Using Analytics to Improve Care Management

Robert Crossey, DO, President, and Francis R. Colangelo, MD, MS-HQS, FACP, VP and Chief Quality Officer, Premier Medical Associates.  Improving care coordination for patients with multiple co-morbidities and chronic conditions is essential to increasing quality and reducing the total cost of care.

These patients face unique challenges navigating the health system, but also oftentimes synthesizing the advice of multiple physicians.  Drs. Crossey and Colangelo lead this 100-provider medical group in the greater Pittsburgh area associated with both UPMC and Allegheny Health, and discuss how identifying gaps and variations in care in high-risk patients help determine the best courses of action for prevention.  They also discuss how the multidisciplinary, analytical approach to transitional care, medication adherence and disease management helped decrease readmission rates by more than 20% for patients with heart failure; improved engagement of patients with prediabetes and diabetes; and significantly improved in diabetes control bundle measures.