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Getting Practical on Population Health: What Pioneers Are Learning Now

May 9, 2017
by Mark Hagland
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Executing on risk contracts requires tremendous organizational strategy, IT strategy, and flawless execution, pioneers are finding
Mission Hospital in Mission Viejo, California, part of the St. Joseph Health system

No one said population health management would be easy, nor has it been. Indeed, as patient care organization leaders have laid the foundations for serious population health initiatives, they’ve been facing down a welter of challenges, among them strategic, process, practical, and technological. But things are beginning to turn a corner now.

And the truth of that perception is confirmed by the results of a survey published by consulting firm KPMG in January. According to that survey, provider and health plan leaders are making progress in key areas. As stated in the consulting firm’s Jan. 23 press release, “In the survey, 44 percent of respondents at payer and provider organizations found that they have a population health platform in place that is being ‘utilized efficiently and effectively.’ Another 24 percent are in the process of implementing a population health program within the next three years. Only 10 percent said they have no plans to implement a population health platform and another 21 percent of respondents said their organization doesn’t require a population health platform.”

Importantly, KPMG found that “The biggest individual barrier to implementing a population health program is aggregating and standardizing information from multiple sources, 30 percent of respondents said. Stakeholder adoption (10 percent) and integrating with clinical work flows (10 percent) were cited as additional barriers. Another 34 percent cited ‘all of the above,’ which includes those barriers, as well as enabling patient engagement, funding investments, and selecting appropriate vendors as additional challenges.”

Gathering data from diverse sources remains a core challenge

Jess Vamvas, senior product manager, technology, at The Advisory Board Company (Washington, D.C.), is not surprised by such results. “Apart from the overall strategic planning, the analytics is the most complex part of this,” she says, referring to population health management initiatives. “Organizations want to assemble high-performance networks; and along with that comes the various different source information systems and applications the different organizations are already suing. So getting the data from the EMR is really complex; same with combining clinical and claims, even though that’s where everything is moving towards. Even professional billing services data is really, really important in order to aggregate and get a comprehensive view for population health. For instance, registries have long been important, but now, pre-registries—who could become a diabetic, not just who already is.”

Dennis Weaver, M.D., executive vice president and chief medical officer at The Advisory Board Company, emphasizes that there are several layers to the complexity involved in leveraging data and analytics to support population health. “We can dive down into the clinical examples of the registries and the other things going on,” he says, “but we also need to talk about these multiple stakeholders and the financial aspects of population health management. Too many organizations look at people, process and technology—and they look at these tools that they need to buy for pop health, and then on an economic side of the ledger, they’re looking at accountable payment, whether pay for performance or shared savings, or any number of arrangements. And too many folks just do it based on those payments.”

In other words, Dr. Weaver says, most patient care organization leaders are sabotaging themselves by looking too narrowly at the implications of the population health management framework for their overall operations. And that really speaks to the core strategic challenges of taking on financial risk to begin with. “When we look at population health management,” he says, “we find that focusing on the payment misses two other areas of return beyond accountable payment. As you start to take care of defined populations, the economic return turns out to be 7 to 10 times greater if you can keep that population inside your CIN [clinically integrated network] or your ACO [accountable care organization]. Some people call it reduction of leakage, domestic utilization, or seepage. But the economics here and the quality return that you get if you can keep the patient inside the management system in which you’re doing population health, are very important.”

Dr. Weaver goes on to say that “The third piece of this is an element that people often don’t see as connected to population health; but that is that we’ve got much unwarranted clinical practice variability—and we don’t spend enough time talking about reducing that variability. Because doing that reduces cost and improves quality. There are the clinical components of pop health, but the economic components are so important, too.”

And all that, he says, makes population health “so complicated. And when you talk about the IT components, there’s the clinical, there’s the financial, there’s the patient-facing. But too many folks try to get the ROI just from the payment piece, but not from the network management and clinical variability pieces.”

A complex—and sometimes-messy—ongoing evolution

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