Medical Management
The health care community is continually faced with the challenge of lowering costs while at the same time improving quality. One useful way to accomplish this difficult task is to compare treatment results for patients with the same diagnosis but with different complexity. Illnesses are highly variable, and that variability profoundly influences treatment and cost. To be effective, tools that measure quality must take this complexity into account.

Achieving Value-Based Outcomes (VBO) in Healthcare Management through PCIX (Patient Complexity Index)

Partnering with academic leaders in the medical field, CTG has addressed the need to accurately measure quality by developing a unique information system that objectively scores illness severity and treatment results in a manner meaningful to patients, payers, and providers. By empowering stakeholders with the information they need to make improved healthcare choices, CTG’s medical management tool can help achieve value-based outcomes.

CTG’s powerful approach to medical management builds on current IT systems and energizes existing tools to improve coordinated strategic care. The CTG approach enhances the flow of clinical information between patients and providers with the goal of delivering optimal care in a cost-effective manner. Partnering with the New York State Center of Excellence (COE) in Bioinformatics & Life Sciences, CTG has created a health information data center for model prediction and data analysis that facilitates achieving value-based outcomes.

Using its super computer facilities, the COE organizes, stores, and analyzes multiple data streams, and then applies medical informatics and ontology methods to compare treatments and evaluate illness severity and outcome—all with the goal of returning this information to healthcare providers in a timely manner.

CTG, working with the COE, continually refines our patented ‘interpreter’ technology on PCIX (Patient Complexity Index), which is the tool we use to improve the grading of health outcomes. The PCIX identifies treatment success, based on objective blood chemistry values and reliable physical measurements. Key to PCIX effectiveness is that patients can clearly see how both treatment and compliance affect results. PCIX uses color-coded graphic displays to group related health measures so that patients can see how compliance with doctor’s orders and lifestyle choices affect wellness. CTG’s value-based software has shown application in managing numerous medical conditions.

For example, the chart below shows how one ESRD patient’s blood chemistry values and physical measurements compare to scores for the general population.

To determine a value-based outcome, the CTG interpreter uses improved objective blood chemistry values (as scored with the PCIX) to identify the critical data elements that drive medical management. Among these are:

• Pharmacy data

• Laboratory and other diagnostic data

• Claims information

• Demographic information

One example of how this works is a recent project that used PCIX to evaluate patients with ESRD. The patients were followed for one year, and a marked variability in treatment results was observed. Under current CMS reimbursement, which is based on partial capitation, patients who entered dialysis with lower complexity scores were found to have reimbursements that closely matched their needs. However, as illness severity approached the upper third of complexity scores, reimbursement was observed to be significantly lower than costs.

Client Benefits

CTG clients can benefit from our medical management services in the following ways:

• P4P based on objective medical data confirming health and outcome

• Easier access to data that supports evidence-based medical care

• Identification of preferred practice networks

• Improved disease management tools

• Provider evaluation based on outcome data rather than economic data