The U.S. healthcare market projects that by 2022 90 million Americans will be in an ACO. The upward trend in population health management (PHM) makes the move towards risk-based contracts increasingly urgent for health systems. The industry has been largely unprepared for the shift, as it hasn’t established a clear definition of population health or solid guidelines on transitioning from volume to value. Organizations can, however, prepare for the demands of PHM by adopting a solution that manages comprehensive population health data, provides advanced analytics from new and complex challenges, and connects them with the deep expertise to thrive in a value-based landscape.
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Population health and value-based payment demand data from multiple sources and multiple organizations. Health systems must access information from across the continuum of care to accurately understand their patients’ healthcare needs beyond the acute-care setting (e.g., reports and results from primary care and specialists). While health system EHRs have a wealth of big-picture data about healthcare delivery (e.g., patient satisfaction, cost, and outcomes), HIEs add the clinical data (e.g., records and transactions) to round out the bigger picture of patient care, as well as the data sharing capabilities needed to disseminate the information.
By pairing HIE capability with an advanced analytics platform, a health system can leverage data to improve processes in four important outcomes improvement areas:
- Machine learning
- Professional services
- Data governance
Population health management (PHM) is in its early stages of maturity, suffering from inconsistent definitions and understanding, overhyped by vendors and ill-defined by the industry. Healthcare IT vendors are labeling themselves with this new and popular term, quite often simply re-branding their old-school, fee-for-service, and encounter-based analytic solutions. Even the analysts —KLAS, Chilmark, IDC, and others—are also having a difficult time classifying the market. In this paper, I identify and define 12 criteria that any health system will want to consider in evaluating population health management companies. The reality of the market is that there is no single vendor that can provide a complete PHM solution today. However there are a group of vendors that provide a subset of capabilities that are certainly useful for the next three years. In this paper, I discuss the criteria and try my best to share an unbiased evaluation of sample of the PHM companies in this space.
Population health strategy can borrow a lot from public health. However, health systems haven’t had to deal with patient socioeconomic issues and need to build new skills and use new data. The skills can be adapted from the public health sphere, with hospitals developing health interventions alongside law enforcement, community-based social support, etc. The most important data are patient-reported outcomes data, social determinants of health data, and activity-based costing data. With this approach, the fundamental equation for population health would be Return on Engagement, that is the clinical outcome achieved divided by the total patient investment.
There seem to be a lot of definitions for population health management and population health analytics. But all these definitions share one thing: outcomes. The goal is to provide quality care outcomes with good patient experience outcomes at a low cost outcome. So, how can organizations systematically improve their outcomes? The answer lies in three key questions: What should be done to provide optimal care? How well are those best practices being followed? And how do those best practices move into everyday care for patients? Using a systematic approach to answering these three questions will lead organizations toward becoming an outcomes improvement machine.
Why Population Health Management Strategies Require Both Clinical and Claims Data (Executive Report)
Health systems are interested in population health management strategies for two reasons: to manage the escalating costs of treating chronic diseases and to survive the shift in the government’s payment model. But for health systems to survive, they’ll need to change their traditional way of accessing and analyzing only claims or clinical data because this approach omits valuable information. Overcoming the barriers to accomplish this goal won’t be easy, but by following these two strategies, health systems will be able to create a superior population health management initiative: map outpatient codes to clinical care process families and select flexible and scalable technology.
Population health management will require healthcare providers to care more effectively, efficiently, and safely for more people—despite shrinking reimbursements and rising costs. This white paper outlines the strategies you can adopt to help to turn the reality of population health into a solid, marketable asset for your health system.