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April 20, 2016 Readers Write 1 Comment

Three Tips for Supporting a Population Health Management Program
By Brian Drozdowicz

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Provider organizations have a lot of options when selecting population health management expertise and system support, including analytics, data aggregation, clinical workflow / care management, and patient engagement solutions. With the market for these solutions expected to reach $4.2 billion by 2018, it is not surprising that new vendors pop up practically daily, or that existing vendors are beefing up their solution portfolios to capitalize on the opportunity.

As providers’ wish lists continue to grow, driven in part by government initiatives and commercial payer programs, system selection starts to take on the overwhelming feel of a second EMR implementation. This is causing providers to hesitate just when they need to act. How can providers find the right path to effective population health management?

No matter what shape a program might take, the right team is a foundational imperative. Assuming risk for populations often means that provider organizations are learning and mastering a new set of skills while simultaneously balancing the demands of “business as usual.”

One frequently deployed tactic is to hire staff from payer environments. They bring the requisite knowledge to the table and can help incorporate proven payer techniques and processes that both build on and complement a provider’s current infrastructure. Team members are needed who “speak data” and are also representative of groups across an organization (e.g., clinicians, program managers, business leads, finance team members, IT staff) to best determine what program goals are, what is possible for the specific organization, and what actions should be taken along what timeframe.

Once  the right team is in place, here are three tips to support the implementation of a population health management program:

  1. Recognize that data quality is more important than data quantity. The foundation of any population health management program is data. However, providers don’t need or want it all because each type of data has to be managed and maintained, often by separate people and according to different rules (e.g., privacy constraints). Focus on obtaining and properly maintaining the right data to drive population analysis, program structure, program management, and ongoing assessment.
  2. Learn to embrace claims data. Provider organizations need the longitudinal view that claims data provides to adequately assess utilization, total cost of care, and provider performance, and in turn to answer complex, multi-faceted questions about risk. Other benefits of claims data include that it is: (a) easier to manage and maintain; (b) more readily available and accepted than ever before; (c) controllable from a systems perspective; and (d) proven to yield accurate insights.
  3. Show physicians the numbers and what drives those numbers. Physician change is required to embrace the concept of value-based care. Comparative performance data can be a huge eye-opener. Physician leadership can help physicians be the champions of program performance assessment by making sure they can dig deep into the data, develop confidence in its findings, and understand what precisely needs to change. Complement performance data with compensation plans that reward participation, improvement, and outcomes. Start by placing the emphasis on participation, and then weight improvement and outcomes more heavily over time.

Provider organizations must know what is essential versus nice to have before they go into the vendor evaluation process. In a new and volatile market, the number of vendors offering potential solutions is huge, and the allure of slick user interfaces that can perform every population health management function, while integrating all types of data, is understandable.

However, little is proven, and most organizations do not have the time to wait until it is. Solutions have a gestation period to build, test, and revise before they become accurate, produce valid results, and deliver actionable business value. Answers are needed now, so organizations should look for a track record of results in a similar setting.

What does an organization need to effectively manage risk and care for populations? Of course, the answer is, “it depends,” but if you build the right team and thoroughly research your options, these tips can help bring order to the chaos.

Brian Drozdowicz is executive vice president of product management at Verisk Health of Waltham, MA.

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Currently there is "1 comment" on this Article:

  1. Brian, agree that claims today is, by nature the default for most PHM programs. However, HCOs will need to quickly move beyond those datasets as they are only a rough proxy of the health of a given population. Talk to any clinician and they will be more than happy to point out the multitude of flaws with claims data.

    Thus, while I agree with you that claims data is a good starting point, HCOs need to have a PHM vision that quickly looks beyond claims data to other datasets to be successful in risk-adjusted care contracts.







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