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Thought Leaders in Healthcare IT: Carol Clayton, Relias (Part 2)

Posted on Tuesday, Jan 29th 2019

Sramana Mitra: Let’s take a hospital that has these kinds of behaviors. Could you take us through a live customer and what you have been able to do? What kind of numbers are you seeing?

Carol Clayton: I’m going to use a different model. I won’t use a hospital system. I’m going to use a behavioral health system. In the state of Oklahoma, they have implemented a behavioral health home model for their Medicaid beneficiaries. That is for behavioral health agencies to provide directly or coordinate care for persons with behavioral health disorders who also have chronic health conditions.

Each of those health homes use our solution to look at a variety of performance measures. There might be measures such as, have they had a test within the proper time frame, or are they being treated appropriately with a medication regimen that they’re actually adhering to. The performance tools allow that behavioral health home to see that enrolled population where they might have opportunities to close gaps or improve care and then drive their staff to engage in activities that address those concerns.

When we look at the first year of that program, it was about an 18-month period for the impact of that result. What Oklahoma at the Medicaid agency level solved was an estimated savings on all costs. It was about $8 million in savings for that enrolled population in the health home. They saw, on average, about a 25% decrease in the use of emergency room and hospital services for what would be preventable ambulatory care sensitive conditions. These are conditions that are preventable and to be treated in the ER, and better treated in the community. They saw a reduction of about 25%. These are big number savings in terms of millions of dollars.

Sramana Mitra: What kind of adoption are you seeing of these types of solutions?

Carol Clayton: We are seeing significant adoption of these types of solutions in geographic locations where the payer, whether it be the insurance or health plan, is moving the provider system into a value-based contract. Any time we see an initiative that says, “We’re going to ask the provider to do something around the quality of care measures. They’re either going to be incentivized financially to do that or they might be penalized if they don’t do that.”

We see the urgency of need for these kinds of technologies. Now everyone has an electronic record. Electronic records are pretty uniform across the healthcare system. However, those records serve individual patient care. When the person shows up for the appointment, you pull them up and enter the information about their care. You submit your payment. Those types of technologies do not generally support value-based purchasing where you are focused on managing a population and you’re not going to touch every single enrollee in that population.

You need to do risk stratification, find the people within the population who need something to close that care gap, go after the care gap, close the care gap, and be able to track to your performance. At the end of the annual period, your business model will be contingent on how well you performed. New technologies are needed in this space to support this changing business model.

We certainly see it across the board within large ACO systems. It’s an untapped opportunity. In behavioral health, the movement is for behavioral health organizations to demonstrate their outcome relative to lowering total cost of care on the physical health side. Those models are way ahead of the technology tools to support those arrangements.

This segment is part 2 in the series : Thought Leaders in Healthcare IT: Carol Clayton, Relias
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