Care Continuum Alliance 2012 Outstanding Leadership in Population Health Awards
Care Continuum Alliance (CCA) presented the 2012 Outstanding Leadership in Population Health Awards to eight researchers from Alere, Apixio, Krames StayWell, Oregon Health and Science University, Silverlink, Sun Health and U.S. Preventive Medicine for their contributions to the population health management industry.
The Care Continuum Alliance, the leading organization for the population health management industry, announced the awards at the closing plenary session of The Forum 12, the industry’s annual meeting. The association has presented its widely recognized industry awards since 1999. This year, along with its customary peer-reviewed process, CCA implemented a juried format in which panels of experts selected one presentation from each of five categories, and the posters exhibition.
The awards recipients and categories are:
Leveraging the Tools of Technology with the Power of Prevention
The research provides insight into the converging trends of preventive medicine and new technology. It identifies the potential opportunities and challenges of wireless health and evaluates the potential for wireless health technology in the delivery of preventive medicine for more effective population health management.
Ron Loeppke, MD, MPH, FACOEM, FACPM, Vice Chairman, U.S. Preventive Medicine, Inc.
“Our research demonstrates that leveraging the tools of technology with the power of prevention can drive better health at lower cost,” said Dr. Ron Loeppke, Vice Chairman, U.S. Preventive Medicine, Inc. “Smartphones and other mobile devices are transformative tools that will empower consumers and providers in more effective population health management and will play an important role in the emerging wireless health ecosystem.”
Sun Health: Innovative Partnerships for Community Health
The work showcases how a community-based organization is leveraging innovative partnerships and unique service models to promote healthful living and independence among local residents. It offers a review of the community-based health and wellness strategy developed in partnership with hospitals and extended care providers; identifies best practices and specific tools community programs can use to improve health, wellness and independence, while activating patients in self-management of their health; and illustrates proven outcomes measures employed to evaluate community health programs.
Ronald D. Guziak, FAHP, President and CEO
Jennifer Drago, MHSA, MBA, Vice President, Business Development, Sun Health
“Sun Health Services is honored to receive recognition for its pilot project in population health management,” said awardee Ronald D. Guziak, President and CEO of Sun Health Services. “Through the Care Continuum Alliance’s Forum 12, successful solutions to major health care issues are now brought to the forefront and can provide benefit to other communities.”
Home Blood Pressure Monitoring Improves Medication Adherence and Blood Pressure
This research discusses how a pilot program integrating home blood pressure monitoring into a CAD management program enhanced patient and physician insight and overall health outcomes. It examines a pilot program that provided home blood pressure monitoring to 859 high-acuity commercial health plan members to reinforce physician office treatment for CAD, while explaining how home blood pressure monitoring was integrated into an existing CAD condition management program. It also reinforces the value of home blood pressure monitoring in the diagnosis and ongoing management of hypertension.
Gordon Norman, MD, MBA, EVP & Chief Innovation Officer, Alere, Inc.
“Though doctors know very well when and how to treat high blood pressure, the CDC noted this year that a majority of those diagnosed with this common and serious condition do not have their blood pressure well-controlled,” said Dr. Gordon Norman, EVP and Chief Innovation Officer of Alere, Inc. “This is a prime example of the common population health problem of “doing better what we know” vs. “knowing better what to do.” Our pilot study demonstrates that using home monitoring of blood pressure to augment high blood pressure treatment by clinicians is a highly cost-effective means for achieving improved hypertension control.”
Expanding the Evidence
Beyond the Predictive Model: Identifying Readmission Risk Factors
This published work examines the effectiveness of hospital readmission predictive models and the alternatives to these types of tools. It reviews the results of a recently published Journal of the American Medical Association article studying the effectiveness of risk prediction models for hospital readmission. The work also analyzes a program that included communication with patients after discharge and found that 29 percent of those who responded had gaps in care; and identifies best practices for identifying and triaging those at highest risk of readmissions, using predictive models, technology and clinical resources. The work can be reviewed at: Devan Kansagara, MD, MCR; Honora Englander, MD; Amanda Salanitro, MD, MS, MSPH; David Kagen, MD; Cecelia Theobald, MD; Michele Freeman, MPH; Sunil Kripalani, MD, MSc. Risk Prediction Models for Hospital Readmission: A Systematic Review. JAMA. 2011; 306(15):1688-1698. doi:10.1001/jama.2011.1515.
Devan Kansagara, MD, Assistant Professor of Medicine, Oregon Health and Science University
Jan Berger, MJ, MD, Chief Medical Officer, Silverlink Communications
“Our research shows that predictive models for hospital readmissions do not perform all that much better than the flip of a coin,” said Dr. Jan Berger, Chief Medical Officer of Silverlink Communications. “This leads us to ask – how can we identify those at risk so we can provide support to keep patients from being readmitted. At The Forum 12, we presented patient surveys taken during the critical 24 to 72 hours post-discharge. Technology identified key risk factors and importantly the support needs of patients across the entire discharged population solving both clinical and financial challenges.”
Innovations in Care
Using Big Data Analytics to Optimize Clinical Care Pathways
This work discusses the role of “Big Data” analytics to unlock insights about actions for optimal care outcomes. This research identifies three key challenges in using patient clinical data for quality and outcomes improvement; showcases how Big Data analytics techniques are applied to effectively use multi-modal patient data; and reviews three care scenarios, including hospital admissions, that can be mapped and optimized using data-driven insights.
Darren M. Schulte, MD, MPP, Chief Medical Officer, Apixio
"Our Big Data platform and its associated analytics will help bring about insights and breakthroughs into care quality, costs, and utilization for organizations to effectively manage their patient populations,” said Dr. Darren M. Schulte, Chief Medical Officer of Apixio.
How Do Consumers Make Health Care Decisions? New Research to Aid Member Engagement Strategies
The research presented uses the insights from consumer research to help design effective health communication and engagement programs. Has health care reform impacted perceptions and behaviors? If so, how? This work contributes to a better understanding of the health care consumer, their perceptions, expectations, what motivates them and how they prefer to seek/access health information. It applies the insights to improve the effectiveness of communications programs and engagement strategies.
Sue Mihojevich, MBA, Senior Director, Strategic Accounts, Krames StayWell