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Population Health: In The Trenches

June 10, 2015
by Paul Taylor, M.D., Chief Medical Information Officer for Wellcentive
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The most critical questions to consider in transitioning to value-based care with Dr. Paul Taylor, CMIO

Paul Taylor, M.D. has been involved in hundreds of conversations with organizations striving to adopt a value-based care model. Dr. Taylor is a practicing internal medicine physician and Clinical Integration Committee Chairman at Mercy Health, a Trinity Health organization, and co-founder and Chief Medical Information Officer for Wellcentive, a value-based transformation platform for population health management. We asked Dr. Taylor to address the five most challenging questions facing organizations today:

How can we proactively and concurrently manage multiple quality programs, such as pay for performance, accountable care, and PCMH initiatives?

Rallying your organization around a wide variety of outcomes-based programs requires a solution that supports quality program automation. Meaning, your platform must aggregate data from disparate sources, analyze that data through the lens of a program’s specific measures, and effectively enable the actions required to make improvements.  Although this is a highly technical and complicated process, when done well it enables care teams to utilize real-time dashboards to monitor progress and identify focus areas for improving outcomes.

How can we support both employed and affiliated physicians and effectively manage our network and referrals?

An organization that demonstrates its value to healthcare providers is best positioned to engage and align with them; this means providing community-wide solutions for value-based care delivery. This must include technology, transformation services and support, care coordination processes, referral management, and savvy representation with employers and payers based on experience and accurate insight into population health management and risk.

How do we manage our organizational risk and utilization patterns?

Optimizing episodic and longitudinal risk requires the application of vetted algorithms to your patient populations using a high quality data set.  In order to understand differences in risk and utilization patterns, you need to aggregate and normalize data from various clinical and administrative sources and then ensure that the data quality is as high as possible.  You need to own your data and processes to be successful.  Don’t rely entirely on data received from payers.

Should we implement care management programs to improve individual patient outcomes?

More and more organizations are creating care management programs for improving outcomes during transitions of care and for complicated, chronically ill patients. These programs can be very effective. It’s important to leverage technology and processes across the continuum of care, encompassing both primary and specialty care providers and care teams in the workflows.  Accurate insight into your risk helps define your areas of focus. A scheduled, trended outcomes report identifies what’s working and where areas of improvement remain.

How can my organization ensure success with value-based reimbursement? 

The shift to value-based reimbursement is a critical and complicated transformation—often a reinvention—of an organization. Ultimately, it boils down to leadership, experience, and commitment.  The key to success is working with team members, consultants, and vendor partners who understand the myriad details and programs and who thrive in a culture of communication, collaboration, execution, and accountability. 

Whether it’s PCMH or PCMH-N, PQRS or GPRO, CIN or ACO, PFP or DSRIP, TCM or CCM, HEDIS or NQF, ACGs or HCCs, care management or provider engagement, governance or network tiering, payer or employer contracting, you can find partners with the right experience to match your needs. Because much is at stake, ensure that you partner with the very best to help navigate your transition to value-based care.