A great deal of public attention was focused this spring and summer on the U.S. Congress, where various bills worked their way through both houses of Congress that would seek to repeal, or repeal and replace, the insurance-related provisions of the Affordable Care Act (ACA). Yet even as national attention was understandably focused on that drama, the reality is that, earlier this year, it was made clear that the so-called international health system reform elements of the law were largely going to be spared any threat of repeal.
And, with regard to that, a recently published survey confirms that most leaders of U.S. patient care organizations are pushing ahead with their plans to participate fully in population health management and accountable care initiatives. Indeed, more than 80 percent of patient care organization executives responding to a survey conducted online in July by the Salt Lake City-based Health Catalyst, said that the effort to repeal and replace the ACA has not caused them to pause or otherwise change their approach to population health management. In fact, 68 percent of survey respondents reported that population health management is “very important” to their healthcare delivery strategy during the next two years, while fewer than 3 percent assign it no importance at all.
According to the survey data, 82 percent of survey takers indicated they are continuing with their PHM strategy in spite of uncertainty over the future of ACA. Four percent of respondents said their organizations were actually accelerating their PHM plans.
As our news article noted, when asked to clarify why they were accelerating their plans, survey respondents mirrored the answer of a physician leader at a large multispecialty physician group near Boston, who wrote, “Accelerating your PHM strategy has never been more important given uncertainty and expanding hurdles to achieving quality care and outcomes.” Another 4 percent of respondents answered that they were “pausing” their PHM plans in response to the current political situation. Ten percent of survey takers said they were undecided on the question.
Still, while enthusiasm for population health management remains high, relatively few organizations have taken on PHM contracts with payers that put them at risk of a financial loss if they fail to meet goals such as improving the health of their patient population.
When asked how soon they expect to have more than 30 percent of their patient population covered by such risk-based contracts, 37 percent said achieving that level of risk would take between three and five years. The next largest group put the date within the next one to two years. Fourteen percent estimated it would take six to 10 years. Only 13 percent of respondents—the smallest share for this survey question—said their organizations have already achieved the threshold of having 30 percent of their patients covered by contracts with downside risk.
What’s more, the most common impediment to starting a PHM program or succeeding with an existing program, according to the survey data, is “financial issues” such as “getting paid for our efforts” and “balancing competing contract incentives.” That answer, selected by 37 percent of survey takers, reflects the pressures that healthcare organizations face as they attempt to operate under the dominant fee-for-service reimbursement model while simultaneously transitioning to value-based care.
The next most significant impediment to starting or realizing success from PHM, according to the survey, is access to high-quality data and analytics (17 percent). Data access also figured into the fifth most commonly selected barrier to PHM, “risk evaluation issues” (9 percent), including “access to the right data useful to evaluate at-risk contracts.”
Meanwhile, in the context of the release of the results of the survey at the end of last month, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed Amy Flaster, M.D. Dr. Flaster is a practicing internist at Brigham & Women’s Hospital in boston, an instructor at Harvard Medical School, and an assistant medical director for population health management at Partners HealthCare. She is also vice president of population health management and care management at the Salt Lake City-based HealthCatalyst. Per the terms of her interview with Healthcare Informatics, all of her comments here reflect her perspectives in her position at HealthCatalyst. Below are excerpts from the interview conducted last week.
It appears now that any repeal of the ACA in Congress appears unlikely, though in any case, internal health system reform was no longer jeopardized. Still, there was a feeling of uncertainty. But the HealthCatalyst survey certainly confirmed provider leaders’ intentions to move forward on population health, correct?
Yes, that’s right. Folks are taking a long-term approach—and the key elements of population health care providing better care in the right venue, at lower cost. And I would agree, that definitely is the takeaway as well.
In that context, where are we as an industry on the journey of 1,000 miles around population health management?
I think that we’re still early in the journey, and if you look at the survey findings, a couple of findings were at odds with each other. And so on the one hand, 68 percent said that they’re all in, and it’s a core part of their strategy, and only 3 percent aren’t assigning any importance to it, and that’s good. But when we asked survey respondents when 30 percent of their revenues would be based on risk-based contracts of any kind, that result surprised me—the largest group, 37 percent, said they planned to get to that level, in between three and five years. And the percentage that said they would reach that level in between one and two years, was 21 percent. Meanwhile,14 percent said they’d get there between 6-10 years. And 13 percent had already achieved it today; and 9 percent said they would never get there.
So the results around timeframe show that the push towards population health represents a key part of the strategy of the leaders of patient care organizations, but that folks are being smart about it. When we talk about 30 percent of your population being at risk, it sounds like a small percentage, but without creating strong infrastructure and data and other forms of preparation, that could have a hugely negative impact. So I think folks are going into risk contracting one or two contracts at a time. And that’s a very rational response. I don’t think folks are reticent to take this leap; I just think they’re taking a phased approach. And this is a multi-year journey. Care management is one important factor. But there are also parts that involve a bricks-and-mortar strategy, and building urgent care centers, and having an ED strategy. So we’re seeing that there’s a commitment to this, but they’re building their long-term strategy on this, which to me feels appropriate.
What’s your assessment of the forward evolution of data in patient care organizations, and of the physician culture, and physician willingness to move forward on population health and value-based care?
I can speak as a practicing physician collecting this data and also as someone collecting this data for HealthCatalyst. Overall, the move to value-based care is energizing to physicians, and not in theory causing burnout, because this really is an opportunity to take better care of our patients, and move away from volume. So in that way, it does reduce burnout and aligns us with the move to value-based care. But it is true that at the granular level, it has the potential to increase physician bunout because of the documentation requirements involved.
So one thing that needs to happen is to be able to help physicians in practice by enabling the tools and technologies that are able to look at and aggregate gaps in care at the system level. We also need to facilitate the ability of care managers to work on population health issues. And in some cases, the solution could be as simple as having scribes involved to help the doctor not having to be buried in their computer while being with a patient. So overall, I think population health is actually decreasing burnout, but I also think that this could be an opportunity to decrease burnout by taking some things out of the workflow of physicians.
In other words, you feel optimistic that things are moving forward at a goodly pace, around the shift into population health? You don’t see some advances being blocked or frustrated, in terms of process or technology?
I do think things are moving forward. One thing I hear in conversations with health systems is that this is moving forward at such a rapid pace, that they’re feeling stretched to implement this adequately. And as health systems are committing to new at-risk contracts, they’re not left with a ton of time to do things. But I’m hearing that folks are feeling excited, and that they’re moving at a fairly fast pace.