PHM Pathfinder Analytics

PHM Pathfinder Analytics

Transforming care delivery with population health analytics

Optum is a market leading health solution provider, delivering population health management tools that help make health and care systems work better for everyone. Introducing Optum

Contents:

3 Introducing Optum 4 Shaping the future of population health management 5 Introducing PHM Pathfinder Analytics 6 The foundation for integrated analytics 7 The population health management cycle 8 Understanding population health and care needs 9 Opportunity analysis and targeting 10 Predictive system modelling 11 Design and begin to implement interventions 12 Active monitoring and rapid improvement 14 PHM Advisory Service 15 Benefits 16 Case study

As demand and pressure on NHS services increase, we’re here to support you with intelligent analytical solutions that enable actionable insights at neighbourhood, place, and system levels. Our insights help enhance the efficiency and effectiveness of healthcare delivery across your integrated care system (ICS). This supports inter agency care service evaluation, redesign and resource allocation to proactively meet the needs of your population. Our analytical tools link up your local and national data sets, creating a shared source of truth for your healthcare economy. This enables you to

strategically plan best-in-class services to meet population needs proactively. Built based on the learning gained from effectively integrating and embedding population health management into practice, this flipbook outlines the power of PHM Pathfinder Analytics and our wrap-around advisory services in driving change and improving patient outcomes. We have impacted

Integrated data is crucial in understanding and building a healthier population, enabling you to make the most of the resources across your organisation. PHM Pathfinder Analytics offers a flexible end-to-end solution with intuitive analytical tools and reports, that can help turn data insights into action, and support the delivery of proactive and preventative care. System-wide access to PHM Pathfinder Analytics supports every tier of an ICS to gain insight, plan, act, and evaluate transformation strategies. Introducing PHM Pathfinder Analytics

Shaping the future of population health management

Healthcare teams are facing increasing demand and growing pressures that can only be met through effective collaboration across all tiers of an ICS. Identifying the challenges in your system can enable you to break down barriers and implement change where it’s needed the most. Our powerful population health management platform, PHM Pathfinder Analytics, empowers your ICS to digest combined clinical and non-clinical data in a highly visual format. By creating a holistic view of how services are used in your area, PHM Pathfinder Analytics helps you to deliver evidence-based interventions to improve outcomes and maximise efficiencies. While there will always be immediate pressures on our health care system, shifting the focus upstream is essential for improving population health and reducing pressure on our health and care system.”

PHM Pathfinder Analytics is helping organisations to improve: • Elective care recovery • Health inequalities • Financial recovery and sustainability • Workforce planning and capabilities • Demand and capacity

*Hewitt, P. (2023). The Hewitt Review: An Independent Review of Integrated Care Systems. Published 4 April 2023.

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— The Rt Hon Patricia Hewitt, Department of Health and Social Care

The foundation of integrated analytics

The population health management cycle

From insight and impact assessment through to interventions and monitoring, PHM Pathfinder Analytics supports your entire population health management cycle, empowering you to nurture a healthier population.

PHM Pathfinder Analytics offers a fully integrated dataset, incorporating activity, finance, outcomes and risk factors across the entire healthcare system.

What does PHM Pathfinder Analytics provide?

Segmentation– The ability to segment your population data in a way you choose. Identify at-risk cohorts, implement proactive and preventative care, and apply interventions for high-risk groups or risk-stratify the elective care backlog. Analytics– Diagnostic analytics for a meaningful insight into local opportunities. This helps you to identify areas for intervention, investment, and resource allocation, according to your population needs.

Evaluation and evidence– Tracking, monitoring, and evaluating current interventions to evidence effectiveness and efficiency, empowering you to make informed decisions to scale up or scale down resources or services. Financial projections– Financial modelling that enables you to plan for future population and workforce needs. You can understand where to invest and remove the barriers to delivering value based care.

Understand population health and care needs Opportunity analysis and targeting

Population health management cycle

Design and implement interventions

Predictive system modelling

Active monitoring and rapid improvement

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Understanding population health and care needs

Opportunity analysis and targeting

Data and analytics

Population insight and action

Linked health and care data can help you to: • Understand demand, capacity, and access challenges across your population

Analysis capabilities: • Health economic modelling to identify risk factors driving increased spend and activity • Identification of high intensity and high- frequency users • Risk benchmarking to identify outliers and areas for system focus • Insightful segmentation of outcomes and total cost of care

Linked data sets provide a shared source of truth, bring together information from across your ICS, including: • Primary care • Acute care • Community services • Mental health • Social care • And other data such as ambulance, police, and housing, with the right permissions in place. Data is displayed in easy-to-read, interactive dashboards that highlight areas of high-risk, unexpected activities, and poor outcomes. This helps you target areas of unmet need or outcome variation.

PHM Pathfinder Analytics enables you to understand patterns and trends in linked data, such as which risk factors most impact your population. This supports better use of resources and the delivery of proactive and preventative care — improving outcomes andv experiences for patients and staff.

• Identify prevalent health inequalities

• Analyse your workforce distribution and skills mix • Gain a system-wide view

of future population needs, and demands, enabling effective workforce planning

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Design and implement interventions

Predictive system modelling

Insight and intelligence

Intervention and incentives

Our powerful system modelling provides a comprehensive view of your ICS, with demographics and total cost of care projections that can offer insights into financial risk using integrated, person-level data.

PHM Pathfinder Analytics supports the design and implementation of interventions for at-risk patient cohorts, or those experiencing variation in outcomes. Using this evidence base can support you to model the potential long-term and large-scale impact of these interventions.

PHM Pathfinder Analytics is used for:

PHM Pathfinder Analytics is used for:

Simulating financial risk using person-level costing data scenarios, for future facing financial analysis

Accessing the clinical interventions library, to

and phased implementation Putting linked data and population health needs at the heart of the planning cycle, shifting planning decisions to outcomes and people rather than activities and organisations

evaluate the potential return on investment of evidence based care models, including workforce impact

Design interventions, based on the needs of the population

Model the impact of an intervention on workforce and costs

Calculate workforce needs, current and future resource allocation, costs, and potential return on investment

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Forecasting, monitoring and evaluation PHM Pathfinder Analytics enables you to continuously monitor the impact of interventions across population groups, actively monitoring utilisation, outcomes, activities, and costs. This supports ongoing quality improvement and helps you make informed decisions on resource allocation for scalable and sustainable change. Active monitoring and rapid improvement

Through active forecasting, monitoring, and evaluation, you can: • Understand future population needs, service demands, and projected costs • Gain a real-time view of

which transformation initiatives are making an impact

Create investment business cases and make informed decisions about where to invest in the spread and scale of initiatives

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PHM Advisory Service

To maximise the benefits of PHM Pathfinder Analytics, we provide:

We’re more than a technology provider. We recognise that engaging your workforce to implement changes and improvements is crucial for getting the best possible long-term value from investment in data and analytics. That’s why as part of the PHM Pathfinder Analytics package, we offer an advisory service to enhance value and utilisation. Engaging your teams and embedding them into operations is crucial for the success of transformational programmes of work. Our integrated approach means you’ll harness the full potential of PHM Pathfinder Analytics and drive meaningful change across your ICS.

Tailored workshops focused on strategy and vision, skills development, and ongoing support

Coaching for analytics and finance transformation

Guidance on managing cultural change

Our core offer includes: • Coaching for analytics, managerial, and clinical staff who will use the tool daily, empowering them to integrate PHM Pathfinder Analytics into their workflows effectively. • Organisational development support to engage managers and clinical leads in cultural change required to support new ways of working.

• Facilitation and development of vision, case for change, and collaborative leadership approaches to create an environment conducive to scaling and expansion. • Skills development for finance, managers, clinical leads, and analytics team to establish outcomes-focused incentives that solidify long term changes.

Alternative resource allocation strategies

Evaluation toolkits for measuring progress

Population health projections and planning programmes

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Case study

Cheshire and Merseyside Integrated Care System (ICS) had a goal to rapidly identify and engage high-risk patients for timely intervention. This approach aimed to alleviate pressure on local services by reducing primary care appointments, accident and emergency visits, unplanned hospital admissions, and calls related to respiratory conditions exacerbated by cold homes. Using PHM Pathfinder Analytics, they now can access information that helps them identify patients and take action to implement preventative and proactive care. We set out a commitment to zero in on fuel poverty as part of our wider mission to tackle health inequalities. Since then, the fuel poverty programme has worked closely with several local “trailblazer” sites, using linked health and social care data to help them identify the most critically vulnerable patients and deliver targeted support.”

Lincolnshire Integrated Care Board (ICB) were seeking a way to join-up and use their population health data to connect their teams and build a deeper understanding of the communities they serve. Adopting PHM Pathfinder Analytics enabled them to successfully access a person-level linked dataset covering 100% of their population. This integrated data via PHM Pathfinder Analytics has provided teams with valuable insights into their patient population. The ICB can now measure the impact of value based care models and interventions at scale, enabling informed investments and fostering a healthier future. Using a suite of analytical tools, we can draw out unique insights into health inequalities, the wider determinants of health and other factors such as social vulnerability. Together, it means we can now confidently plan, predict and measure the effects of new interventions in a way we’ve never been able to in the past.”

– Matt Gaunt , Chief Financial Officer, Lincolnshire Integrated Care Board

– Professor Rowan Pritchard Jones , Executive Medical Director, Cheshire and Merseyside Integrated Care System

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Get in touch

If you’d like to find out more about how we can support you, speak with your local account director today, or get in touch at:

uk.info@optum.com

optum.co.uk/tech-enabled-services

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