Building Sustainable PHM Initiatives: 5 Things You Should Expect From An Industry Partner

By Jack Plotkin, CTO, Virtual Health

The race is on to effective management of high-risk patient populations. Payers and providers recognize future survival in the fee-for-value world depends on having the right systems in place. Yet, in the rush to implement effective care management infrastructures, many forget to consider the big picture of optimization and sustainability.

The reality is population health management (PHM) is a journey, not a destination. Since industry best practice models are just starting to emerge, healthcare organizations that align themselves with strong partners in the field are much better positioned to respond to evolving industry dynamics. Otherwise, initiatives run the risk of plateauing or falling short of meaningful impactful.

Data forms the foundation of any PHM initiative, and the importance of identifying the right infrastructure cannot be overstated. But, besides having a great solution in place, payers and providers need to consider the big picture of aligning technology with the systems and workflow support that will produce reliable outcomes and long-term success. This starts with assessing five key areas of a vendor partnership.

1.Expertise

There are many facets to an optimal PHM strategy. While payers and providers recognize the urgency around managing populations, many simply “don’t know what they don’t know.” A vendor partner needs to first and foremost bring expertise to the table on three levels:

• Technical: Is a vendor equipped to help an organization identify and access all needed data points? Can the team look beyond what is provided to them by a healthcare organization to further pinpoint areas of risk or gaps in strategy?
• Clinical: PHM initiatives are equal parts technology and clinical workflow. Vendors should have the clinical expertise available to help an organization assess care management workflows and make needed process improvement tweaks over the long haul.
• Security: The last thing any healthcare organization wants in today’s highly-scrutinized, highly-regulated climate is to become tomorrow’s front-page headline for a security breach. PHM initiatives are data hungry and data heavy. Healthcare organizations need access to latest security advances, developments and best practice advice.

2.Flexibility, Scalability, And Customization

The evolution of value-based care is expected to remain a fluid situation for some time. Payers and providers need flexible infrastructures that allow them to grow initiatives over time and respond to changing dynamics. They also need partners that will help them customize initiatives to address specific needs on two levels: 1. their unique population mix and 2. regional requirements.

The reality is every PHM initiative is different. For example, a small payer’s case mix may require a very different focus than a large network to address risk. Also, requirements for Medicaid and Medicare populations vary widely by state, and vendor partnerships should encompass customization and support of these needs.

3.Program Design

The best PHM strategies start with an assessment of current challenges and program design opportunities before technology is deployed. This way, high-risk areas and gaps can be identified to best determine specific customization needs that require infrastructure support. A strong vendor partner can walk healthcare organizations through this process and help them develop specific business requirements from a platform. Then, the subsequent design of a program development lifecycle will ensure all needs are met and healthcare organizations not only achieve the most efficient and effective implementation possible, but are also best positioned to move the needle on quality and outcomes.

4.Stratified, Comprehensive Implementation Plan

In tandem with their high-risk patient populations, healthcare organizations also need to stratify and prioritize PHM implementations. Attempts to roll-out large-scale initiatives via a big-bang approach often result in chaos. As such, it is wise to start with a few high-level priorities and build out accordingly. The right industry partner can help prioritize implementation efforts by:

• regulatory needs
• business needs
• business wants
• business “nice to haves”

Payers and providers should also expect vendor partnerships to address: implementation team design and support; adoption and integration methods; and training. Specifically, formal and ongoing training should be provided that considers diverse needs. For instance, some situations call for one-on-one training, while others can be supported by group or web-based methods.

5.Program Sustainability

Vendor partnerships for PHM must be viewed through the lens of a long-term relationship. Value-based care is here to stay, and evolving requirements will continue to up the ante on reporting and care coordination. The right vendor relationship not only ensures adoption and integration timelines stay on track, but also continues to monitor progress and tweak systems through an ongoing analysis of performance. In addition, training programs must support ongoing staff turnover and any new tools introduced within a platform.

Conclusion

As the regulatory climate for value-based care shifts from incentive-focused programs to penalties, effective PHM becomes increasingly critical. Healthcare organizations must make the best infrastructure choices to support program needs, but more important, they must align themselves with the right partner for long-term success and sustainability.

About The Author
Jack Plotkin is the CTO of VirtualHealth and the architect of the company’s population health and care management platform. After completing studies in both computer science and economics at Harvard University, Jack spent the next two decades spearheading technology development and deployment on behalf of both Fortune 500 companies and early ventures with a strong focus on healthcare. He is considered a leading expert on enterprise solutions for large-scale organizations that manage complex patient populations.