Population health management: What will it take?
The transition from a Fee-For-Service (FFS) to a value-based payment model is gathering momentum. The majority of the providers are getting ready to set out on this journey if they haven’t done so already. Whether they are in the early stages, are a part of the increasing cohort of ACOs or are taking on full risk bearing contracts, effective population health management capabilities are critical to making this transition successfully.
Population health management (PHM) solutions seek to achieve the triple aim – better health of populations, better healthcare for patients and lower cost – through cost effective management of complex cases, proactive management of diseases and wellness initiatives to maintain the healthy population. PHM can be a complex undertaking and requires IT enabled competencies in four key areas:
1) Data aggregation and integration to create complete longitudinal patient record: Providers need to aggregate, process and normalize data from disparate clinical and financial systems (Claims, EMR, Pharmacy, etc.) to create a unified longitudinal patient record that is complete and up-to-date.
2) An understanding of the clinical and financial risk of the covered population: Once the patient health records are available, providers need to assess risk and stratify their population according to health state and illness burden. They should be able to identify high risk patients and target interventions that prevent avoidable high cost events such as ED visits, hospitalizations, etc. Further, they must be able to project the clinical risk of the population and its impact on their medical costs over the duration of the contract.
3) Effective care coordination & management for better health outcomes:Providers need to establish a clinically integrated health network and make up-to-date longitudinal patient record easily accessible at the point of care. Providers also need to deploy tools and resources to help care givers easily access patient health records, prioritize, coordinate and deliver care across this network and manage complex cases. Further, improved care coordination can reduce unwarranted variance in care and optimize use of clinical resources so patients receive the right amount and type of care while reducing costs.
4) Patient engagement: Most importantly providers need to empower patients to take charge of their own health, care and improve compliance by providing the tools, resources and education necessary for increasing patient engagement.
For those providers aspiring to be truly self-sufficient risk bearing entity, the final step in this journey will require the ability to design, administer and manage health plans and benefits. While this may be a long term aspiration for many providers today, in the short term, success in the new world of value-based care delivery will largely depend on developing technology capabilities and organizational competencies for population health management.
Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals.