Care Management Platforms for Population Health: Seven Real-World Best Practices
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The document outlines best practices for implementing care management platforms focused on population health, emphasizing the shift from traditional, low-touch care management towards a data-driven, real-time approach. It highlights the need for healthcare organizations to assess their readiness and maturity in various critical dimensions, to effectively redesign workflows, and manage the complexities of integrating these platforms into existing systems. Successful implementation relies on a multidisciplinary governance structure and robust process management, enabling providers to enhance patient outcomes while controlling costs.
Care Management Platforms for Population Health: Seven Real-World Best Practices
- 1. Care Management Platforms for Population Health: Seven Real-World Best Practices Our experience with large platforms offers important lessons and strategies that healthcare organizations can successfully replicate when deploying a population health-oriented care management system. • Cognizant 20-20 Insights Executive Summary Care management platforms are fast becoming a necessity for provider-delivered population health management. Payers have long prac- ticed care management, but in a low-touch environment using claims data. Increasingly, how- ever, providers will practice population healthcare management using a relationship-driven, real- time, high-touch approach. Platforms promise to deliver evidence-based care plans, driven by real-time data from a central repository. This will enable providers to achieve the patient outcomes necessary to meet the value-based care require- ments of delivering higher quality care at lower costs while improving the healthcare consumer’s experience. How well providers succeed at these goals depends on how effectively they plan, prepare and execute the care management platform implementation. This is largely uncharted terri- tory for providers. No individual vendor has been able to offer a complete platform solution that directly addresses all the needs of typical provid- ers for acute and/or ambulatory care. The lessons discussed in this whitepaper are the result of our direct experience with recent care management platform deployments designed to achieve provider population health management goals. These challenging projects touched vir- tually every clinical and business process in the organization. Our work has helped us identify a critical readiness evaluation model that providers can use to streamline platform implementation, including assessing care management maturity in several dimensions. Using this model, organizations can success- fully deploy care management platforms and design new workflow processes that will help them fulfill contractual requirements and align clinical resources more appropriately with actual needs. These care management approaches will also enable providers to effectively monitor and manage populations and deliver wellness services more effectively to improve patient satisfaction while reducing costs. cognizant 20-20 insights | march 2016
- 2. cognizant 20-20 insights 2 Automating Care Management for Population Health: A Brave New World When a care management platform designed for managing population health with real-time data goes live, it identifies hundreds of patients and generates disease cohorts, care plans, reports and dashboards. In just a matter of hours, the platform delivers a long queue of ready-to- engage patients that would otherwise take several months to compile. Such systems interact with key provider business and clinical processes and IT systems. Care management is exceptionally data-driven, using clinical, revenue cycle and utilization data to provide decision-making guidance at the point of care by referencing evidence-based health out- come contractual requirements. To take full advantage of the care management platform’s capabilities and adapt to this new world, providers must redesign organization-wide processes and manage significant change. In an ideal provider organization, creating a closed- loop care coordination system would include a complete exchange of clinical information across all involved entities, with a patient’s care team supported by insights derived from real-time data analytics and evidence at the point of care (see Figure 1). Provider organizations face many challenges in achieving these goals. Platform implementations are not easily replicable because of each provid- er’s unique mix of IT systems, business processes and patient populations. Even within a single pro- vider organization, IT capabilities and business and clinical maturity for care management may vary widely across individual departments and institutions. In addition, care management platforms are still relatively immature. They have not been in use long enough to collect the feedback necessary for vendors to enhance and grow their offerings. During our recent work deploying care manage- ment platforms, we inventoried tools, strategies and key lessons learned that have enabled health- care organizations to more smoothly implement and generate value from their investments. Care Management’s Data Intensity Care management platforms promise to automate labor-intensive data aggregation, more quickly and accurately identify patients, generate appropriate care plans and assist care managers at the point of care with relevant data and evidence-based protocols. 15 SEPTEMBER Data Acquisition Aggregate data to support a longitudinal patient view and patient record-matching. Risk Stratification Update risk inputs in real-time, including demographics, clinical and social data. Disease Cohort Identification Automate patient identification and assign evidence-based care plans. Care Program Operations Implement evidence- based protocols and standardize role and workload management. Reporting Generate administrative, operational, quality reports based on role. Figure 1
- 3. cognizant 20-20 insights 3 Model Key Dimensions of Readiness for Care Management Providers can better position themselves for implementation success by clearly understanding their readiness to mesh existing care manage- ment programs with a sophisticated platform. We have developed a model for scoring the key dimensions of care management implementa- tion maturity; providers can use the results to fine-tune their strategies for launching a care management platform (see Figure 2). The three key maturity dimensions are: • Organization: The work here is to assess the organization’s culture, care delivery infra- structure and technology portfolio in terms of their ability to align with a sophisticated care management platform and support closed-loop care coordination (see Figure 3, next page). The organization’s current care management processes, in particular, are evaluated according to their levels of interop- erability across departments, use of analytics to drive care decisions, caregiver training, business process efficiency and underlying IT system maturity. • Contract: Platform implementation and con- figuration choices are directly impacted by the level of complexity of current contracts. These contracts define key care management requirements and affect the scale of required transformation. Typical evaluation points include number of managed lives, risk level definition, acute or chronic conditions, patient settings, care team structure requirements, process compliance, number of outcomes to track and reporting requirements. • Product: As most provider-side care management platforms are immature, it’s critical to understand the selected platform’s current capabilities, such as how many desired features are available out of the box, its interoperability capabilities, support features and roadmap. # 2 Rethinking, Refining Care Management Platforms Care management platform implementation is an enterprise-wide effort, intertwining with clinical, administrative and IT systems and processes. Healthcare organizations must assess their readiness to integrate automation- augmented care management in these areas in order to identify and overcome potential platform implementation challenges. Vendor Partner Selection • Recognize that the care management platform is relatively immature and that the feature set is both complex and specialized for a single vendor to deliver. • Include implementation maturity and roadmap items in the evaluation. Business Needs Assessment • Recognize and address the lack of clarity on functional needs. • Develop an approach to drive priority customizations. • Address the inability to distinguish team and process redesign needs from application functionality. Consuming Data for Care Management • Enable integration of conventional, social and patient-generated data. • Address challenges in reconciling data to create a single version of the truth. Care Process Re-design and Change Management • Recognize the necessity of process mapping and evaluation. • Identify and focus on change management scope. • Understand culture and policies. Data Acquisition and Preparation • Enable semantic normalization and optimization of data. • Synchronize availability across multiple sources. • Coordinate with interoperability roadmap. • Take a continuous quality improvement approach. Product Configuration • Understand dependencies arising from integration of new and existing care delivery programs. • Manage redundancy in capabili- ties across applications. Enterprise-wide PHM Implementation Strategy • Prepare for long duration, large scope and impact. > Complex multi-partner collaboration. > Large-scale business process modifications. > Diversity of risk contracts/programs. Figure 2 LESSON 1
- 4. cognizant 20-20 insights 4 Scoring Organizational Readiness Organizations receive a score, from 0 to 100, indicating their readiness to implement a care management platform. The scores fall into one of four categories: basic, foundational, emerging and mature/sustainable (see Figure 4, next page). Using a model to calculate maturity, the organi- zation can develop an objective and structured view of its current state to guide the imple- mentation effort. An organization in the “basic” or “foundational” maturity stage should recognize that it will need to engage in more substantive process redesign and change man- agement activities during the implementation vs. an organization that already has well established and interconnected care pro- cesses across its systems (see Quick Take, next page). This approach to readiness helps highlight the areas that will most likely be affected by the implementation, and can pinpoint issues to address, such as care teams needing to learn how to incorporate analytics into their workflows, and/or key interoperability points among systems. It may also reveal other clinical, business and IT initiatives under way that might intersect with the platform deployment, such as ICD-10 transitions, electronic health records, meaningful use projects, etc. We have found that the assessment results provide a solid basis for identifying business objectives, creating an implementation roadmap and guiding project governance and implementa- tion teams. Create a Multidisciplinary Team for Program Governance The readiness assessment process illustrates why providers need a project governance team with clinical, data and operations functions represent- ed to fully address how the platform will affect discrete processes, as well as interconnected operations, data and workflows. These three func- tions must collaborate on the care management system transition plan and apply their perspec- tives and input to ensure smoother acceptance of the platform from clinical, business and IT func- tional areas. This multidisciplinary perspective is also critical for identifying all the existing and planned clini- cal and business systems — electronic health records (EHRs), health information exchanges Deconstructing Care Management Platform Excellence These are the critical organizational elements needed to successfully implement a care management platform. Robust care delivery infrastructure Organizational culture of learning and innovation Balanced technology portfolio Successful Care Management Platform that supports innovative delivery models and engagement techniques for personalized, evidence-based health management interventions. that supports a robust and flexible data infrastructure and enables data acquisition, semantic normalization and care management workflow at the point of care. that supports the essential leadership and governance structure for adopting new care management processes. Figure 3 Using a model to calculate maturity, the organization can develop an objective and structured view of its current state to guide the implementation effort. LESSON 2
- 5. cognizant 20-20 insights 5 Maturity Assessment of Provider-Led Population Health Management Quick Take Organizations that assess their readiness to adopt a care management platform can anticipate challenges and opportunities that arise during implementation. In one case, a client needed a strategy for accountable care, based on a sound business architecture with a care management platform as its centerpiece. We determined that the organization was at a “basic” maturity level, based on the following characteristics: Organizational Dimension • Virtually every physician practice was using a different electronic medical record (EMR) system, so effective data exchange was minimal. • Patient identification was based entirely on discharge information and was limited to three disease cohorts. • The effectiveness of existing care management programs had not been measured. • The current care team was not geared for population health management efforts. • The organization had not assessed the number of staff necessary to support the accountable care organization (ACO). Contract Dimension • The organization had four risk contracts, with three major health plans covering approxi- mately 80,000 lives. Product Dimension • Several siloed applications across departments supported a portion of the population’s health requirements. • Each team approached risk stratification differently; risk levels were not applied to downstream processes. • There was a low level of staff involvement in previous platform implementation projects. • A one-year implementation was expected. Through this assessment, the client under- stood it needed to make essential changes to its governance and technology architecture, and thoroughly review its existing care management delivery processes in order to derive full value from automation and the other benefits of the platform. Ready, Set, Go … The readiness and maturity assessment results in a clearer picture of steps the organization must take to ensure the care management platform implementation delivers clinical and business benefits. Organizations with Level 1 or 2 scores will likely need to make a greater effort to transform care design before or during platform implementation. FoundationalBasic Emerging CCMIM Preparedness Score Matured & Sustainable • Lack of organized care management processes and data interoperability. • Anecdotal use of evidence and risk. • Limited experience with large implementations. • Focused care management processes getting established. • Interoperability and data standards are limited across the organization. • Limited experience with applying care management risk and evidence. • Organization-level care management processes largely established; actively leverage an interoperable patient record. • Interoperability spans multiple departments. • Analytics adoption growing. • Advanced analytics and care management processes established in an intercon- nected healthcare delivery model to serve population health needs. • Health system/product vendor have extensive implementation experience. LEVEL 1 LEVEL 2 LEVEL 3 PREPAREDNESSLEVEL LEVEL 4 20 45 70 100 Figure 4
- 6. cognizant 20-20 insights 6 A Typical Care Management Implementation Governance Structure Quick Take Organizations need to establish clear roles and tasks during the implementation period across systems, departments and facilities. Key entities for establishing program governance for imple- mentation include: • Sponsor: This role is accountable for managing the transition to a new model and applica- tion. The individual has an understanding of the short- and long-term goals of the initiative, as well as how decisions affect other health system programs and contracts. • Steering committee: Project stakeholders and healthsystempartnersoftenincludecommunity organizations and patient advocates. This team works to address pain points during the imple- mentation while accounting for a variety of stakeholder perspectives. • Task force organizations: These teams provide input to solve issues and improve implementa- tion activities specific to their functional roles, including clinical, IT, change management and innovation. • Project management organization roles: These functions manage project activities and establish a transparent implementation plan. The team investigates near misses and failures, and focuses on measurable outcomes. Project managers also catalog potential issues across vendors and analyze risk mitigation plans. • The champions: This includes enthusiasts across organizational roles who understand the workflow challenges of the implementation. These individuals provide feedback to project management and lead respective teams through a seamless transition. (HIE), portals, analytic applications, etc. — that are intertwined with the care management plat- form, as well as their potential impact on the platform’s performance and expected benefits. To gather this information, the team will need to catalog technology initiatives under way in the organization and interact with multiple vendors to understand their systems and upgrade and maintenance schedules. Such understanding is critical to ensuring the care management platform performs as expected. For example, an EHR vendor may have a stated delivery date for supporting Consolidated Clinical Document Architecture (C-CDA), and the care management implementation team might build on this standard, only to learn once approaching the go-live date that the EHR vendor has shifted its deadline. This greatly complicates EHR-to-care management platform communications. Another disruption could occur when an HIE promises full interoperability, then is only able to exchange admission-discharge-transfer data sets. In either case, the lack of functionality expected in other key systems could potentially compromise the care management platform’s performance — and perhaps derail its implementation. Ensure the Platform Has a Major Impact on Care Team Operations For the organization to realize full value from the platform, care manag- ers must focus on higher value outreach and interventions, accepting evidence-based work- flows and allowing the platform to run rote and routine tasks. This shift to a collabora- tive, patient-centered model from a physician- centered approach can require substantial train- ing and support-building efforts to ensure the new platform enables better clinical decision-making and outcomes. LESSON 3 For the organization to realize full value from the platform, care managers must focus on higher value outreach and interventions, accepting evidence- based workflows and allowing the platform to run rote and routine tasks.
- 7. cognizant 20-20 insights 7 Key considerations include: • Staffing levels. By automating care management functions, providers should be able to manage a much larger number of patients. However, many providers have relatively few care managers; even with software augmentation, these smaller staffs would likely be overwhelmed by the patient load compiled by the system. • Redesigning care management processes. Traditional provider-based care management is very labor intensive, with care managers accessing multiple systems just to identify patients. The care management platform will replace these manual, error-prone processes, automatically stratifying the provider’s entire population of patients by risk, providing validated contact data and serving up the appropriate evidence-based care plans for each patient. New care management processes that take advantage of the platform’s automation must also be designed. Care team members likely will need significant training and education to align their expertise and fully engage with the platform-generat- ed evidence-based care plans and workflows. Extensive pilots and testing can help reveal these issues. Clinicians must transition from manual processes for data aggregation and care plan selection to automated tools that per- form these functions via new business rules. Similarly, the platform would offer functional- ity that enables the care manager to manage entire groups of interventions at one time (e.g., marking them complete). It would also enable bulk transfers of patients within or outside the care team, shared work lists for staff pools, and supervisor workflows that reflect the organiza- tion’s structure and roll up appropriate patients for supervisor oversight. These and other new workflows, including patient identification, stratification and trigger- ing of care programs, pose significant change management and training challenges. • Performance measurement. With an automated platform, organizations can identify performance benchmarks that were difficult if not impossible to set up with manually-driven care management. These metrics include real-time identification of care gaps that affect quality measures. For instance, organizations can measure call center performance and its corresponding effects on avoidable utilization, provider engagement and medical adherence improvement. Further, they can track care manager effectiveness on specific interven- tions, such as the discharge process, post- discharge appointment scheduling and transi- tions of care. Providers can accrue substantial gains in population health improvement by continuously monitoring these care measures that affect outcomes. The platform also enables providers to drill down and objectively assess how well indi- vidual teams and their members work with specific disease groups or risk levels. Such information enables providers to more effec- tively align teams and care coordination with target populations. Together, these metrics help organizations understand how evidence-based plans are driv- ing care improvements, and how well care team members are “listening” to the platform and using its analysis and decision-making guid- ance. This type of performance monitoring also helps ensure that care teams are managing new workloads appropriately, given that these platforms enable an organization to interact with an entire patient population, not just the highest risk members. • Division of labor. The care management platform will offer more granular stratifica- tion of patient populations by risk and disease cohorts. Providers will likely find they require new methods and new training for clinicians to gain full value from this more precise risk data. Call centers equipped with wellness and prevention-trained clinicians can serve lower risk groups, enabling more highly-trained pro- fessionals, such as nurse case managers, to interact with higher risk patients. The clinical governance team should also identify issues such as how the frequency of real-time updates to patient conditions might affect work- flows, the portfolio of necessary care programs and their timing (e.g., phased vs. big bang) and building support for evidence-based workflows. Take a Continuous Quality Improvement Approach to Data Governance Care management platforms rely on data from a wide variety of sources to ensure their func- tions streamline processes and provide accurate decision support data. A continuous quality improvement (CQI) approach to data governance can help prevent gaps in data that create work- LESSON 4
- 8. cognizant 20-20 insights 8 flow issues, such as a missing element from a patient’s longitudinal record preventing accurate stratification or predictive readmission modeling results. The data governance team must under- stand these key interdependencies. A key data team activity includes conducting a comprehensive inventory of data types and source systems and identifying platform processes with the highest dependency on interoperability. The team must identify impacts and risks and rec- ommend workarounds or data optimization techniques to feed back to clinical teams. Data sources typically include EHRs transmitting HL7 messages, CCDs or extracts, claims, electron- ic prescription data and lab results. Suplemental data sources include patient assessments, sur- veys and patient wearables. A reasonable amount of high-quality historical data is also necessary to provide context for current data. Another impor- tant factor to consider is whether the platform will exchange data with an HIE. Align Workflows and Platform Configuration Decisions with Key Performance Indicators Health systems need to model the structure of their post-implementation care teams and workflow designs based on the needs of patient populations and the specific requirements and KPIs of each contract, clinical outcome and other program success factors. These scenarios help ensure that the platform’s automated patient assignment features are properly implemented to support workflows. Organizations may also want to turn off certain features, such as intervention types to be managed, and launch with a smaller set of features that will enable care managers to gradually adjust to the system capabilities. This can help keep care managers from being over- whelmed by features and data availability. The formal process modeling and workflow designs also inform report and dashboard config- uration. This approach to process standardization and measurement creates a shift in reporting, from fragmented and department-specific to a more holistic and standardized definition of enterprise-wide data and process. Platform users will need training in order to effectively use the analytics outputs. Use Business Needs to Guide Platform Customization and Feature Selection Some healthcare platforms, such as EHRs, have well-honed implementation methodologies that guide customization choices. Because that is not the case with care management platforms for population health management, providers must endure more trial and error than necessary when selecting platform options. To avoid this situation and keep the project on schedule, implementa- tion governance teams should use business requirements, namely key contracts and their requirements, as lode- stars for choosing among available options (see Figure 5, next page). Setting priorities for which features the care management platform will deliver first, whether out-of-the-box or cus- tom-developed, is best driven by business needs. Two key areas to consider: • Care management risk. Key considerations would revolve around how the care team will use patients’ care management risk and how the organization in general would accept and use the concept of care management risk. This could be a key contractual requirement and would define the segment of managed lives to be targeted with evidence-based care programs. • Evidence-based programs readiness. The implementation readiness assessment should reveal the organization’s ability to use care To keep the project on schedule, implementation governance teams should use business requirements as lodestars for choosing among available options. LESSON 5 LESSON 6 A continuous quality improvement approach to data governance can help prevent gaps in data that create workflow issues, such as a missing element from a patient’s longitudinal record preventing accurate stratification or predictive readmission modeling results.
- 9. cognizant 20-20 insights 9 interventions as the platform generates them. Certain key parameters must be in alignment, including language of the interventions, the sen- sitivity of the business rules, and the number of similar- sounding interventions across care programs. Finally, care managers and physicians who are expected to use the care management platform must work close- ly with teams charged with configuring features and deploying customizations. The workgroups that create the list of required features should remain intact after the platform is live to gather and implement feedback. Start Small Organizations that embark on ambitious care management platform implementations find great success when they start with small, tightly planned rollouts by department and facility, and roll out the care management platform in phases. This phased approach helps minimize disruption and help gauge and adjust alignment of interoper- ability, analytics, IT and business maturity before expanding the rollout. A phased approach also helps the implementation team understand the specific feature, configura- tion and process needs of individual departments and facilities that can be addressed or added to the platform in the future. Moving Forward: Best Practices for Care Management Platform Implementation Healthcare organizations may not be able to accelerate the technological maturity of care management platforms or avoid the impact these systems have on key processes and profes- sionals. However, they can conduct a thorough assessment of their organization’s readiness in its operations, contracts and clinical processes to adopt such platforms. Increasing readiness in those areas is rapidly becoming the cornerstone best practice for achieving the organization’s goals for population health quality, cost and patient experience from a care management platform. Prioritize risk contract-based and operational reports and dashboards. Set up care team user and role privileges. Define intervention assignment by risk and role. Identify relevant care plans for the population (transition/acute). Analyze adoption of stratification to drive care programs. Prioritize interventions by type (condition, prevention). Care Management Operational Focus Clinical Care Coordination Program Focus Business Needs Assessment Focus Leading with Feature and Functional Requirements Healthcare organizations should initially look to their key contract requirements for guidance about which care management platform customization options to select. Prioritizing these requirements enables organizations to better evaluate their platform vendor’s off-the-shelf availability of features vs. custom development efforts. Necessary custom work can further be triaged and weighed against rollout schedules and business requirements. Figure 5 LESSON 7 The workgroups that create the list of required features should remain intact after the platform is live to gather and implement feedback.
- 10. About Cognizant Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process out- sourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 100 development and delivery centers worldwide and approximately 221,700 employees as of December 31, 2015, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant. World Headquarters 500 Frank W. Burr Blvd. Teaneck, NJ 07666 USA Phone: +1 201 801 0233 Fax: +1 201 801 0243 Toll Free: +1 888 937 3277 Email: [email protected] European Headquarters 1 Kingdom Street Paddington Central London W2 6BD Phone: +44 (0) 20 7297 7600 Fax: +44 (0) 20 7121 0102 Email: [email protected] India Operations Headquarters #5/535, Old Mahabalipuram Road Okkiyam Pettai, Thoraipakkam Chennai, 600 096 India Phone: +91 (0) 44 4209 6000 Fax: +91 (0) 44 4209 6060 Email: [email protected] © Copyright 2016, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. TL Codex 1759 About the Authors Ravi Mariwalla is a Senior Manager with Cognizant Business Consulting’s Healthcare Practice. He has led product management and care management implementations for population health management programs, has solution development expertise in enterprise analytics and interoperability, and has per- formed several consulting engagements in business and IT strategy for healthcare providers globally. His background includes over a decade in managing specialty hospitals. Ravi has an M.B.A. from the Sri Sathya Sai University in India. He can be reached at [email protected]. Rebecca Litner is a Senior Consultant with Cognizant Business Consulting’s Healthcare Practice. Her work focuses on integrated health management, product development and implementation, and patient/ provider engagement. She has helped design and implement care management programs and solutions for risk-based contracts, including BPCI and Medicaid Health Home. She received her M.P.H. in health policy and management from Boston University and is Six Sigma Green Belt certified. Rebecca can be reached at [email protected]. Aparna Paluri is a Manager with Cognizant Business Consulting’s Healthcare Practice. She has led teams for assessment, application/product development and implementation for payer-provider businesses. Her work centers around coordinated care management, population health-related solution devel- opment, ICD-10 regulatory compliance implementation, portal assessment, customer contact center strategy, financial sensitivity evaluation of transformational programs, payer enrollment-billing process automation and data warehousing efforts. In addition to being a Fellow, American Health Management (FAHM), Aparna has an M.B.A. from Xavier Institute of Management, Bhubaneswar, and holds a bach- elor’s degree in electronics and communications. She can be reached at [email protected]. Preethi Srikanth is a consultant with Cognizant Business Consulting's Healthcare Practice. She has expertise in a wide range of healthcare products/applications in both the provider and payer spaces. She has been involved in the development and implementation of care management/population health, computerized physician order entry (CPOE), EMRs/EHRs, provider/patient portals, and enrollment and billing functions. She has vast experience in meaningful use and ICD-10 consulting and earned an M.B.A. in IT and operations from Great Lakes Institute of Management (Chennai) and holds several healthcare certifications from AHIP. Preethi can be reached at [email protected].