BY JOSE ALEJANDRO, PhD, RN-BC, MBA, CCM, FACHE, FAAN
As a child, I remember watching space travel and future world television shows and movies. I thought some of the technology advancements were far-fetched and would never come to reality in my lifetime. Admittedly, I was wrong, and much of what I saw in the past has become a reality that requires me to change my mindset.
It seems like every day we hear about at least one new technology or application that is geared toward monitoring or improving our health and wellness. Predictive analytics is the new rage in healthcare. There are a number of large healthcare centers that are building “command centers” that use algorithms to dispatch rapid response teams, predict bed census and create transition of care pathways for individuals being served by the organization.
Retail product developers and marketers have used predictive analytics extensively in the last decade and continue to work with software developers to find ways to better mine big data. In the past, healthcare has lagged in adopting this technology, but this is quickly changing. Healthcare futurists predict greater use of artificial intelligence, wearable diagnostics and gene therapy.
Geo-medicine is being developed as an analytical tool that can tracks illness and disease burden within geographic areas. For example, the U.S. Department of Health & Human Services GeoHEALTH Platform (https://geohealth.hhs.gov/arcgis/home/) can be used in emergencies to identify geographic areas where there are large groups of people dependent on electricity to support durable medical equipment. The platform links large datasets and geographic information to create real-time maps that can be used to mitigate risk.
Savvy case managers have always held mental models that help them predict the risk of admission, readmission or re-entry into the healthcare system. Our past premonitions are now being hard-wired within technology as risk algorithms. Scholarly research and evidence-based practice clearly demonstrate the linkages between social determinants and the health and wellness of an individual within a population. Innovators will continue to use data to develop strategies and interventions to manage risk.
Our healthcare financing system is evolving to a risk-based population health model. Actuaries use sophisticated models to predict healthcare consumption, which is then used to develop payment methodologies and target performance levels. Big data is being leveraged in the development of more advanced and robust performance metrics.
Case managers will need to continue to develop our information literacy skills and competencies in order to keep up with burgeoning technology. Our practice will continue to utilize and leverage data-based tools to assist us in helping individuals traverse the healthcare continuum. Most importantly, case managers have a responsibility of refocusing attention back to the individual amidst a population health paradigm.
Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN
President, CMSA
2018-2020
Dr. Alejandro is the director of case management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.
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