Balancing the Population Health Management Equation
By Tamara StClaire
The increased accountability of healthcare providers was discussed at length during HIMSS 2016; they need to show improvements to the overall health of the patients they serve or face stiff financial penalties. Indeed, “value-based care” is not an option, but a mandate: CMS will require at least 50 percent of payments be value-based by 2018.
We’re hearing from providers that they are nervous about that requirement, and for good reason. Value-based contracts currently make up less than 10 percent of the portfolios of many providers and payers, according to research from Xerox – that illustrates a long journey ahead.
As readers of this HIStalk Practice are likely aware, population health management programs are not a new concept, but providers are increasingly turning toward them in order to make the jump. Information technology plays a big role in population health management efforts. Most begin with aggregating data from a wide variety of sources, such as medical claims, EHRs, patient portals – and yes, even mobile applications and wearables. Data analytics also helps develop attribution models, segment populations, and improve our understanding of specific groups of patients. Intervention programs, complete with feedback loops for optimization, are ultimately designed and developed with the help of advanced information technology.
Too often, the solution stops here – but that’s only half of the puzzle. As my friend Geeta Nayyar, MD chief healthcare and innovation officer for Femwell Group Health, stated at a roundtable discussion at HIMSS, “Technology plus people is the best formula for population health management success.”
Sometimes we forget about the second half of that formula. What really makes a difference and makes it possible to improve the health of diverse patient populations and reduce costly interventions is the ability to turn data into meaningful, actionable information with timely execution of necessary programs. For example, technology makes it possible to analyze populations and segment at-risk groups of individuals. But it’s equally important for “health coaches” to have numerous touch points with those at-risk patients and provide specific instruction on how to stay healthy or remind them to take important medication. Even administrative services like appointment scheduling and patient onboarding improves levels of patient literacy and engagement, resulting in a direct and clear impact on the bottom line.
It’s important to remember that technology should support people and processes – not the other way around.
If we can master both sides of the equation, we’ll end up with healthcare delivery that improves outcomes. Population health management solutions can help providers make the leap to value-based care and achieve an era of more accessible care with lower costs and healthier patients.
Tamara StClaire is chief innovation officer for Xerox Healthcare Business Group.