How Population Health Will Help Providers Get Compensated For Successful Outcomes
Population health, population health management, interoperability — these things mean different things to different people. But no matter how you define them, the desired effect is to drive better outcomes, both for the patient and the provider.
Tamara StClaire, chief innovation officer for Xerox Healthcare Business Group, took time to speak with Health IT Outcomes to help define these terms and, more importantly, provide insight as to how proper use of PHM, interoperability, and Big Data are going to drive the outcomes healthcare desires.
Q: What is your definition of population health management?
StClaire: That’s an important question and a great place to start, because for as much conversation is taking place on population health management, the industry as a whole still has a difficult time agreeing on what exactly it is. For instance, there’s a crucial difference between “population health” and “population health management.” Both raise the health outcomes of a given community, but those practicing population health management practice on a population for which they are financially responsible. This “attributed population” is the key to building population health management programs with a positive return-on-investment.
Q: Most think of technological concepts when asked to define population health, but isn’t the human factor important as well?
StClaire: I would argue the human factor is at least 50 percent of the equation. Population health management efforts typically include aggregating and analyzing data from a wide variety of sources to develop attribution models, segment populations, and improve our understanding of specific groups. But they can’t stop there, they need to take the next step to turn data into meaningful, actionable information with timely execution of necessary programs.
While technology makes it possible to analyze populations and segment at-risk groups, I believe it is equally important that we execute the necessary intervention programs to improve health outcomes. Real, live health coaches need to have numerous touch points with identified at-risk individuals so they can provide specific, personalized instructions on how to stay healthy.
Administrative services are often overlooked as well; scheduling appointments and properly onboarding patients improves health literacy and has a huge impact on personalization, adherence, and engagement.
Q: How close are we to value-based care and what needs to be done to make the transition more efficient at a cost that makes sense?
StClaire: While CMS is requiring half of all payments be value-based by 2018, we still have a long way to go. A Xerox survey found only 6 percent of payers and providers have already reached that goal. Even more worrisome, 43 percent of payers and providers say less than 10 percent of their current portfolio is value-based, and 77 percent agree some providers are losing money by adopting value-based care.
Population health management is the solution that many — including myself — believe will enable us to close this gap and help ensure providers are compensated for successful outcomes. By analyzing underperforming value-based contracts and identifying opportunities to improve specific financial and clinical contractual outcomes, providers can mitigate the high risks of value-based care.
Q: What advice would you share with organizations implementing technologies to ensure increased interoperability?
StClaire: Hold us, the vendors, accountable for interoperability. And remember that interoperability and health information exchange (HIE) are words that are often used interchangeably but, to avoid the debate, all roads should lead to true integration. This means HIE is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability. Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.
Q: It’s obvious user input is needed when designing health IT technologies, but whose input should be prioritized? Doctors, nurses, C-level executives, someone else?
StClaire: The most important stakeholder for whom to design technology is the patient. At the end of the day, if technology does not support the patient in achieving their healthcare goals, it shouldn’t be developed or deployed.
One should agree on the end goal with the strategic/financial stakeholders (C-suite) and prioritize the end use for solution design. Technologies developed hand-in-hand with its end users will ultimately be adopted and integrated into physician workflows.
Q: It has been said healthcare has gotten very good at collecting data, but there is much work to do filtering it. What can be done to take Big Data and make it actionable, thereby driving better outcomes?
StClaire: There is much discussion that data visualization is how you make big data actionable. I believe, and I rarely approach things with a technology answer, that AI/machine learning has the opportunity to make it useful. We’re beyond “asking the right questions” to what questions should we be asking.