Guest post by Mohd Haque, vice president and global business head, healthcare, Wipro Technologies.
Population health management (PHM) isn’t just the latest buzzword. Or a new initiative mandated by the Affordable Care Act. Implementing a successful PHM program requires a complete shift in mindset from volume healthcare to value-based and outcome-based. PHM can’t be something that your healthcare facility “does,” but it must become the cornerstone of everything related to how your facility practices medicine.
Although the shift in perspective is the first step, it is essential to arm yourself with Population Health Management IT tools as well. According to 26th Annual HIMSS Study, half of the respondents (51 percent) have improved PHM through IT tools with only 38 percent saying that their organization was using specific Population Health Management tools.
By using big data analytics, EHR integration, IT infrastructure and security as part of a PHM program, providers can ensure patients that need high levels of care aren’t overlooked and the lower risk patients don’t get unnecessary care. This will in turn increase quality of care while saving money on interventions needed for low risk patients.
What are the Components of Effective PHM Program?
Since PHM is such a large shift, it is important to know exactly how to go about creating an environment that focuses on outcomes instead of volume. Population Health Alliance recommends the following four components to a PHM program:
- Assessment – Evaluate each patient’s health and assign patients to a risk group (high to low)
- Stratification – Provide the same interventions for everyone in the same risk group
- Person-Centered Intervention – Provide interventions based on each specific patient’s needs, including community health research
- Impact Evaluation – Determine the impact of interventions for each risk group as well as each individual patient
However, you can’t simply change the process without changing how each person on the team views healthcare and their patients. It must be a fundamental shift in your facility from the receptionist to the department chief.
Population Health Management in Action
Brookings Institute recently reported on work from the Center for Health Policy and the Asthma and Allergy Foundation of America (AAFA) on how PHM can be used to increase the quality of life and reduce costs for asthma patients. The report found that in order to be successful treating asthma using the PHM model, clinicians will need to use a team approach, tap into community resources, and use payment models that pay for value. The shift to PHM affects the following players in unique and specific ways:
- Providers — In addition to the interpersonal dynamics of creating a team approach, providers will be performing new tasks at the highest level of their training so doctors can focus on the highest-risk patients. Examples given in the report included nurses working with patients on asthma action plans and nebulizer training while social workers identify community resources, such as community health workers to perform air quality checks at a patient’s home. By using IT tools and analytics, providers can ensure patient information follows the patient as well as tracking outcomes.
- Payers — While a shift in PHM management starts with the providers, payers must shift their mindset, processes and IT tools. According to the Bookings report, payers must use alternative payment methods that not only pay for outcomes and value but offer financial incentives for physicians who work with community providers. In order to pay for value, payers must now use analytics to track outcomes and total cost to determine the new pay scale.
- Life Science Companies – These companies must also make the shift to PHM by no longer measuring success by the number of devices or pharmaceuticals sold, but by the outcome of the patients ultimately using their products. By tracking the number of asthma attacks in patients using their latest inhaler, life science companies can provide added value to providers since they are now being measured by this outcome. Additionally, companies can give providers predictive analytics to help select patients that are high risk and could most benefit from the products.
Using Technology in Your PHM Program
Technology shouldn’t be something you add into the program, but a core component as you design it from the ground up. To ensure privacy, data security tools as well as network infrastructure should be in place to prevent a data breach from day 1. Since data essential to determining risk is often in EHR records from past physicians or other specialists, EHR integration is essential to the PHM program as well. However, the backbone to a successful PHM program is using big data analytics from the assessment phase to the impact phase.
The bottom line is that it is not a single factor that creates an effective PHM program, but how healthcare enterprises combine the technological tools, strategy and process components. To meet the promise of PHM, a program must encompass the clinical, operation and technology together.