There’s so much going on right now around population health management and care management, it really is worthwhile to pause for a moment and think about a key question: what do we know about patients with high and complex needs—the patients who are going to be the clear focus of many of the efforts going forward in the U.S. healthcare system? Let’s take a step back and consider.
To begin, the announcement a week ago that the federal Centers for Medicare and Medicaid Services (CMS) was expanding the map of regions open to participation in its Comprehensive Primary Care Plus program, or CPCP+, was yet another signal that federal officials are looking to expand the ways in which the federal government can help providers provide higher-quality, more efficient patient care in a primary care setting.
As I wrote in a blog on the topic earlier this week, the CPC+ program’s core payment elements—including paying a care management fee to primary care practices to account for the intensity of care management services required for the specific population of individual practices; the prospective payment of performance-based incentive payments; and a shift in how fee-for-service payments are made, to account for participation in the CPC+ Program—are elements in CPC+ that build on the original Comprehensive Primary Care Program, and that are intended to incent improved care management and patient outcomes.
And, in that blog, I wrote this: “What CPC program participants have been learning, and what CPC+ program participants will be learning going forward, could help reshape care delivery at the primary care level—the potential here is enormous. And healthcare IT leaders will need to be broadly and deeply involved at all levels, working as a team with clinician leaders and frontline clinicians to get it done. And, given the five-year framework of CPC+, you can bet we’ll be hearing about developments in this critical initiative going forward. Meanwhile, there’s not a moment to waste for the healthcare IT leaders and professionals working with the leaders of primary care practices involved in CPC+, in order to make rapid advances to show that it can be done. I’m excited by the prospects, and will be watching the forward evolution of this program very closely, in the coming months and years.”
I also noted in a blog earlier this month the results of a recent KPMG study that found that both provider and payer organizations are gaining ground in effectively using population health IT infrastructures and platforms to care-manage patients. As I noted in the May 9 blog, “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.’”
In that blog, I further noted that KPMG’s researchers had 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.”
I’ve recently also written a blog noting what’s been learned at one innovative organization, Massachusetts General Hospital in Boston, whose leaders had participated in the Medicare Care Management for High Cost Beneficiaries Demonstration and had developed an intensive care management program, in what turned out to be a test run for what later became the Pioneer ACO Program. Writing in the May issue of Health Affairs, a large team of researchers led by John Hsu found, in examining Mass General’s program, that “The care management program (the ACO’s primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent.”
Looking at high-need patients—and the gaps in their care management