To effectively manage care, care team members need to have access to the right information at the right time. Without access to relevant data at the point of decision, however, consumers might unfortunately experience a variety of unwanted outcomes.

Maria Colaberdino, RN, BSN, Clinical Principal, Government Programs, Medecision

When a consumer of health care — whether a member, patient or client — experiences mental health issues, when a consumer suspects he or she might have torn a ligament, when a consumer suffers from recurring headaches, or when a consumer is at risk of an adverse health outcome because of his or her educational level and access to health care, care team members need to do the right thing.

“To effectively manage care, care team members need to have access to the right information at the right time. They need to have the data in front of them that enables them to identify the best and most cost-effective service, care options and resources for the consumer’s needs. To support this, data needs to be integrated into their workflow — so that they have access to all of this important information at the click of a button,” said Maria Colaberdino, RN, BSN, Clinical Principal, Government Programs at Medecision.

Without access to relevant data at the point of decision, however, consumers might unfortunately experience a variety of unwanted outcomes. They “could wind up back in the hospital or could experience a variety of problems or complications because they were not taking the right medications or did not receive the needed services,” Colaberdino said.

A data and analytics platform and warehouse, such as the Medecision Aerial solution, can bring together the relevant information needed to empower care team members to make the best decisions. With such a platform in place, care team members have access to integrated pharmacy claims, medical claims, electronic medical record (EMR) encounter data, admissions-discharge-and-transfer (ADT) and social determinants of health information. In addition, care team members can make the most of this integrated information and improve clinical workflows by leveraging the following:

Automated workflow, which relies upon clinical best practices to help direct care team members to implement the most effective care interventions at the most appropriate times.

“Automated workflow helps with efficiency and consistency. Let’s say there’s two care managers ⁠— Maria and Tom. Maria is good about reaching out to social workers but Bob always forgets. With automated workflow, the alert to contact the social worker pops up at the appropriate time in the clinical workflow. As such, all the care managers are prompted to do the right thing at the right time, ensuring that consumers get needed care. The automation also, ensures the proper interventions are occurring for those designated populations requiring the specific action,” Colaberdino said. “Aerial has been helping our customers manage specific client populations with automated features, by allowing our customers the ability to update their own rules when needed.”

Analytics, which can be used to determine which consumers need a particular service. With analytics, health plan care managers, provider system care managers, or agents of the state can develop person-centered care plans that identify the individual’s problems, goals and interventions, as well as desired outcomes and potential barriers. For example, analytics can help to find consumers who are over the age of 50 and have not yet had a colonoscopy. Aerial users have a variety of mechanisms to assist them with these types of care opportunities. Through campaign management, information and reminders can be automated and sent through a variety of channels based on consumer preferences. The care managers work with providers to ensure that members are aware of the need to schedule the procedure. The analysis could also help care managers recognize — and overcome — barriers such as lack of transportation.

Analytics could also identify members who suffer from multiple conditions and are in need of a comprehensive assessment and care plan. And, finally, care team members can leverage analytics to identify population clusters that are in need of interventions. Analytics can even help identify those groups that are not in immediate need of intervention, but are at risk and may need outreach before an event occurs.

Machine learning, which can be used to improve clinical workflow by empowering care team members to more efficiently identify optimal interventions and resources.

“If a care manager is working with a consumer who has diabetes and lives in a specific area, a machine learning model can look at what other members who have diabetes and live in that same area have used – and immediately pull up a primary care physician, a diabetes educator and an urgent care center that the consumer can work with. Machine learning can provide a great starting point and can save the care manager so much time,” Colaberdino pointed out. “In essence, the model can identify the right tools, interventions and resources based on what is known about others and then continue to learn and refine best practices and identify the most appropriate resources in a more timely fashion.”

The impacts of machine learning are being leveraged to predict the best course of action for one specific individual, based on all like individuals with the same or similar variables. It looks at those who have achieved favorable outcomes and predicts the likelihood that the newly identified consumer will respond the same way to a recommended intervention, such as a support group, educational program, or treatment modality.

Dashboards, which provide care team members, as well as CMOs and CFOs with the ability to quickly view specific populations, and drill down to trends, outliers, network leakage, over-utilization, under-utilization — or high spend whether it is prescribing brand versus generic, or utilizing emergency room versus primary care provider.

“With the information “right in front of them, care managers can quickly identify the right and most effective service for the member’s needs – and the most cost-effective service. For example, if a member is in need of behavioral health service, the care manager will be able to immediately identify all the available community resources,” Colaberdino said.

Bringing all the necessary tools together to support the workflow is key. However, healthcare organization must also address consumer engagement.

“Without consumer engagement, it is impossible to change behaviors and manage health. Providing proper engagement tools, such as consumer facing applications that share data and care plans across care and support teams, along with secure messaging, or interactions based on consumer preference is really how we can begin to change the landscape of healthcare,” Colaberdino said.

In the final analysis, with the right information and the right tools, care team members can efficiently and effectively take the right actions that will lead to improved clinical workflow – and ultimately to the best outcomes.

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