Success with value-based contracts will be critical for every healthcare organization and will become an even greater imperative over time, as more and more revenue is tied to such models. CMS, the largest payer, has clearly expressed its intent to progressively tie payments to cost and quality metrics. As the healthcare industry as a whole shifts away from Electronic Health Records (EHRs) as the top priority, organizations need to focus on implementing a robust population health program. A recent KPMG LLP survey shows that providers expect to recoup investments in population health management programs within three to four years. There are tactics providers can pursue now to accelerate their success, such as investing incrementally in strategies and tools that will help them accomplish their population health goals in a scalable and manageable time frame.
Organizations need to create a roadmap they can reference and use to align their teams to accomplish their population health goals. Here are the keys to success:
Assure Organizational Alignment
Agreement and alignment on a population health strategy across the organization and among all constituents is a fundamental success factor. This is required for physician engagement – it requires good leadership and that the whole management team speaks with one voice. Implementing a population health model will create challenges, especially for the hospital CFO, as inpatient and emergency room volumes fall. This is most problematic early in transition. Mitigation strategies, such as network expansion and repatriation of out of network care, are important so everyone can see a path to success.
Engage Providers
There are three keys to success in engaging providers. Leadership and education are important to ensure that providers have a good understanding of why transitioning to a population health model is good for them. Setting up a compensation structure that provides meaningful rewards for properly managing costs and improving quality helps drive behavior change within the organization. It is important to make it easy for providers to do the right thing and implementing a team approach so all the effort does not fall to the physicians is an important aspect.
Focus on Incremental Achievable Goals
Prioritizing and working up to more robust initiatives is the surefire way organizations can ensure they are on the road to a mature population health program. Here are a few manageable approaches to population health management:
- Care coordination across the continuum – Establish common care guidelines and implement a program and registry solution to ensure quality objectives.
- Care management – Identify high risk patients and those undergoing transitions in care for attention by care mangers.
- Cost and utilization – Leverage analytic tools to understand key utilization trends and focus attention on key opportunities. Keeping care in network and avoiding ER visits are often best early initiatives.
- Practice pattern variation – Identifying improvement opportunities among high volume outlier physicians is a valuable intervention but often best deferred due to the complexity of the required analyses and provider pushback.
Choose the Right Platform
Data is the key to understanding where your organization currently stands and their path for moving toward population health. Establishing the appropriate type of analytics will shine light onto the issues that need to be addressed and how organizations can best implement management techniques for value-based care. Sophisticated analytics are required for credibility in this complex environment and automation facilitates managing a population efficiently at scale.
Cost Still Matters
The most successful organizations will be those that excel at population health (managing the total cost of care) and at operational efficiency (traditional operating costs).
By following this scalable approach to population health, providers can easily shift into faster, broader programs as they see fit throughout the journey. But like many things, the journey is just as important as the ending in population health programs and it is important to build a solid foundation in the beginning.
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