A Landmark, 12-Point Review of Population Health Management Companies (Executive Report)

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Population Health Management and Accountable Care

Ignoring the complexities of the federal definition, the concept behind Accountable Care Organizations (ACOs) has been practiced for many years by integrated delivery networks, such as Intermountain Healthcare and Kaiser Permanente. Accountable care boils down to a very simple combination of: (1) Managing fixed-price contracts for the treatment and management of individual patient health (in contrast to fee-for-service, time-and-materials contracts); and (2) Applying the patient-specific concept of balancing cost-of-care with quality-of-care, to large populations of patients. The Venn diagram looks like the following:

AC-venn

The purpose of this paper is to discuss the data management requirements of the outer circle—Population Health Management (PHM)—not the claims processing, detailed cost accounting, and contract management systems of the inner circle—fixed price contracting.

In full disclosure, I am associated with a vendor, Health Catalyst, that claims to provide a solution to the requirements in that outer circle of PHM. For 22 of my 30 years as a healthcare professional, I’ve been a CIO—the person on the other side of the table, looking for vendors that I could trust to provide the products and services that my organization needed, particularly analytics products.  I joined Health Catalyst under a contract that guarantees my rights to tenured public opinion, whether the opinions I publicly express expose shortcomings of Health Catalyst or not.  My loyalty resides first with the betterment of healthcare for our country. All other loyalties, including those to Health Catalyst, fall to second place.

Sanders’ Criteria vs. CCHIT ACO Framework

In June 2013, The former Certification Commission for Health Information Technology (CCHIT) released a white paper entitled, “A Health IT Framework for Accountable Care,” which had a similar intent to that which I undertake in this paper. It is an excellent paper in its own regard and should be referenced when organizations are evaluating vendors and plotting their PHM strategy. In the CCHIT document, the authors make a powerful statement about the need for analytics, which is, of course, in total alignment with my opinion:

“A high priority is the establishment of a data warehouse that can accept, store, normalize, and integrate data from multiple clinical, operational, financial, and patient derived systems. All of the key processes and many of the functions and HIT capabilities listed are dependent on the existence of such a data repository. How your organization performs with respect to its goals will be dependent on a timeline that outlines what data will be incorporated and when.”

While I agree with and admire the quality and thoroughness of the CCHIT white paper, as a CIO, it left me looking for something more succinct—an objective checklist for strategy development and vendor evaluation—and a sense of timing and prioritization tailored to the realities of the market. Those realities include: (1) A vendor market with incomplete PHM offerings; (2) Of the US patient population, only 18.2 million lives are being managed under an ACO (according to a report on Health Affairs Blog). Therefore, the current economic model is insufficient to drive many of the changes outlined in the CCHIT paper—that is, the CCHIT paper does not provide me with a sense of realistic timing for assembling the IT and data management systems needed for PHM. That, above all else, is the most significant motivator behind my paper. I incorporate the concepts contained in the CCHIT paper and turn those concepts into a checklist for sequenced implementation of PHM, given the state of the market.

Evaluating Population Health Management Companies

One thing is clear about the future of healthcare: our ability to deliver high-quality, economically sustainable care will depend on how well we can manage the health of populations. For many integrated delivery networks that have been balancing the economics of care with the quality of care for decades, the concept of PHM is embedded in the culture, even though the term “population health management” was not commonly used until recently. At places like Intermountain Healthcare, they were simply delivering what they considered the best care for their patients and community and didn’t see the need for a new term to describe their natural tendency. PHM is in its early stages of maturity and, as is normally the case in such early stages, it is suffering from inconsistent definitions and understanding, overhyped by vendors and ill-defined by the industry. Rarely a group to shy away from chaos, 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. As a result of this chaotic environment, the usual sources of reliable information on such matters—KLAS, Chilmark, IDC, and others—are also having a difficult time classifying the market. At the end of this paper, I will grade a sample of the vendors in this space and their ability to meet the PHM criteria I’ve outlined. I welcome all the vendors listed to rebut my grades if they feel slighted. The goal here is to represent only the truth.  Here is the representative sample of leading vendors that I will evaluate:

  • Crimson
  • Explorys
  • Health Catalyst
  • Lumeris
  • Optum/Humedica
  • Phytel
  • Premier

Let me say with emphasis:

No single vendor in the current healthcare IT market currently meets all the requirements of population health management, as practiced by the leading integrated delivery networks.

To help organizations make sense of the vendor options that are available—and to help them understand all that is required to

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