Health Industry Post population health management

Health Industry Post: population health management

Health Industry Post:

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Payers are collaborating with providers and integrating population health management (PHM) principles and technologies in an unprecedented approach to curtailing costs and delivering value. This Health Industry Post looks at the concept and drivers of PHM, as well as the capabilities needed to support and advance it in a new age of accountable care.

Population health management is a model for helping providers and payers assess the populations they serve across the continuum of care.

Foundation for an effective PHM program

Functional efficiencies

The ability to:
  • Generate robust data
  • Integrate platforms
  • Provide a comprehensive suite of tools
  • Use clinical, operational and financial parameters
  • Identify patients who would benefit most from intervention
Operational effectiveness

The ability to:
  • Align processes and systems
  • Enhance the patient experience
  • Establish wide-ranging business processes
  • Cultivate a diverse set of involved stakeholders
  • Address client-specific needs
Strategic alignment

  • Ensure that changes in the PHM model align with your organization’s long-term vision
  • Position the model to complement other strategic initiatives
  • Consider the far-reaching impact across your internal and external stakeholders

Source: EY, 2013.

ACA as a driver of population health management

ACA provision PHM can help health care organizations to
1. Reduce readmission rates. The ACA eliminates payments for unnecessary readmissions, making hospitals financially accountable for patients up to 30 days after they leave the hospital. Monitor activities across the care continuum to promptly identify care gaps and better manage care transitions.
2. Conduct community health needs assessments. Nonprofit hospitals must conduct a comprehensive community needs assessment every three years and report their activities to the Internal Revenue Service. These assessments must include information on how the hospital plans to meet identified needs and why any such needs are not being addressed. Collaborate with community partners in creating initiatives that address defined community needs, such as smoking cessation and child obesity programs.
3. Provide coverage for prevention and wellness services. The law requires health plans to cover preventive, wellness and chronic illness management services with zero copays. It also expands coverage for a wide range of prevention and wellness services, increases incentives for employers that establish wellness programs, and provides coverage for wellness visits under Medicare and Medicaid. Create strategies that engage patients in their own care, including health promotion programs that increase awareness of health risks associated with certain behaviors and lifestyles.
4. Develop medical home and communitybased care transition grant programs. These initiatives encourage partnerships between hospitals and other community organizations to connect the care process. Develop relationships among providers (hospitals, physicians, long-term care, rehabilitation, alternative care providers), payers and community organizations to ensure that the population is receiving the appropriate level of care.
5. Create health insurance exchanges. The ACA creates state-based HIEs administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can buy qualified coverage. In 2014 and beyond, Americans who work for small businesses or obtain their coverage in the individual health insurance market will likely do so through HIEs. Align health services operations and processes with innovative analytics and technologies, enabling provider-payer collaborations that capitalize on HIE opportunities.

Source: The ACA; EY analysis, 2013.

Into the future: achieving effective PHM

Building a sound PHM program requires functional efficiencies and operational effectiveness. Five steps for moving forward are listed below.

  1. Define your target population and its needs
  2. Set, measure and monitor program outcomes
  3. Develop the technology infrastructure for data analytics and reporting
  4. Manage the growth in demand for IT services
  5. Expand partnerships

As health care transitions from a volume-based to a value-based reimbursement system, organizations will continue to be pressed to take a more proactive approach to patient care. They will need to create new systems and infrastructures that extend across larger populations — while better leveraging health care resources to deliver quality care to more patients. With its potential for patient-centered, better coordinated, more cost-effective care, PHM holds the promise of being the next revolution in health care delivery.

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