Hunting for the Heart of a Changing Community

by Jack Murtha and Ryan Black
APRIL 12, 2018

How Data Pinpoint Health Needs

Castle Rock Adventist Health is but one of Centura Health’s 17 hospitals, which constitute just one arm of a network that encompasses dozens of clinics and more than 100 physician practices in Colorado and western Kansas. The nonprofit health system’s facilities serve cities, such as Denver and Pueblo, along with isolated mountain towns and suburbs, a footprint that has made it important to scrutinize the demographic, public health, and social data of each place. “It’s essential to understand our communities and how they’re changing, becoming more diverse and culturally different, and then address it on that level,” says Corbett, the Centura executive.

The people who patronize Centura’s hospital in Garden City, Kansas, for example, kill 30,000 cattle per day, putting them in the crosshairs of different health issues from those of the urban patients who walk into Denver’s Porter Adventist Health. In fact, Corbett adds, the network is seeing more amputations among young adults, who are settling in the Mile-High City without health insurance and then breaking bones while skiing. In Pueblo, Colorado, more than elsewhere, Centura clinicians are battling the effects of the opioid crisis. Canyon City, on the other hand, is struggling with violent crime, and 18,500-resident Durango has its own suicide problem.

So what is Centura Health doing to collect and interpret the right data to tell the story of each population?

First, every 3 years, it performs a needs assessment for which staffers compile quantitative data from public health departments, health data exchanges, and insurance claims—along with qualitative interviews of various players in each neighborhood—to get a feel for factors like tobacco use, alcohol consumption, and violent crime, Corbett says. Centura also scours its emergency department data to glean insights that could predict coming trends. Further, the health system undertakes healthcare market analyses across Colorado, a process that homes in on demographics.

The health system obtains hard numbers from public health departments, sometimes paying for the privilege. It also participates in the Colorado Regional Health Information Organization, a health information technology exchange that curates and promotes the flow of de-identified patient data among the state’s hospitals. Then there are claims databases, another pay-to-access data well for Centura. Next, employees sit down with community stakeholders—churches, police departments, fire departments—to tap their on-the-ground knowledge.

Finally, the organization employs analytics and other tech-centric tactics to make sense of everything. “We’re in an era where there’s data overload, and too much can be a problem,” Corbett adds. “What we’re trying to do is take a bunch from different sources and turn it into useful information.”

What’s Changing?

Data collection isn’t new. Neither are healthcare’s efforts to forecast market demand. But aside from advanced analytics and AI, experts say innovative population health efforts differ from data endeavors of the past 50 years in a key way: They don’t revolve around managing the disease state. “Hospitals didn’t treat wellness; they treated sickness,” Topchik, of Chartis, said. “So they used big data to pinpoint every cardiology patient in a geography, understanding who went where, which procedure they received, and how much they paid.”

Subsequently, health systems placed cardiac specialists in areas rife with fast-food restaurants. Health systems also learned how to maximize staffing schedules so that each physician might see X number of patients each day, for Y minutes, to earn Z dollars. Without hesitance, experts acknowledged that this sort of fee-for-service-driven data gathering remained more common than outcomes-driven, long-range planning.

“Health systems have been in the business of competing on a basis of who provides the better service. They don’t necessarily segment the demographics,” notes Randy Gordon, MD, a managing director with Deloitte Consulting. “They have been accustomed to looking at the population on an insurance status—and how they can best serve populations for whom they get paid.” The thing is, how healthcare organizations get paid is shifting with the ascent of value-based care. Only the charge toward wellness and value have led hospitals to embrace population health, and most have yet to tweak their care plans to more heavily consider criteria like demographics. “I think that’s coming,” Gordon says, “but it’s right at the beginning.”

The technology that’s opening the door to community-based planning is the electronic medical record (EMR) system. Over the past several years, EMR adoption rates have soared, thanks in part to billions of dollars in government incentives, to the point where it’s rare for a hospital to run on paper. Despite its interoperability and workflow issues, the EMR has empowered health systems to absorb clinical and demographic data, laying the groundwork for analytics that result in actionable insights, Gordon says. Such an act was all but impossible in the paper age.

Even better, the EMR data trove can extend into outpatient, primary care, and surgical data, sometimes collecting social determinants of health and other demographic elements. “Without having digitized this information, there would really be no way to look at the populations that they serve,” Gordon says.

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