogicStream Health leverage their analytics to provide retrospective views of clinical effectiveness and spur effective end-user change management.

KLAS interviewed 102 providers who have not adopted sepsis solutions, finding that 53 percent are considering an EMR module or in-house development using the EMR platform, 19 percent are considering a third-party solution, and 28 percent are not considering solutions.

And, KLAS researchers found that while many of these providers are approaching sepsis detection and treatment through established protocols and reporting, one VP of Quality, who was quoted in the report, said, “Deciding to do something about sepsis needs to be a hospital’s or health system’s first step prior to thinking about what tools to use.”

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