5 hurdles en route to population health
The term "population health" is at fever pitch these days. But just like so many buzzwords, an exact definition remains unclear.
Is it the transition to value-based care? Reduced readmissions? The emergence of care management platforms? Affecting change on a large-scale, such as the smoking ban in New York City and elsewhere? The consumerization and hybridization of care delivery? All of the above?
The industry has yet to iron that out. In the meantime, providers and payers must overcome several challenges before population health becomes common practice.
Here are five big obstacles along the way.
1. Lack of compliance by clinicians. While many leading health networks have instituted evidence-based pathways, protocols and decisions trees outlining how they want doctors and nurses to treat patients, that actually getting those clinicians to comply with those in the real world remains challenging, aid Raymond Solone, chief marketing officer at Sanitas, a company offering care management software-as-a-service.
2. Too little clinical care coordination for patients. Despite the numerous and various technologies coming to market, poor adherence continues and it leads to massive overutilization of the system. But evidence exists that this is changing. "Technology is transforming how people buy care and how insurance companies pay for it," said Charles Kennedy, MD, chief population health officer for Aetna’s Healthagen unit.
3. Population health "hotspotting" not yet widespread. The emerging practice, something of a precursor to the move from predictive to prescriptive analytics, involves providers taking a deep dive into their data to pinpoint patient populations that consume large percentage and costs of care, then identity the ways to bring and impact and change to those population subsets. "I don’t know if that’s where we really are yet," Solone said, "but it’s where we need to be."
4. Abundance of data. Whereas it might seem the more information the better, the industry is being threatened by a data deluge. It’s in EHRs and myriad other systems, patients are generating information via an ever-expanding number and type of devices, all against the backdrop of precision medicine. The big potential for improving care and lowering costs is to aggregate claims data with electronic health records and other systems and running analytics against those sources, said Jerry Schultz, president of population health vendor Lightbeam Health Solutions.
5. The need to activate more patients. Providers need to better understand how to engage their patients, whether that’s as simple as taking medications regularly or actually changing long-standing lifestyle habits, to drive adherence because it’s the key to better outcomes, reducing overutilization and ultimately slashing costs. "Let’s give doctors the ability to find those patients who are not coming in but are ticking time bombs and practice prevention and wellness to avoid expensive disasters," Kennedy said.
And that brings us to the whale of an obstacle – the one perhaps too clichéd to include on the above list, but without which no discussion about population health management is complete: changing payment models from fee-for-service to a value-based structure.
"If you pay people for volume, you’re going to get increasing volumes," said Schultz. "If you pay for value, people will find a way to deliver value."