How Providence is pushing population health beyond data and building comprehensive care strategies

Population health capabilities span well beyond data aggregation, and at Ayin Health Solutions, a spinout of Renton, Wash.-based Providence, data insights driven from patient populations are used to help healthcare clients on a full-service scale, according to CEO Rhonda Medows, MD.

The population health management company, which launched in December 2018, leverages data analytics to help health systems, payers and employers develop more informative strategies to address gaps in care and pinpoint areas of their businesses that could be improved. 

Ayin primarily works with Medicaid, Medicare and dual-eligible populations. Dr. Medows, who also serves as president of population health management at Providence, said she and her team started the population health management company after realizing they had success cross-analyzing data from vulnerable populations' health plans with claims, pharmacy and clinical data from EHRs.

"We learned how to use some of the pieces from the health plan where we have proven successes in improving clinical quality patient experience and reducing inappropriate utilization," Dr. Medows said. "Then we marry that [data] up with our experience of the health plan working with our large provider delivery system, which is kind of like working with several different countries because each community and each region works a little bit different."

After realizing how to make population health management strategies coincide with improving clinical quality, Providence expanded its services beyond its insurance plan Providence Plan Partners and formed Ayin. Defined as "all knowing and divine," Dr. Medows said Ayin strives to help healthcare organizations see beyond the multiple facets of population health and build a more comprehensive strategy.

Here, Dr. Medows discusses Ayin's approach to distinguish itself in the world of population health and how the organization navigates privacy concerns relating to the use of patient data.

Editor's note: Responses have been lightly edited for clarity and length.

Question: What does the term population health mean to you? 

Dr. Rhonda Medows: I've gone to conventions where I've seen a ton of people talk about their population health initiatives in a way that reminds me of that old parable of the seven blind men standing around an elephant. They all touch different parts of the elephant, and when asked to describe what an elephant is, they each describe the part they touched but don't describe the whole elephant. That's what it feels like when I hear people talking about population health. People describe a portion of the work under population health management but not the whole comprehensive. It's not enough to aggregate the client's data and give it back to them; you must help them figure out its use ahead of time, what solutions they're trying to achieve and then help them achieve their outcomes. It has to be full service, but the data is not the sole solution, there's so much more to it.

Q: How did you develop a comprehensive meaning to population health at Ayin?

RM: When you go in and Google search population health, you see a variety of companies that all offer different aspects of what we consider the full compendium of what population health management is. There are people who do the analytics analysis of populations using different lenses. There are people that sell you the data aggregation or some portion of the analytics that are needed to inform strategy. But with Ayin, we wanted to not only provide and inform the strategy for data analytics but also do the assessment for the organization trying to figure out what resources they have that could be married into a bigger, stronger strategy.

Q: How do you help healthcare organizations grow their strategies based on population health insights?

RM: We use a mixture of patient-related data — claims data, pharmacy data, community health factors data and social history — that helps us inform planning not only for Providence and how caregivers take care of patients but then through Ayin we can provide some of those same services where we use the advanced predictive analytics to begin to anticipate what a patient or a patient population might need. This informed planning covers everything from care management to social service resources and it can also help clients who are in more of an employer space through benefits design.

The population health data repositories and analytics and tools are separate from some of the traditional clinical data. They represent a higher level of analytics that we use to assess what's going on in populations, either by payer groups, age-ranged conditions or geography, and then to plan forward insights we create and get knowledge about on the population side so they can be turned around and funneled into actual individual patients and families.

Q: As healthcare continues to become more data centric, what guiding principles does your organization have in place to ensure that data — whether clinical, financial or social determinants of health — is used ethically?

RM: The data that we use within Ayin has a single purpose: to improve patient health outcomes in a measurable way and to enhance the process behind making that happen. We are using, for the most part, de-identified aggregate data to inform us about population trends, health needs, utilization, pharmacy needs and resource needs in the community. We are very respectful of the information that we receive, collect and analyze by keeping it secure and keeping individual information private. Because most of our analytics is done on our own proprietary system, the patient's individual information doesn't go outside our system.

Q: How do you navigate patient privacy concerns?

RM: We have formal rules and policies that we follow, but in addition to HIPAA and privacy and security rules we have our own ethical standards, so to speak. We have corporate ethical standards on data sharing and when it can occur even within our own organization itself. Not everybody needs to see all aspects of patient information because not everybody's involved in that patient's care.

Using the de-identified aggregate data helps inform us enough on trends. When we are ready to translate a population analysis into actual care treatment and services for patients, then we are like HIPAA on steroids. Only the healthcare providers and service providers who need to have access to any of the information will then use the data to help arrange care coordination and care management, such as having conversations with patients about needing transportation or helping them get utilities.

Q: As a leader in the field, what's your take on gender equity in the health IT sector?

RM: I know there's definitely challenges with gender equity in health IT, but I think this issue affects women in leadership all over. In the medical field, this includes among physicians and health executives. I have told people the same thing that I have told my own children. First, you must know who you are, know what you want to achieve and never let somebody define you. That means you're going to have to stretch.

It's up to the women and men who are in leadership now to recognize, mentor and pull up the next couple of generations. And no matter where you are on the rung — just starting out, middle management or in a supervisor role — you have an obligation to reach back and pull up. It's not enough to educate and encourage young women. We also need to educate our sons and husbands because they are also part of the solution. Without this, you're just setting up these young women to try to be successful against barriers that could be a little bit resolved by having the men who may create the barriers address the issues.

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