Rita Parhar, vice president of analytics at EHE Health
Photo: Rita Parhar
EHE Health, a national preventive and primary care provider organization, has a simple premise for its employer partners: When your people take advantage of preventive and primary care services available at EHE-owned clinics or partner providers in the EHE network, it can lower the total cost of care and improve employee health and productivity.
Ever-rising healthcare costs, with close to double-digit increases year over year, can make it difficult to offer benefits that attract and retain top talent without a significant impact on companies' bottom lines.
THE CHALLENGE
The challenge was quantifying the true impact of EHE-provided services so employer partners could see the tangible benefits of a preventive care program on care costs and quality.
"We had a lot of data on patient encounters at our clinics and with our provider partners, but no visibility into total cost of care for the same patients once they got outside of the EHE network," said Rita Parhar, vice president of analytics at EHE Health.
"Additionally, we couldn't compare the results of people who received care in the EHE network with those who went outside the network for preventive care, or those who received no preventive care at all.
"Without access to extensive data on care outside our network, our ability to prove the value of our services – and improve services based on the same in- or out-of-network comparison – was limited," she added.
Data was also a challenge. Many of EHE's partners – such as large payer organizations – were not willing to share data in a way that would enable the kind of analysis EHE needed to do.
"It's a problem many healthcare organizations encounter, with vendors unable or unwilling to share data for various competitive and security-related reasons," she explained. "Even if our partners wanted to share data with us, we didn't have a way to securely house the information and thoroughly analyze it without custom programming. The added risk of data breach was not one that EHE or our partners wanted to take."
PROPOSAL
When EHE was evaluating analytics technology vendors, Cedar Gate's software stood out for a few reasons.
"First, it offered the capability to look at that patient information for all the cohorts we wanted to compare," Parhar said. "That included patients whose care was entirely within our network, patients who got some care in our network and some outside the network, people who received all their preventive care from external providers, and those who did not receive any preventive care at all.
"Second, the analytics software made it easy to build and analyze these various cohorts for a wide range of activities and metrics over multiple years," she continued. "For example, we look at total cost of care, utilization metrics such as emergency room visits, and compliance such as flu shots or recommended preventive screenings."
There also is value-add functionality in the tool that makes it easy to build new cohorts or measure additional metrics as staff identify other things they want to track over time or introduce new services, she added.
"Additionally, the company had a reputation as a data-first company," Parhar noted. "They could securely ingest and house millions of data records from our various partners – some of which were already working with the company, which made it even easier – giving us the information we need without exposing organizations to additional HIPAA risks.
"Not only could they secure the data, but the analytics was built on an enterprise data management system that was designed for interoperability – it could marry all of the data feeds to create a single source of truth," she continued. "It could bring together data from hundreds of disparate sources and normalize, cleanse and enrich the information so everyone was working from the same high-quality data files."
EHE also offers clients access to the analytics software. This provides an extra incentive for clients to share their data, giving everyone advanced insights into the cost and quality metrics that are important to them.
"Finally, the vendor offered an extensive benchmarking database with de-identified data on millions of members," she explained. "This capability would give us a tool to compare cost and quality metrics from our population with similar populations by region and nationwide."
MEETING THE CHALLENGE
Once the implementation was complete, staff immediately started building cohorts to analyze the impact of EHE preventive care services.
"The tool has an array of prebuilt reports we could use, and we also built some custom reports for audiences that might not be as data-driven, like a high-level executive overview our clients could share with leadership teams to demonstrate the value of EHE's services," Parhar said. "At EHE, we have a team of analytics experts with clinical, actuarial and population health reporting backgrounds who use the software on a daily basis.
"Our clients and their consultant partners immediately bought into the idea as well, with their own analytics and data teams identifying key reports that surface opportunities to improve member health, high-cost or high-risk populations, cost-saving opportunities, and more," she continued. "They could immediately find actionable steps that would help reduce costs and improve employee health and productivity."
EHE doesn't integrate the analytics with any of its other systems, but it does have an extensive amount of client data in the system.
"However, we do appreciate the ability of the software to integrate with a wide variety of systems and vendors," Parhar noted. "This makes it easy for all of our partners, including payers, clients and consultants, to seamlessly share information on patients and members, and to trust that we're all working with the same accurate, up-to-date information.
"Without it, we would either be stuck doing a lot of manual work to piece together and clean up several disparate data sources, or we would be stuck where we were before – unable to truly quantify and track the impact of our services and our care," she added.
RESULTS
From an analysis using its value-based care analytics tool, EHE was able to find hard results showing the positive clinical and financial impact of participants using EHE Health's preventive program. One example of a key financial achievement it validated with the data was superior cost and trend performance among participants, Parhar reported.
"Specifically, our analysis showed EHE Health participant costs were substantially lower, averaging 8% below the employer's general adult population and 14% below the traditional primary care group that received preventive services elsewhere," she said.
"Perhaps even more revealing, the medical cost trend for the EHE Health cohort was -1.3%, a significant achievement and a strategic advantage when compared to the positive trend experienced by the overall employer population, which was 4.8% overall for the employers and 6.4% for the traditional primary care group."
Staff achieved this validation by using the platform's cohort-building capability to isolate specific groups and apply them to the analytics software's standard financial reports. This gave staff the ability to perform a precise, multiyear analysis of medical and pharmacy claims costs and trends.
"Another critical success metric was the reduction in ER utilization and inpatient days, signaling effective proactive health management," she noted. "Our analysis confirmed 26% fewer emergency room visits and 35% fewer nonmaternity-related inpatient admissions for the EHE Health population compared to benchmark cohorts.
"The analytics tool was essential here, with a cohort analysis feature that allowed us to seamlessly compare different groups while also providing the flexibility to easily exclude maternity admissions from our inpatient data," she added. "This ensured the resulting metric was a pure measure of how our preventive services impacted costly, acute care utilization, removing potential confounding variables."
Staff also were able to confirm enhanced preventive care compliance as participants' rates for key screenings, chronic disease testing and flu vaccinations significantly exceeded benchmark performance rates.
"We validated this metric using the analytics platform's prebuilt reports for utilization, and combining that with access to comprehensive benchmark data, providing the necessary context to confirm true clinical success relative to the broader healthcare landscape," Parhar reported.
ADVICE FOR OTHERS
Based on the successful adoption of this analytics software, the primary advice Parhar offers other healthcare provider organizations is to treat this technology as a strategic investment essential for quantifying value and driving client-focused decision-making.
"The platform was a game changer for us, providing the ability to accurately calculate the value and return on investment for our participating clients – a capability we were not previously able to do at this level," she said.
"Data-driven insights are critical for ensuring our clients and prospects are fully informed, enabling them to make optimal healthcare decisions for their employee populations. This tool allowed us to track, measure and report on verifiable financial and clinical outcomes.
"When evaluating analytics vendors, prioritize finding one built around a robust single source of truth for your data," she advised. "Look for a vendor that excels in securely housing, cleaning and merging disparate datasets during implementation, and maintaining the data in near real time."
For EHE Health, this process created a unified data environment on which it relies for all analyses.
"Finally, we recommend viewing an analytics platform as a long-term investment, with a key focus on finding the right vendor that offers extensive data access and insights with a proven impact on reducing costs and improving population health," she concluded.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
WATCH NOW: What is our why?' is a question that needs answering for AI
