Despite investments, big PHM and VBC challenges persist
Few U.S. health systems are strategically positioned toward value-based care, and many are struggling to define and demonstrate clear return on investment from their population health management initiatives, a new report from Chilmark Research shows.
And while there's been some progress made in trading volume for value, the examples of how that's occurring are highly variable – and at the moment there aren't many surefire best practices to build needed competencies.
Those were just some of the findings of the new Chilmark report, A Path to Value for Population Health: Adopting a Value Chain Model, which was based on surveys and focus groups with senior health system executives leading pop health initiatives.
Perhaps unsurprisingly, one of the biggest takeaways is that data— its aggregation, management and governance – is the fundamental building block for a successful PHM project.
However, provider organizations interviewed for the report said they struggle, to varying degrees, with two primary challenges on that front.
First, clinical and claims data from partners is often inconsistent and error-prone and (especially with claims data) contains high latency.
Second, technology to access, aggregate, normalize, and map terminology of data remains immature.
"These shortcomings place a significant burden on any organization’s PHM efforts and should be planned for in advance," said Chimark researchers.
Chilmark's founder and report co-author John Moore told Healthcare IT News that the most concerning finding from the study was the need for technologies that are highly configurable to value-based requirements, which are highly localized.
"Such localization, due to population, payer and employer mix, makes it difficult to create a solution suite that is highly scalable incorporating best practice models from other deployments leading to more rapid deployments in the field and ultimately, time to value," he said.
Moore predicted that in 2020, the most talked about trend would be the incorporation of social determinants of health data into broader PHM platforms.
But he also said the most important trend would likely be the move by providers to take on downside risk in their contracts, and whether or not they'll be successful at managing such risk, delivering quality care at a lower cost.
"As our research and focus group findings show, the path to value for PHM infrastructure investments to support new VBC models of care and reimbursement is still very much in its infancy," according to the Chilmark report.
It noted that even those healthcare organizations found to be "at the pinnacle of strategic intent and maturity have yet to define a clear ROI for their PHM investments to date."
However, the study noted these same organizations have seen value creation from their investments and believe that a demonstrable ROI is within their grasp within the next several years.
The Chilmark study follows a December 2019 report from KLAS that explored how PHM platforms are being used for care management, and outlined how various vendors' tools are able to support care managers' work.
The study found vendors are struggling to keep pace with delivering care management capabilities due to siloed data and high variation in customer needs, even as providers keep pushing for better, more automated ways to manage the care of at-risk patients.