Submitted by: Populytics
Written by: Mark Wendling, MD, LVHN
It is interesting to reflect on how far Lehigh Valley Health
Network (LVHN) providers have come on the journey to value-based care. I
have been a family physician at LVHN since 1997 and I now have more
patient information at my fingertips than ever before so that I am able
to provide the right care at the right time and place. You may be seeing
a great deal of news headlines lately highlighting stories of health
networks and insurers working together. By partnering with insurers like
Highmark, and combining their insurance data with the medical data we
already have, even more care coordination is possible. Let me provide
you with an example.
Patients Mr. and Ms. Jones (not their real names) had multiple health
problems when they sought my care. Ms. Jones, only 48 years old, had a
major heart attack, and while still in the open heart unit, suffered a
massive stroke. Meanwhile, Mr. Jones, who was the caregiver for his
wife, had heart disease and unfortunately ended up in the hospital the
same time she did.
At the time of discharge, Mr. and Ms. Jones’ medications were
reviewed with their insurer, whereby a frightening discovery was made.
The medications on record with the insurer were different than what was
documented on their medical charts, which were also different from what I
had recorded. I suggested the couple bring all of their medications
into the office so we could review them together. Upon investigation, I
discovered that they were taking multiples, some of the same drug
classifications. As you can imagine, this could be harmful, if not
Mr. Jones also mentioned that he couldn’t see the writing on his pill
bottles clearly. I reviewed when he had last received an eye exam, and
noticed that he was long overdue. My team immediately made him an
appointment with a retinal specialist who discovered severe bleeding at
the rear of his eye. This was likely caused by the duplicative blood
thinners he was taking. The specialist was able to stop the blood
thinner and treat his eye, saving Mr. Jones from even further serious
conditions such as muscle breakdown or liver failure.
So, what does this all mean? In the past, providers only had patient
information that was gained through medical records. Now, by partnering
with insurers, physicians and their clinical teams have access to
insurance claims data. By means of innovative partnerships with
population health management companies that have the ability to merge
the medical and insurance data and turn it into actionable information,
clinicians have a wealth of information that provides a complete view of
a patient’s health.
“You have to get to know people, really know them, and that takes
time,” says Dr. Wendling. “By utilizing population health analytics,
where the aforementioned data is sliced and diced in meaningful ways,
duplicative services and care gaps are identified almost automatically.
This allows me to have more meaningful conversations with my patients
during visits whereby I can really get to the core of their health care
In the case of Mr. and Mrs. Jones, their lives could have ended up
very different had Mr. Jones issues not been caught, affecting not only
him, but also his wife who depends on him for her care.
Dr. Wendling is Executive Director at Lehigh Valley Physician Hospital Organization(LVPHO)/Valley Preferred, and guest author to the eNews