Insights On Launching, Sustaining Pop Health Initiatives
By Vicki Harter, VP of Care Transformation, Caradigm
By now, most healthcare organizations realize value-based reimbursement is becoming the new reality. With CMS and private insurers now embracing this model, healthcare providers know they must begin implementing effective quality-improvement programs to succeed.
As a result, many provider organizations are turning to population health management programs to produce the clinical results that will enable them to financially succeed under value-based reimbursement. These initiatives aim to enhance outcomes for an entire group of individuals, instead of merely looking to improve health on a one-to-one basis.
With population health clearly a top priority for provider organizations, healthcare professionals are no longer simply talking about the potential of such programs but instead zeroing in on how to get the job done. To move in this direction, organizations must rethink their financial and clinical strategies to consider how to optimize their reimbursement in the transition to new payment models under population-health management.
The HIMSS Analytics’ 2015 Population Health Trends & Insights, a recent study of large integrated delivery networks, offers insights into how organizations can launch and sustain population-health initiatives. Researchers surveyed CIOs, CMOs, and others at 25 leading organizations, each of which manages between 25,000 and 300,000 at-risk lives. The study looked at the value as well as the limitations of EMRs in supporting these programs; and what additional technologies might be needed to ultimately succeed.
Committing To Population Health
According to the report, healthcare organizations are jumping in headfirst, launching a variety of initiatives aimed at improving the health of various populations. Study participants said they are supporting population health efforts with care/case management (37 percent), patient engagement/portals/outreach (29 percent), disease management/registries (14 percent), and analytics/business intelligence (10 percent).
When starting out with population-health, however, some are experiencing challenges, as the new model is dramatically different. One organization noted that for years, physicians have been compensated and incentivized based on the more patients they see, the more labs they order, the more radiology tests they order — the more money they make. Now, however, providers need to take a different tact and concentrate on keeping patients out of emergency departments and clinics, which means shifting resources and rethinking treatment goals. This focus on keeping populations well is challenging as it is, for the first time, requiring various providers to communicate with one another: Another respondent noted that in the past, the physician office might not even ask for a patient’s discharge summary, and now they are calling the hospital asking for the discharge summary or emergency department record from two days ago. In this population-health world, the handoffs are so critical. The physician is being incentivized to know what is going on with patients and physicians are being pushed to have much more information.
With this new focus, healthcare providers are running up against a variety of challenges including technology/data exchange/accessibility issues (26 percent); resistance to change (23 percent); money/financial issues (21 percent); understanding the proper pace for change and investment (16 percent); and resource constraints (14 percent).
One of the most challenging aspects of the transition is the fact that it is difficult to move expediently from fee-for-service to value-based care, according to a CMIO. He noted that when moving from here to there, you need money to build the bridge. However, as reimbursement models change, many organizations are struggling to come up with the funds to build an infrastructure that will support new care delivery models.
Evaluating Health IT Options
Implementing an EMR system that can accommodate an entry into population-health is a top priority for many organizations. A CMIO noted that his organization needs a good EMR platform — something that is comprehensive, interoperable, and talks to exchanges and other healthcare systems. He noted that it is a challenge in and of itself to reach that level of data exchange that allows his organization to look at patient as a whole.
Many healthcare leaders are finding that their EMRs simply are not built to handle these sophisticated functions. A CIO reported that his EMR platform is not set up efficiently to support population health initiatives.
Similarly, another CIO said that his organization’s biggest challenge is having EMRs report on data in a meaningful way. He said that some only create paper-based reports while others can’t create reports that are in a common format so they can be imported.
Another executive more specifically pointed out that his organization’s EMR has the data required for the individual care of the patient but does not provide the data aggregation and analytics needed to actually change performance and behavior. As a result, the organization is looking to use other solutions in addition to the EMR to buoy its population-health programs.
Going Beyond EMRs
The health IT infrastructure needed to support population health management initiatives includes capabilities that go beyond what an EMR was designed to do. Organizations must be able to aggregate various types of data from disparate systems across the community; provide deep insights from the data through analytics; and improve clinician workflows by leveraging those insights to drive better outcomes. Organizations that adopt an enterprise strategy to assure a Health IT roadmap that supports not only the challenges of today, but flexibility and extensibility to support the more connected world of the future , are most likely to succeed.
As such, provider organizations are apt to move beyond EMRs and explore other technologies to manage population-health initiatives. In fact, according to the study, leaders acknowledge that their organizations need to add other solutions to help reach their population-health goals.
Consider these findings: 56 percent of organizations are looking to invest in business analytics, 52 percent in patient engagement, 52 percent in care management /coordination, and 36 percent in data-aggregation solutions.
One CIO noted that healthcare organizations need to consider investing in population health management platforms that offer workflow and capabilities that drive care coordination and remind patients of appointments. In addition, these systems need to be able to look into the patient base and identify who needs to be contacted, such as those who have not been seen recently. And, finally, these systems should have the ability to generate reporting and provide the ability to perform analytics.
With such goals in place, many organizations are looking to dive much deeper into advanced solutions — such as an enterprise data warehouse, predictive analytics, and care-management solutions that can better support population health programs.
Indeed, one leader said that population health requires a wide array of technologies. To support a variety of patient-centered initiatives, his group has implemented an IT infrastructure to perform claims analytics and clinical analytics to identify high-risk patients while also leveraging disease management registries and care navigation for the highest risk members in an effort to get utilization management to appropriate levels.
By leveraging these more advanced solutions, healthcare organizations will be better able to support the new workflows required to achieve the Institute for Healthcare Improvement (IHI) Triple Aim of improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of healthcare. In the end, healthcare organizations need to achieve the clinical results that lead to financial success under value-based models of care.