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This blog is a #HIMSS18 primer series for attendees, and the industry at large, to discuss major health IT issues that will help move health and healthcare delivery forward in 2018 – and beyond.
The industry is aggressively moving from fee-for-service to risk-based payment models; more healthcare providers and payers than ever before are implementing value-based care reimbursement contracts.
This reform is being fueled by both the public and private sectors: 50 percent of Medicare payments are to move to alternative payment models by this year, ACO’s are proliferating across the country, and the nation’s largest employers are moving toward value-based approaches to contain health costs and improve quality.
Population Health Management at Core of Value-Based Care
There is industry consensus that population health management (PHM) is the core of value-based care; successfully managing the health of a population using analytics to define patient cohorts, stratifying members by risk, and delivering targeted care to the needs of those members is key to improving clinical and financial outcomes. There have been many reports that cite varying degrees of stakeholder success toward implementing PHM. The analyses address metrics such as outcomes, IT implementations and financial results. But net-net, it’s clear we have continued work to do.
Challenges of Implementing PHM
Having been in the trenches the last several years, I’ve witnessed a number of executional challenges that my colleagues and partners are facing in reaching their PHM goals. The four common tactical hurdles are:
As we all can profess, healthcare data exists in silos. If we’re to understand how to effectively deploy PHM, we need to understand the requisite costs of delivering care and the related opportunities around clinical intervention. Tying these two data streams together will give organizations the view and levers they need to invest beyond critical care and stay in the black.
The industry has awakened to the understanding that our most critical patients last year won’t likely be the highest utilizers in the current year. Identifying the rising risk within our patient population and understanding how to manage that cohort is key.
The boon of analytics in PHM is forever changing our clinical workflow. CRMs are taking a front seat in PHM and integrating the vital players across the delivery network, including social workers, behavioral specialists, post-acute care staff and hospital staff, is in full swing.
Traditionally, patients have been passive care recipients, but patients are the single most important factor in influencing their own health. On the ground, I was shocked at the number of patients opting out of PHM programs. There needs to be a very different relationship between patients and clinicians. We need to take time with our patients and design personalized management programs that navigate around their barriers and best address their needs.
PHM as a Journey
The drive for better clinical outcomes is a heartfelt mantra amongst most of us in healthcare. And per the Advisory Board, “the difference in cost of care for a well-managed versus a loosely managed population of 5,000 patients exceeds $10M per year,” so there’s significant incentive to continuing the journey.
At HIMSS18 this year, there are lots of opportunities to learn about strategies, successes and tools to help advance your PHM agenda. I’ve highlighted several that you’ll want to add to your calendar: