She adds that as HVPA transitioned to modified risk slowly, they needed to close clinical quality gaps in care and better understand the populations’ disease burden and risk acuity to manage the associated costs and utilization effectively. She stated that this is where HVPA Executive Leadership and Board decided to invest funds to build its own data warehouse and measurement engine along with other components supporting population health management. This led to the product and company, now called HealthFocus Software Solutions, also known as HealthFocus. There have been several iterations of the product from initial development to today. The current version of the platform has the entire measure engine rewritten for flexibility to accommodate payer specifications which change frequently, and to accommodate modifications or enhancements more easily to the tool.
Debra shares that the data warehouse is the most comprehensive in existence, aggregating data from multiple sources. She adds: “It’s the concept of no data left behind.” The data sources can include but are not limited to eligibility lists, claims, lab, radiology, colonoscopy, Admission, Discharge, Transfer (ADT) feeds, payer opportunity reports, and multiple EMR interfaces to include CCDA files and much more.
Debra says: “HealthFocus will and can accept from all data sources. Once received, the data is staged and presented through the viewer within the product. It provides the end-user (physician/clinician) a complete view of the patient’s health record, from when services are due for preventive health and chronic disease metrics such as a female past due for a mammogram to managing a patient’s hemoglobin A1C level to addressing hierarchical code conditions (HCCs) gaps and risk acuity”.
She adds, “Using the application simply provides a direct but simplistic view for patient health management and allows the clinician to do this proactively and cost-effectively no matter the disease state.” Additionally, much more focus has been on capturing Social Determinants of Health (SDoH) and PHQ9 depression screening questionnaire results and pharmacy med-adherence data. This data is critical to know the patient’s overall care and to consider other applicable interventions that would support the compliance and cost-effective management of care.
Many questionnaires have been built within the EMRs and can be pulled into Health Focus. Additionally, for those practices still not on an EMR, these forms have also been replicated within the tool. This information supports the emotional, economic, and other social impacts that may hinder a patient’s medication compliance and recommended care plan. Without it, it is much harder to effectively manage the patient and see everything you should know about the next steps and decisions for managing the patient’s health. Therefore, payers are emphasizing incorporating and tracking this data much more.
Debra says that HealthFocus is functionally different from an EMR but does integrate with all EMRs if the EMR is capable. Today’s EMRs capture what is done at point-of-care, documented in patient notes and billings. Some have lab feeds, and others can pull in other data feeds. However, Health Focus aggregates the data from ALL sources, such as hospitals, MiHIN, individual feeds, lab, radiology, and other one-off data feeds. The EMR is not as comprehensive of a tool for aggregating the data and presenting in a format to know all open clinical gaps in care or to tell you where, in aggregate are your most significant financial opportunities, or the ability to present it from an all-payer perspective to a single-payer view. The EMR is simply not at the level of sophistication of population health management or identifying high-cost patients or populations by various disease states. EMRs are not a tool for companies trying to manage risk contracts or large multiplayer populations, but they add value to Health Focus if they can interface with the platform.