With 2014 ushering in new momentum for value-driven healthcare models, healthcare organizations increasingly are looking to the promise of population health management strategies to achieve healthcare's triple aim. This three-pronged industry goal is pushing organizations to improve population health, enhance patient experiences and reduce costs, putting the spotlight on PHM as more than just a buzzword heard in thought leader circles.
As healthcare executives embrace the common-sense application of PHM, impressive initial outcomes produced by early adopters are starting to turn heads. It's a simple formula: Proactive responses to health trends in patient populations lead to healthier patients overall, which improves outcomes and minimizes the need for higher-cost interventions. Yet, while simplistic in theory, a successful approach to PHM requires three fairly sophisticated elements: effective care coordination models, appropriate change management strategies and a technological infrastructure capable of supporting longitudinal patient views.
Right now, much of the industry is in trial-and-error mode, feeling its way through PHM and trying to identify best practices. With the success of early adopters, though, there is little doubt that adoption of this model will quickly gain momentum throughout the coming year.
2014: PHM gains maturity
Healthcare organizations should expect a number of trends to emerge this year that will begin to change the culture of care delivery. For instance, the expansion of Medicaid and impact of coverage changes in the exchange market are likely to create a greater urgency to deploy PHM to effectively manage outcomes and cost.
Up until late 2013, a great deal of time and energy was expended on health insurance exchange readiness and deployment. While the dust continues to settle, the rubber is now meeting the road for both health systems and payers as each begins to manage populations to meet new quality and cost expectations. The need for PHM tools and effective management capabilities is pressing, as providers and payers seek to effectively leverage data in real-time across disparate systems and prioritize care through patient stratification, particularly in exchange populations where little to no traditional claims history is available.
As a result, technology that is not equipped to evolve with the PHM movement will become less relevant. The expected urgency in the marketplace has created a perfect storm of new vendor activity in the PHM space, with a 2013 study by KLAS Research revealing a wide variance in the ability of technology vendors to support providers and payers in their efforts.
Still, early success stories pointing to significant ROI and outcomes will drive further momentum for healthcare organizations to do more than pay lip service to PHM. With limited best practice guidelines available in the industry, newcomers to the PHM space and smaller healthcare organizations will look to align with industry pacesetters.
Don't expect alignment to necessarily fall along traditional geographic boundaries, however. Instead, there appears to be a rise in alignments designed specifically to bolster shared PHM. Geisinger Health System in Danville, Pa., for example, is a physician-led organization that is often viewed as an industry leader in care delivery that promotes quality and cost efficiency. It has recently joined forces with Egg Harbor Township, N.J.-based AtlantiCare. Both organizations specifically cite common goals for population health as key drivers in their decisions.
With the convergence of all these trends, 2014 will be characterized by a new focus on health IT deployments. Technology will need to reinforce PHM efforts by creating an infrastructure around data and robust analytics for more real-time monitoring of clinical, operational and financial issues. Consolidation trends will also create economies of scale opportunities for investment in strategic infrastructure, and technology is replacing bricks and mortar in that arena.
Tips to create a robust PHM approach
As healthcare organizations evaluate their best strategies for adopting PHM, a number of foundational best practices should be top of mind. A valuable and achievable benchmark is the establishment of meaningful family, patient and community advisory boards. In light of the significant changes that must occur for true PHM to take shape, it is essential to engage and educate all stakeholders in the process.
Healthcare organizations also can help ensure a smooth start by identifying pockets of win/win opportunities. For example, reducing readmission rates fits into the PHM equation very easily, and already is typically an area of focus due to the Hospital Readmissions Reduction Program and other national quality initiatives. Because of their tremendous toll on both healthcare costs and patient outcomes, some obvious entry points for chronic disease PHM include diabetes, asthma, chronic heart failure and hypertension. While a little more challenging to define and address, strategies to support the sickest, most complex patients with multiple comorbidities have the most immediate payoff in improved outcomes.
It may go without saying that a strong focus on effective change management also will be critical to success, and healthcare organizations must take a strategic approach to helping all stakeholders navigate the shift away from fee-for-service models. A proper transitional balance will need to be considered — one that moves to new quality-focused models as quickly as possible without leaving stakeholders behind. From a big-picture perspective, the larger healthcare community will need to look at the total impact of this transition and ask questions such as:
- If we were to operate as a community under best practices for PHM, what would it look like?
- What is the PHM end-game for our community?
- How many primary care teams and hospital beds will be needed when the dust settles?
Healthcare organizations will have to be both courageous and relentless in their quest to reduce "waste," even when that quest strays from traditional norms. Furthermore, they will have to commit to having the right tools and technological infrastructure in place to offer longitudinal patient views across the continuum. Effective care coordination hinges on the ability to bring together and integrate a variety of people, processes and technologies. Technologies will have to be capable of gleaning appropriate information from all disparate systems, and presenting it in meaningful ways to clinical and administrative teams.
Preparing for the future of PHM
Once healthcare organizations make the important shift from fee-for-service care delivery to a value-based approach supported by PHM, it will be nearly impossible to turn backward. With hard data from early adopters already proving the effectiveness of PHM initiatives, organizations that fail with PHM initiatives will be forced to evaluate the execution of their plans, rather than the efficacy of the model itself.
It's important to understand that the evolution of PHM is expected to vary widely from region to region. As 2014 marches forward, however, there will be no stopping this movement toward enhanced care delivery.
Katherine Schneider, MD, M.Phil, FAAFP is the executive vice president and chief medical officer at Medecision.
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