I spoke recently with Cindy Friend, who is Vice President of Clinical Population Health Solutions & Transformation at Caradigm – a GE Healthcare company Twitter: @caradigm. Cindy is a registered nurse with more than 20 years combined experience in healthcare administration, clinical delivery, and health information technology both in the public and private sectors. Our conversation focused on the opportunities for improving population health through ACOs.
Caradigm is focusing on population health by stratifying patients with multiple chronic conditions, and supporting ACOs in managing their care. The key is looking at entire communities in order to prioritize efforts at the populations level. For example, nationally we may have a heightened focus on heart failure and diabetes; however, Cindy noted that in a mid-Atlantic market she was working with, the key chronic condition to focus on was, surprisingly, osteoarthritis.
Behavioral health, said Cindy, doesn’t necessarily have to be integrated into the delivery system, but assessments should be integrated (e.g., PHQ-9’s may be administered by primary care providers), so that the behavioral health data may be integrated into the analytics framework used to manage population health. Other sorts of information that need to be captured and integrated include what we call social determinants of health, including for example literacy levels of patients — a critical but often overlooked issue.
Cindy is more optimistic than I am about the successes of ACOs; she discussed some recent reports on ACOs and noted that we’re still in the early days of this care delivery and payment innovation. You can see a bit of my perspective on the relatively small savings realized to date here. We also discussed some of the bright spots in the ACO landscape, and the benefits to be gleaned from looking closely at care management across the continuum of care, and from improving provider engagement as well as patient and caregiver engagement, using systems supporting improved data collection and information sharing, which can lead to better integration across the continuum of care.
When I asked Cindy what she would like to see five years from now, she said she would love to see “literally, not another paper record . . . not another post-it note around.”
I spoke with Cindy as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.