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Got Risk Stratification? Unlocking the Keys to the Mystery of Population Health Success

November 10, 2013
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What they’re learning at The Advisory Board Company speaks to some key steps in making population health management work

It was quite interesting to speak last month with Lisa Bielamowicz, M.D., executive director and chief medical officer for The Advisory Board Company. Bielamowicz was a key organizer behind the organization’s National Population Health Symposium, held in September in its headquarters city of Washington, D.C. One of the key takeaways for me was what the people at The Advisory Board Company have been learning about some of the more granular aspects of population health management lately.

Bielamowicz told me about two aspects of population health management that were quite thought-provoking. The first has to with the populations themselves that are being managed now by provider organizations. As she noted, everyone knows who the highest-risk patients are, “the five percent or more of patients with huge co-morbidities and the most intensive utilization,” as she put it, Indeed, as she emphasized, most physicians and nurses in any medical practice could probably name most of the highest-risk patients off the top of their heads, without the need for analytics to identify those patients for them (of course, as she agreed, one still would need good analytics for other purposes, with regard to that group). But here’s the particularly interesting part of her dissection of the subgroups of patients to be managed: it is the second group, whom The Advisory Board folks have designated as the “rising-risk” population.

As Bielamowicz told me, “Where it’s incredibly important is to have analytics for the rising-risk population, so you can have a system that allows you to prioritize where you devote your limited care-team time. With a high-cost patient,” she noted, “ I can essentially marry them to a nurse practitioner and be done with it. But with the rising-risk patients, you have to put them into a patient-medical home and then use predictive analytics to figure out how to manage their care.”

And then of course, the third group is the healthy or relative healthy group of patients and healthcare consumers, who interact only  sporadically with patient care organizations. “Now, with the healthy and relatively healthy patients at the bottom of the pyramid,” Bielamowicz told me, “there’s an IT architecture that’s critical to make them “sticky” to us. Two or three years ago, if you’d asked me where a patient portal fits into this, I would have said it’s a phase-three kind of thing. But now, I’ve come to realize that a patient portal is incredibly important early on.”

What I really appreciated about this way of looking at population health management is how both sweeping and granular it is at the same time. For now, of course, as Bielamowicz told me last month, most organizations that have embarked on the population health management journey have only begun to break the surface of the population health phenomenon, and are lucky if they can say they’ve identified their highest-risk patients and begun to put in place the analytics and the care management systems they will need in order to succeed in at-risk contracting for their  populations. But in the next few years, leaders of patient care organizations nationwide are going to need to start thinking in the big-picture ways that Bielamowicz and her colleagues at The Advisory Board are urging.

And the second takeaway for me from my conversation with Lisa Bielamowicz relates directly to the first, and that is around success at risk-based contracting. As Bielamowicz told me, we’re really at the very beginning of developing risk-based contracts that work for everyone—particularly for the hospitals, medical groups, integrated health systems and accountable care organizations (in the broadest, most generic sense, encompassing private-insurer contracting vehicles) now pushing ahead to make accountable care, in the broadest sense, begin to happen. What will be absolutely necessary will be for the earliest experience of the true pioneers in this area to be disseminated at conferences, through publications like ours, and in other ways, in order for the healthcare system in the United States to begin to create the new value-driven healthcare.

Right now, some of the most experienced organizations in the whole population health arena are the integrated health systems that have provider-owned health plans, as well as a small but growing number of partnerships being created between the biggest national health insurers like Aetna and Cigna, and a variety of provider organizations. Clearly, this whole phenomenon is in its earliest phases of development right now.

How exciting it will be when providers of all types and payers of all types (public and private) work through these very embryonic stages and move forward into more mature phases of risk-based contracting. That is where healthcare is going, and where it must go, if we as a society are to bend the cost curve while at the same time improving the health and the healthcare of many millions of people in this country. For now, learnings like those shared with me by Lisa Bielamowicz will provide important clues along the way, as we move forward in this incredibly important broad effort in healthcare.