Healthcare organizations across all settings cannot help but hear the clamor to put population health management strategies into action. Although it's the next logical step towards accountable care, many providers are hesitant or simply lack the resources needed to get a sustainable strategy off the ground.
Regardless of organizational readiness, population health discussions are taking shape. Forward-thinking payers, health systems and ambulatory care providers have all started to make the paradigm shift on some level--reaching varying degrees of maturity and success.
Take payers, for instance. As a group that has long applied data analytics in an attempt to improve quality and reduce costs, many believe that health plans are the most advanced in the population health space. However, most plans have achieved somewhat limited success with having a real impact on achieving population health goals, mostly because they don't have the appropriate relationships with the patients. In addition, they typically only have access to claims information which minimizes their effectiveness in understanding the complete picture.
On the other hand, large academic medical centers and health systems have made some inroads from a clinical perspective in recent years, pulling from deep pockets and broad expertise. The momentum has not been the same for smaller community and rural hospitals. Many are struggling to simply stay afloat amid so many competing regulatory initiatives.
Caught in the crossfire of fee-for-volume and fee-for-value, ambulatory providers face a great challenge in gaining population health management momentum. Although some larger group practices may be in the early stages of devising a strategy, and some have jumped into risk full steam ahead, most smaller and independent practices have yet to move past initial discussions.
Understanding the challenges of population health
Even though population health management is an unchartered path for most providers, early adopters of risk-bearing care delivery models are realizing significant benefits to revenue streams and patient outcomes by addressing these strategies. The opportunities are real and are worth the effort.
That said, there are some substantial roadblocks standing in the way. For example, physicians have long been experts in diagnostic and episodic care-- taking a somewhat siloed approach to patient interactions that was dictated by previous reimbursement modalities. Now, they must begin to think about patients more holistically, reaching out to other providers and care settings to collaborate. Enabling strong communication across the continuum requires resources and infrastructures to enable information sharing.
Data is also essential to a sustainable population health strategy. Electronic health records (EHRs) provide the foundation for capturing needed data, but many systems lack the functionality to achieve the high-level analytics needed for population health initiatives, thus limiting a provider's ability to access, aggregate, normalize or even find the necessary information.
Large, multi-specialty practice models that encapsulate operations under one umbrella are better positioned than most to properly deal with data. When an entire population data set is housed underone technological infrastructure, dynamic data analytics become much more achievable. Alternatively, physician practices that refer patients to services and specialties outside of their network face tremendous challenges in data integration, information sharing and content accuracy.
Although data access is one hurdle, achieving population health management while still operating within a fee-for-service model is another equally daunting challenge. Many practices have not considered how they will make the transition to fee-for-value and are trying to operate on some level in both worlds. However, in general, ambulatory providers are far less schizophrenic than hospital providers who need to balance the need to keep their beds full while at the same time reduce costs.
Exacerbating the situation is a fluid quality measurement landscape. Risk-bearing contracts and requirements are characterized by countless payer variations and no standard protocols. Physician practices, who have long been reimbursed simply for services rendered, must now manage multiple layers of risk. Adding to this change is that the quality measures set by these different arrangements vary from each health plan, making it difficult to standardize best practices around care delivery and quality.
Moving towards comprehensive population health management
Despite the difficulties, making inroads into population health management is possible. Following are a few strategies for getting started.
· Agree on a new world order. The most important component of any sustainable population health strategy is culture--a willingness to make a philosophical change in how care is delivered. Fringe attempts to "try population health on for size" have repeatedly proven unsuccessful in healthcare organizations across the nation. Organizations must make the commitment to fully embrace the concept of proactive and collaborative care while taking the leap into population health management with all hands on deck. That said, there is no need to jump head first into taking on complete risk on day 1. Culture change is going to take time and as such, the organization has to assess their risk tolerance and create a plan that enables a transition. Interestingly, the vast majority of ambulatory providers that have been most successful with the transition from fee for service to fee for value are those that have taken on as must risk as they can given their payer mix.
· Deploy the right infrastructure. Pursuing population health is not practical without technology. Infrastructure that delivers longitudinal patient views can support workflows, and a robust data analytics platform can quickly and accurately identify at-risk patients. Organizations should also leverage automated tools to support patient engagement strategies that connect patients with designated care managers. These tools can also manage the operational complexities of multiple risk-bearing arrangements.
· Allocate and train staff. Proactive chronic disease management requires dedicated care management staff, which most ambulatory care organizations do not have readily available. Providers also need to retool workflows to support upfront outreach to patients. In some cases, it may be helpful to leverage outside expertise to retool workflows and train current staff to assume a more holistic approach based on care management methodologies.
Getting the ball rolling on population health
Population health management is a critical component of healthcare's work to enhance the patient experience, improve population health and lower costs. Although industry experts tout proactive health management's ability to positively impact outcomes, pulling off a strategy can be challenging. To achieve these goals and become a sustainable program, organizations need to look at population health first and foremost as a cultural change--then back it up by powerful technology to succeed in value-based care.