How data is helping OSF care for the chronically ill

It’s well known among health care systems that those with chronic diseases, such as diabetes, heart disease and cancer cost the industry over a trillion dollars each year. When you understand how some of these debilitating illnesses impact people, it’s easy to see how these costs quickly add up.

Let’s take an individual with diabetes and a number of other conditions. This person suffers from nerve pain and is on a variety of medications to control discomfort. The problem is that these pain meds are causing nausea. As a result, this patient is making frequent, high-cost trips to the emergency department for relief.

In August 2019, OSF HealthCare launched OSF Virtual Advanced Care to manage the care of those at the highest risk of needing hospital or emergency care. The program offers chronically ill patients daily virtual care from a team of clinicians. Participants use at-home monitoring equipment such as a blood pressure monitor, scale and thermometer to report their vital signs and any other concerns.

In partnership with Healthcare Analytics, OSF Virtual Advanced Care is using data models to pinpoint those who need this type of care the most. They also track the program’s impact on both patients and the organization. The goal of these tools is to ensure the virtual advanced care program is helping reduce costs of care while improving patients’ quality of life and outcomes.

Data analytics models

How are individuals selected for the OSF Virtual Advanced Care program? HealthCare Analytics built a predictive model that identifies people within a certain population who are most at risk for high expenditures, including repeated visits to the emergency room or hospital admissions. A primary care provider then reaches out to those individuals to explain the program, gauge their interest and enroll those who want help.

“We are trying to reach those individuals who are suffering, but are not yet the sickest of the sick,” said Suzanne Hinderliter, director of Digital Acute Care for OSF OnCall Digital Health. “They, in many cases, have multiple chronic conditions that can put them in the hospital. The OSF Virtual Advanced Care program is a way for us to get their problems under control at home, help navigate decisions and keep them in a steady state of wellness.”

At any given month, there are about 160 patients in the program. Healthcare Analytics developed a data analytics dashboard that provides demographic information, different chronic conditions a patient may have and patient spend. It also compares outcomes for this group of individuals to those who have similar illnesses but are not in the OSF Virtual Advanced Care program.

“This allows us to do a statistical effectiveness analysis of the program to determine its impact on patients,” said Bryan Kaiser, director of Analytics and Reporting with Healthcare Analytics. “This dashboard is helping us show whether we are keeping these people as healthy as possible and reducing care costs.”

What’s the impact for the chronically ill?

While Healthcare Analytics is still in the process of collecting the information it needs to show financial impact, the program is anecdotally a success.

“We were able to enroll a diabetic patient who frequently visited the emergency room for various reasons,” said Beth Wharton, operations manager for OSF Virtual Advanced Care. “To date, this individual’s diabetes is very well controlled and they’ve had minimal ED visits compared to what they did when they first entered the program.”

Wharton says using data analytics models paired with OSF Virtual Advanced Care gives her team quick insights into what’s going on with their patients’ disease management. That allows them to easily identify problems before they become big issues for the people OSF HealthCare serves. This not only benefits some of the sickest patients, but it also benefits the organization as a whole.

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