It is often difficult to predict new trends, best practices and what will become an industry standard in healthcare. But one thing appears certain: The era of fee-for-service as the primary payment model is gradually coming to a close.
Soon, most payment will be value-based. For as much as this change has been accepted in healthcare, it remains unclear what the value-based care world will ultimately look like.
Looking toward future success
As the shift in payment models continues, a clinician's need to better understand their patient population exponentially increases. This understanding, in turn, will help providers treat entire populations in a way that not only improves clinical outcomes, but also drives reimbursement.
Additionally, having a population health strategy focused on improving both clinical and financial outcomes will, in part, determine your eligibility for participation with health plans. As plans move to narrow networks, they become more selective about who they include. If health systems and practices fail to show quality results, they will most certainly be excluded from those networks — limiting their access to patients.
Health and disease management is key
More than anything, metrics matter when it comes to succeeding in value-based care models. In 1987, 29 percent of women over the age of 40 had a mammogram within the prior two years and by 2015, that increased to 64 percent. Certainly better, but a change that still leaves room for further improvement. Now, let's assume that percentage increases to 90 percent. With more patients receiving appropriate mammography, short-term costs will increase, but so should quality. Breast cancer may be detected sooner, leading to earlier, and often less expensive treatment with — hopefully — better results. Without early detection, it is possible that the cancer advances prior to detection and the payer is responsible for covering much more of the patient's care. Increased costs with lesser outcomes help no one. The additional upfront cost for monitoring patients' health will pay off over time. If the value cycle starts now, the industry can improve both patient care while lowering healthcare spend.
This is all to say that understanding and addressing a population's most common diseases invariably helps organizations improve patients' health status while controlling long-term costs. Preventing, managing and effectively controlling diabetes will reduce the risk of one day needing to treat the patient for a variety of known complications including both ophthalmologic and renal issues. This is one practical way to succeed within this payment model shift.
Thriving in the change
For organizations to successfully manage the health of their populations, they need a strategy.
When devising a population health strategy, looking at how your organization addresses each of population health's four components — data aggregation and connectivity, analytics, care coordination and patient engagement — is a good place to start.
Data aggregation and connectivity
The need for comprehensive connectivity may seem obvious — of course organizations need to ensure they can "talk" to one another to get the best, most robust picture of a patient's health information. But a strong population health strategy also needs to offer a streamlined way to enable several organizations to harmonize all the relevant data and put it in clinicians' hands at the point of care. In doing so, the most up-to-date and relevant patient data can be used to inform the treatment and care plan. While this is only one piece, it serves as a foundation for an entire population health strategy.
Analytics
Having the most complete view of patients' health records is critical for providing the most detailed care, but understanding the data — disease trends, gaps in care — is what drives population health management. Turning patient data into information promotes a deeper understanding of how to treat entire populations. With an analytics solution, organizations can look past the data and react to the information, which is especially useful to ensure that what we know works to maintain and improve health is done. Analytics can also be a key component of the clinical decision-making process. As we look at population health management, analytics layered with data aggregation and connectivity can be thought of as the deciphering force behind all the data that flows throughout any organization.
Care coordination
Building a population health strategy includes focusing on how organizations can effectively collaborate, communicate and support a smooth journey for every patient — no matter where their care takes them. When organizations streamline care coordination, they can help reduce readmission rates and appropriately control utilization. Care coordination is also the part of population health that significantly improves the patient experience.
Patient engagement
As patients continue to embrace technology in their lives, from online shopping to banking, it's important to embrace the fact that patients are consumers. We, as an industry, need to find ways to reach them where they are most: on their mobile devices. As the fee-for-value payment model takes hold and reshapes how providers deliver care, it is increasingly important to care for patients beyond the walls of the hospital and physician offices. That means going beyond the standard patient portal.
Patient portals are now enabling engagement and communication between the patient and provider. A comprehensive platform can help providers care for an entire patient population with mobile and telehealth tools that engage and promote wellness at the appropriate time and place. This not only improves outcomes for patients, it creates a strong return on investment for your organization.
What's next
Caring for and being reimbursed based on the care outcomes of an entire population is a daunting reality, but one that all healthcare organizations must plan to thrive in. Putting a strategy into practice that pays close attention to each of the major components will help manage disease, understand health trends, streamline coordination across the continuum and enable patients to take a more active role in their health and wellness. Organizations that act on these principles now will undoubtedly see a brighter future as the industry continues to evolve. With the right health IT partner, the challenges of devising a strong population health strategy can be more easily addressed. It's time to start. And if you already have, it's time to keep going.