Separating the Signal From the Noise


A few months ago, I met with a doctor who runs a patient-centered medical home.  This doctor – who also doubles as the CEO of his business – has roughly 12 primary care physicians working directly for him, supported by approximately 60 medical personnel, ranging from medical assistants to nurses and nurse practitioners.  He also has a tight affiliation with roughly 10 specialists, who all drive referrals to each other and literally practice in the same building.

This physician – let’s call him Dr. C – thinks a lot about managing risk in the new world of accountable care.  He knows he needs to move his practice approach from managing sickness to managing wellness.  He knows that in the near future, he’s going to get a set payment from his payers – whether they are private insurance, Medicare or Medicaid – for each of the patients in his practice, and it’s going to be up to Dr. C to keep these folks healthy and happy.

If Dr. C keeps the patients healthy, and it costs him less to do it than what he brings in from the payers, then Dr. C is in great shape.  He’s profitable, he can pay his physicians and personnel, and maybe even set aside a little money to join that golf club he’s been eyeing.  If not, well, then Dr. C likely winds up selling his practice and becoming a hospital-employed physician or some other form of provider where he loses the independence he so greatly treasures.

Now here’s the kicker – Dr. C doesn’t know which patients are costing him the most money.  He’s pretty sure that his sickest patients are costing him the most.  But with more than 3000 patients in his combined practice, it’s not like he can easily find out who these folks are.  He can’t very well call a staff meeting of the 12 primary care physicians and say “Who are the sickest folks in our collective practice, and how do we treat them proactively?”

But that’s exactly the question that Dr. C needs to answer.  Because he needs to keep them healthy before they get sicker and go to the emergency room, which will really cost him a lot of money.  Or as Dr. C says, “We get roughly 500 calls a day, 300 emails, 100 faxes, and we see maybe 80 patients each day.  Am I seeing the right patients?  Are they the sickest folks in my practice?  I’m pretty sure that the sickest folks are in those 500 calls.  But how do I find them?  And how do I get to them before they call me?  Because by that point, it may even be too late.”

This is exactly one of the problems that we’re trying to solve here at GE Healthcare.  How can we look through Dr. C’s entire patient population, and use a predictive algorithm to find out the patients who are going to be the sickest?  We’ve got a couple of ideas how to do this, but I’m not going to share them here. But I can tell you that it’s more than just looking in Dr. C’s patient records.  We need to pull data from all the associated medical providers that his patients may go see – and many of these providers are using different EMR systems.  The trick here is to collect all that data from multiple locations, and then apply intelligence to that data set.

Obviously, this is a big data challenge, which is one of the tech buzzwords du jour these days.  But it’s also an integrated care challenge.  As I’ve written before, integrated care is a patient-centric, outcomes-driven philosophy of delivering healthcare.  While the idea sounds like motherhood and apple pie, adjusting the clinical and financial workflows to enable integrated care isn’t easy.  But it’s a challenge that we think about every day here at GE Healthcare, and over the next few years, you’ll be seeing a lot of new solutions from us to address the challenges faced by Dr. C and others like him, as they evolve their medical practice for the new generation of care delivery.



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