Value-Based Care Drives Progress in Population Health Management

January 18, 2017 - Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health Technology Transformation sponsored by IBM Watson outlined how many healthcare systems are investing in population health management by partnering with accountable care organizations and patient-centered medical homes.

A survey from the HIMSS Analytics Essentials Brief found that, out of 104 hospitals, 75 percent of these healthcare systems were pursuing some sort of population health management initiative in 2016. Payers and providers will need to address behavioral health needs and coordinate care for treating mental and physical conditions. This may include integrating social workers and community organizations in the fabric of a hospital system.

Many providers are still not implementing health IT tools that are meant to target population health management. The report details that less than 25 percent of providers are using health IT systems designed to handle their population health initiatives. However, these issues are likely to change as health insurance companies continue to transition payment contracts toward value-based care and position financial downside risk onto providers.

As value-based care reimbursement becomes a reality for providers, many will begin adopting useful health IT tools that will improve their population health management efforts, according to the report.

“Both CMS and private health plans can help healthcare organizations in their PHM quest,” the report authors wrote. “In markets where payers and providers have made less progress toward value-based reimbursement and financial risk, healthcare organizations are more likely to be aided by CMS demonstrations and programs than by private insurers.”

“By contrast, in markets where risk contracting has begun to take hold, health plans are more fully engaged with healthcare organizations in building PHM and preparing for financial risk. So healthcare organizations need to evaluate their markets to decide how and when to partner with payers.”

Providers used to operating in a fee-for-service environment will face a general challenge of transitioning the culture of their operations toward a value-based care reimbursement model. However, there are certain initiatives that payers could incorporate to assist their provider networks in changing their financial and operational structures.

Payers could incorporate automation technology and data analytics tools to better track the population health of their membership. The information could then be sent directly to primary care practices and hospitals so that providers are aware of high-risk patients.

Providers will need to monitor the health of high-risk patients more closely and offer home visits as well. Coordination will also be key with primary care physicians working alongside specialists.

As payers and providers move toward value-based care reimbursement, a number of vital players will need work side-by-side including social workers, behavioral specialists, post-acute care staff, and hospital staff.

Risk-based population health management solutions have also become more common in hospitals around the country, according to the HIMSS brief. Chronic disease management remains a key aspect of providers’ population health programs with 77.2 percent of polled providers participating in targeting heart failure, diabetes, and other chronic conditions.

The adoption of patient-centered medical homes has also grown by about 2 percentage points from 2015 to 2016. The patient-centered medical home is becoming a main building block of population health management. Private payers could benefit from partnering with medical facilities adopting the patient-centered medical home approach to healthcare delivery.

Patient-centered medical homes function by providing wellness and preventive care as well as tracking chronic conditions. Patient education and self-management training are also key aspects of running a patient-centered medical home structure.

The report sponsored by IBM Watson includes interviews of healthcare experts most of whom stated that patient-centered medical homes are necessary for success in population health management.

“There’s no other mechanism to motivate and change behavior for the provider group than to be part of a team-based care system,” said Creagh Milford, DO, President of Population Health Management for Mercy Health. “The PCMH includes a variety of structural measures that require providers to be a team not only among themselves, but also among other provider groups and specialists. It’s the foundation for all our PHM initiatives.”

Health insurers looking for their provider networks to focus on strengthening their population health management initiatives will likely need to transition to value-based care reimbursement contracts as well as partner with new healthcare delivery platforms like patient-centered medical homes or accountable care organizations.