Buyers Guide: What to look for when picking a population health platform
Population health management is an important next step in improving the quality of healthcare, and it is now part of many enterprises’ planning. Because both the strategy and the technology that supports it are relatively new to provider organizations, health IT managers will need to set aside time to carefully research the options.
Population health technology is a complicated buy. The technology must deliver information at specific points in the continuum of care and interact with a variety of existing information systems, such as electronic health records. This is not a simple matter, say HIT managers who have implemented these solutions already.
We talked to experts in order to understand the features that today’s pure-play population health systems offer, and how to avoid “gotcha” moments.
Dashboards: identifying gaps in care
Population health management technology offerings vary, though at the same time, most have a bottom-line set of features and functions designed to help healthcare provider organizations improve the health of groups of people while keeping costs down.
For example, most population health offerings manage gaps in care, alerting clinicians to times when patients may need attention.
The systems can work well in the realm of accountable care organizations. However, the ability of systems to track different payer contracts with clinical dashboards that match those contracts diverges widely among vendors, said Terri Steinberg, MD, chief health information officer and vice president of population health informatics at Christiana Care Health System.
“That is an important feature that differentiates an add-on to an EHR versus a true population health player,” Steinberg said.
Data dashboards are a central feature in most population health offerings. They can provide important metrics displayed in a form that supports the perspective of individual caretakers and of the health system overall.
“Providers need to see total cost of care, utilization metrics, and quality metrics an organization is being incentivized on. Many platforms are integrating this into their products,” said Dody Fisher, MD, chief clinical officer at Forward Health Group. “And some systems have a tip of the hat to workflow – in other words, how do you leverage the existing technology you’ve spent an enormous amount of money on? How do you leverage that into a workflow with a new population health platform? Some vendors are integrating that into a workflow component.”
Data integration in population health offerings increasingly means both claims data and clinical data. Further, these technologies often dig into risk stratification and the subsequent ability to build patient lists upon which providers can take appropriate clinical actions, said Malcolm Costello, chief product officer at Enli Health Intelligence Corp.
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“We see a lot of that in the market, though sometimes with less thought into what it means to take action on those patient lists,” Costello said. “Most systems will at least produce a list of cohorts aligned with some combination of clinical data and predictive utilization algorithms.”
What to look for when buying
When a healthcare provider organization is in the market for a population health management system, there are some key considerations. First and foremost, according to Steinberg of Christiana Care Health System, is workflow.
“As a clinician and someone who has implemented systems most of my professional life, you have to look for a system that supports whatever workflow you are trying to accomplish,” Steinberg said. “We could spend all day talking just about the importance of that, along with the various flavors of workflow. Suffice it to say, who needs to use the system, who needs to see the results of the system, and who will it help among the group of people who will participate, such as the providers, the care coordinators, and so forth?”
Provider organizations also must consider the functionality they require, Steinberg added.
“Most of the systems on the market today, they do care coordination,” Steinberg said. “But if you are full-risk and you manage utilization and more, then you need a product where that is integrated into the workflow. And another consideration is making sure you can integrate as needed with your EHR, both inpatient and ambulatory, while recognizing that an EHR is an entirely different workflow. I feel strongly that executives should not be thinking they can just grow a population health system on top of an EHR system; population health is far more complicated than that.”
Charles DeShazer, MD, a population health evangelist and physician leader who most recently served as chief quality officer at BayCare Health System, said that provider organizations must also consider whether a population health management system helps with the practice of evidence-based medicine.
“You can’t make every decision anew every time. You have to say here are the evidence-based practices, here are the key decisions to make based on data,” DeShazer said. “You need a tool with a robust rules engine, and ideally that rules engine would be accessible to the provider organization where the organization can change rules on the fly and do processing on the fly, to have the rules help generate workflows and help with tracking and escalation.”
Settling on a definition of population health
But some experts point out that it is quite important that provider organizations know what the organizations themselves mean by population health as they are shopping for information technology to help with these efforts. There are differing views of what population health actually means, and that will change what organizations must take into consideration when buying technology, experts said.
“On one end of the spectrum is managing the health of a defined population, usually patients who have an advanced disease or different conditions, like diabetes,” said Michael A. Stoto, professor of health systems administration and population health at Georgetown University. “Then there is a middle point on the spectrum, managing the health of a defined population in a care organization or some other value-based arrangement. Most vendors that say they do population health do primarily the former and to some degree the latter.”
But Stoto places his focus on what he calls the far end of the spectrum, where the population in question is defined as the service area of a hospital – in other words, a community.
“This means reaching out beyond the current patients of a hospital or health system to think about the community they serve, and that means doing things like community health needs assessments ― or CHNAs ― which are now required by the IRS for non-profit hospitals,” Stoto explained. Joseph Siemienczuk, MD, chief medical officer at Enli Health Intelligence, agrees with Stoto that organizations must understand exactly what population health means when they are considering a purchase of information technology to enable it. This may seem obvious, but it is an overlooked point today, he added.
“Executives talk past each other because they’re not always talking about the same thing,” Siemienczuk said. “This is the most important thing. Population health has to mean delivering the Triple Aim. The first thing a provider organization needs to look for in an IT offering is a balanced delivery of the Triple Aim – more than just cost management or any other narrower focus. And in order to be successful, a point-of-care component of a population health solution must be able to be seamlessly embedded into an EHR platform. Otherwise it will fail.”
And when considering a population health IT purchase, provider organizations should consider the design of an offering and the support a vendor provides with that offering, said Fisher of Forward Health Group.
“Executives really need to talk with other organizations that have a product to see if they truly can use the product the way it is supposed to be used,” Fisher said. “And regarding support, it’s wonderful to have a wonderful product, but if something goes awry, does a company have the bench strength and capacity to help a client navigate through issues?”
So what should healthcare provider organizations be mulling when it comes to the price tags on population health management technology offerings? “I love this question,” said Steinberg of Christiana Care Health System. “First, it depends on what you define population health as being. If population health is an add-on to your ambulatory EHR because you just want to look at gaps in care, it is not so price-sensitive. For us, it has to be a per-member/per-month (PMPM) pricing model. What we rapidly discovered is the pricing model with population health that always worked for payers did not work for providers because of margin. And if we were to do a vendor search again, we would want to be in some risk-sharing arrangement, so if outlined benefits are not achieved, then the price changes.”
DeShazer, the independent population health expert, said it is difficult to fully understand pricing considerations in a comparative fashion because population health is so driven by financial factors that vary widely by organization.
“The thing that has to be considered with this investment is that the business case for population health is driven by managing an at-risk population,” DeShazer explained. “Population health has no business case if you are entirely fee-for-service. Every provider must assess how much risk they currently are taking on and how much risk they plan to take on going forward. The more risk you are taking on, the stronger the business case is for population health and making a more and more significant investment in technology to support it.”
When Fisher of Forward Health Group previously was working for a provider organization, that organization reviewed 20 vendors and Fisher said pricing was all over the map.
“It all goes to predicting the future and what you can do with the technology you are using,” Fisher said. “Just because one vendor comes in with a price that is a little bit less does not mean that vendor is where you should go. A provider organization needs to compare apples to apples, so having a set number of scenarios for a potential vendor to price out according to surrounding factors is a good way to do an apples-to-apples comparison.”
‘Gotcha’ moments to avoid
When making any major information technology purchase, there can be “gotcha” aspects that organizations simply do not or cannot foresee. Population health management technology experts point out a few areas provider organizations should keep their eyes on during the IT-buying process.
“It really is a very complicated purchase,” said Forward Health Group’s Fisher of population health. “One gotcha provider organizations do not really think about is where a vendor is in its lifespan. Is it in the process of being purchased or merged? This kind of thing is really important. I have now worked for two provider organizations where that factor came back to bite us. We purchased a product from one company that was in the process of being acquired by a much larger company with more of a market share, and after the acquisition, service and everything else went to hell and a handbasket.”
Another gotcha moment might be a population health management system that focuses too heavily on the Centers for Medicare & Medicaid Services’ clinical quality measures ― or CQMs ― said Costello of Enli Health Intelligence.
“Healthcare executives need to remember that clinical quality measures are the end, not the means to the end, and an over-focus on CQMs is like practicing to the test,” Costello said. “Thoughtful information system focus needs to be on delivering clinical evidence in a way that supports the delivery of care and ensures as decisions are made between patients and physicians that the decisions are captured and committed to. Then your CQMs improve across the board, and the goal of CQMs is to measure that improvement.”
To help avoid gotcha moments and, ultimately, with any population health management IT buy, provider organizations have to figure out what they want to do, said Steinberg of Christiana Care Health System.
“If all an organization wants to do is manage its primary care gaps in care, then it almost can’t go wrong with any selection,” Steinberg concluded. “If it wants to go after risk, it needs to make sure whatever vendor it picks can do full-fledged quality and cost reporting, and that the reporting can reflect all quality measures inside and outside the organization’s walls as well as all costs. And further, an organization must have an integrated system. It cannot have care coordination on one screen and utilization management on another screen – it has to think about the workflow of the people running its business.”
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