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Clear definition of the patient panel, its explicit constituents (e.g., individual patients and/or families, and potentially other groups), and its characterized composition are critical initial considerations in the development of accountable care models.
Organizations pursuing this stage are often seeking to answer key analytical questions such as:
Who are my patients?
What are their Treatments?
What other Providers are they seeing?
At What Locations?
With What Frequency?
The following Action Plans are concrete steps organizations must consider for progressively achieving this stage.
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Achieving Accountable Care Executive Briefing
Specialty Children’s Hospital Enterprise Data Initiative Case Study
Patient Panel Analytics Case Study
Assemble and integrate Patient Identifiers from multiple source systems, operating units, care settings
Identify and resolve duplicate Patient/Person issues
Assess data quality issues on all related master data entities: Patients, Persons, Providers, Locations, Encounters, Payers, etc.
Assemble and Integrate records of clinical care for individual Patients from multiple source systems, operating units,care settings
Incorporate key encounters, events, observations (e.g., diagnoses, labs), interventions (e.g., procedures, treatments), and providers in various roles; verify provider attribution; include charges and payments where available
Establish standard data representations for primary entities such as Patients, Providers, Encounters, Locations, etc. and the related patient experiences
Assemble and align [normalize] Encounter & Claims (reclaimed encounters) history data
Examine assembled Records of Care using bundling rules to aggregate individual Encounters and Events into a unified (clinically, operationally and financially coherent) representation for analytics
Examine bundles (e.g., Episodes, Targets) using predictive models to understand risk, projection, forecast, resource mix, quality and financial performance baselines
Assemble and integrate Provider Identifiers from multiple source systems, operating units, care settings
Identify and resolve duplicate Provider/Group/Practice/[Org Unit]/Location issues
Examine record of encounters and care provided; align Patients with Providers delivering greatest legitimate impact, frequency, effort or preponderance of care-related services; quantify where possible
Assess roles and extent or level of responsibility for care for individual Patients across multiple Providers, care Locations, and consumption of resources
Designate Primary (or Specialty) Care Provider status and relationships
Perform analytics to characterize and/or classify Patient-to-Provider care relationships, their durations, transitions, outcomes, resource consumptions, impacts, etc. Examine higher-order relationships or patterns
Assemble and align patient panels with individual Providers, Groups, Service Lines, Business Units or other entities
Perform analytics to align demand (for encounters) with supply (of service providers or other resources) and assess impacts on clinical outcomes, service quality and consistency, financial outcomes and patient and provider satisfaction