Using Analytics Tools to Drive Care Coordination for Wildfire Victims

January 22, 2024 - Climate change is a public health crisis, threatening human health by increasing the frequency and intensity of natural disasters like hurricanes, tropical storms, floods, heatwaves, wildfires, and more. These events have significant ramifications for the healthcare system worldwide, increasing costs and exacerbating infectious diseases.

Air pollution caused by agricultural emissions and wildfire smoke may also contribute to adverse outcomes in chronic disease.

Links between air pollution and brain damage have been found in medical literature for decades, but more recent studies have confirmed that air quality can play a significant role in the development of neurodegenerative disease. One longitudinal study published in 2018 found an association between air quality improvement and slower cognitive decline, while another published in 2023 revealed that living in areas with high levels of particulate air pollution significantly increased the rate of incident dementia.

As wildfires spread across Canada and the Northeastern United States last summer, health systems faced the challenge of caring for a variety of patients dealing with wildfire smoke-related conditions. Some public health stakeholders have asserted that health informatics and health information exchange can help mitigate the impacts of climate change, but these tools are only one part of a larger strategy for helping wildfire victims.

Roseburg, Oregon-based Umpqua Health, a coordinated care organization (CCO) primarily serving Medicaid beneficiaries, recently leveraged an analytics-driven population health management platform to avoid and prevent emergent care for patients exposed to wildfire smoke.

HURDLES TO CARING FOR WILDFIRE VICTIMS

Healthcare organizations face a myriad of obstacles when trying to effectively care for those impacted by wildfires and related air pollution, but identifying, tracking, and engaging these patients are some of the major challenges.

“Wildfire smoke is a big public health concern, and so the ability to identify and track the patients that have a higher risk of cardiovascular or respiratory issues, due to their medical history, their geographic location, or other risk factors — like health equity or social determinants of health (SDOH) — is important,” explained Robin Traver, PharmD, MBA-HM, vice president of Clinical Operations at Umpqua Health.

Historically, limitations related to the amount of data the CCO has at its disposal have hindered these efforts.

“We can have too little data — so we don't have any claims data, or we have claim lag issues — but sometimes, we have too much data,” she stated, noting that this “data overload” can make it difficult to sift through the information and identify patients in real time.

Resources are also often scarce, making flagging patients who need the most help and identifying the efforts that will be most impactful even more crucial.

Proactive steps, such as distributing air purifiers to members ahead of wildfire season, are key, but data and resource issues can also contribute to scalability and outreach challenges.

“During a natural disaster or a wildfire, it can be challenging to deploy resources that are scalable for outreach to everyone who needs them and do what we need to do to protect our members and help the public,” Traver said.

Even if staff can utilize the data to generate a list of members for outreach, coordinating care for those individuals and tracking that care effectively creates another hurdle Umpqua Health must navigate.

To overcome these problems, the CCO utilized the Arcadia Analytics platform.

LEVERAGING POPULATION HEALTH ANALYTICS

Traver indicated that the platform has multiple functionalities that have helped the organization better tackle some of the challenges of providing care for wildfire victims.

The first is the data integration component. Identifying high-risk members for outreach in any population health initiative requires pulling and analyzing a wealth of information. Since the risks associated with natural disasters are often serious and complex, this is especially true for health systems dealing with phenomena like wildfires.

Traver stated that the platform allows Umpqua Health to pull a variety of data — electronic health records (EHRs), patient demographics, SDOH, geography, language, sexual orientation, gender identity, and other information — to inform its wildfire-related risk stratification and outreach strategy in a way that promotes health equity.

“Knowing that certain cohorts of individuals are not necessarily going to the provider as much [tells us] we might need to have a lower threshold of how they qualify for some services,” she explained.

These data are then utilized to generate a respiratory risk report, which helps the CCO determine how its 500 air purifiers should be distributed before the start of the wildfire season.

Before implementing the platform, Traver stated that the list was generated via ICD-10 codes and claims data, which did not provide a complete picture of members’ risk.

This is where one of the platform’s other capabilities comes in: risk stratification.

Traver explained that the tool is designed to stratify each patient’s risk of cardiovascular and respiratory complications, assign them a risk score, and then rank individuals based on that score. She emphasized that this has been significantly more accurate than the CCO’s previous approach.

The platform also offers real-time monitoring, which care coordination teams use to drive patient outreach.

After generating the respiratory risk report and identifying high-risk members, these teams use the platform to send each patient a text message to notify them that they qualify for an air purifier and direct them to contact the CCO for more information.

Then, Umpqua Health can distribute the devices and track patient outcomes for high-risk members who did and did not receive them. Traver highlighted that the organization can also track secondary outcomes using the platform, improving care in other areas.

“One of the biggest things that we saw from this effort was that as we interacted with these very high-risk members, we got them to do health risk assessments, which resulted in enrollments into other care coordination programs,” she said.

Recently, the CCO reached roughly 850 members and distributed approximately 400 air purifiers, she continued. As a result, 150 new health risk assessments were completed, and over 40 members were enrolled in care management programs for the first time. Overall, the effort led to a host of care coordination interventions, some related to providing air purifiers, while others focused on initiatives like housing assistance.

Many of these interventions have helped Umpqua Health prioritize health equity while tackling climate-related healthcare challenges.

CLIMATE AS A SOCIAL DETERMINANT

Traver indicated that the Oregon Health Authority is focusing on health equity and climate responsiveness.

The Oregon Health Plan 1115 waiver formalized Health-Related Social Needs (HRSN) benefits, including housing support, nutrition services, and climate devices for the state’s Medicaid enrollees.

Traver emphasized that these benefits help promote a more proactive approach to improving population health.

A pharmacist by training, she underscored that a mix of approaches is necessary to help patients attain their highest level of health.

“Now, my work is so [focused] around social determinants of health, and I've stepped out of the pharmacy space,” she said. “Medications are important, but when someone doesn't have a home, how are they going to be successful? And when they have a chronic illness, it's really challenging. So, recognizing that up to 80 percent of health outcomes are not related to the [recommended] medical interventions, but to these other social factors, is important and impactful.”

This knowledge is particularly relevant in the case of wildfires and other natural disasters, as experts explore the environment and climate as SDOH.

Moving forward, Traver indicated that the CCO will be testing other advanced analytics tools to further its care coordination, health equity, and climate responsiveness efforts.