Co-Morbidities and Using Data to Manage Population Health

© 2016 Laureate Education, Inc. Page 1 of 1 Medicare Data Scenario Examin e the CMS Chronic Conditions Triads : Prevalence and Medicare Spending spreadsheet located in your Learning Resources. F amiliarize yourself with CMS data regarding chronic conditions an d Medicare spending (CMS.gov), begin ning with the first tab in the spreadsheet , titled Overview , that summarizes the data sources , study population chronic conditions , and socio -demographic variables involved in the data. Note that the remainder of this data set presents five years of data on va rious triads of chronic conditions that represent material co -morbidities studied by CMS. With the CMS development of ACO’s (accountable care organizations) there is an emphasis on managing certain chronic conditions to minimize hospital readmissions. The pro -active medical management of heart failure, specifically CHF (congestive heart failure) , is a focus in trying to prevent unnecessary hospital admissions. In the medical management of this condition and associated comorbidities such as diabetes chronic kidney disease and hyperlipidemia, patients must manage both their fluid intake and maintain a rigorous regime of medication such as beta -blockers. A lack of medication compliance and or fluid management in these patients often results in repeated emergen cy room visits and or hospital readmissions to stabilize physiologic parameters. In this scenario assume you are an administrator of an integrated delivery network who is working with CMS on developing an ACO. Using these historical, five year data on CMS patients with comorbidities related to Heart Failure and per capita spending , you are asked to work with an IT analyst to lead the design of the functional requirements for the data warehouse. This business intelligence application will upload information from your organization to CMS as a part of the ACO. Senior leaders want to understand which HIT systems and which data within those HIT systems will be required to contribute relevant information to CMS regarding comorbidities on heart failure patients. They also want to understand the availability of those data and the level of quality of those data in the organization, as they will be key to the financial parameters set within the ACO agreement.