By Dr. Chris Hobson, chief medical officer, Orion Health.
Health information exchanges (HIE) help care teams provide more informed patient care by supplying a complete longitudinal healthcare history of the patient to healthcare professionals, as well as enabling high quality reporting and analytics on the data. The goal of an HIE is to accurately store all relevant patient information from as many sources as possible, including medical history, medication history, past treatments and detailed personal information. A comprehensive reporting system allows for health delivery that is more responsive and tailored to each patient, and subsequently, the broader population.
Today the transition to value-based funding models seeks to lower costs and improve patient care and outcomes in order to lead to the better management of entire populations. Population health management (PHM) involves changing the behavior of engaged consumers to lead healthier lives and encouraging physicians to focus on providing the best possible quality of patient care at the lowest possible price. This requires providers to collaboratively address whole populations and orchestrate healthcare provision at large scale. Below are several challenges organizations must overcome before closing in on the goal of PHM.
Payer-provider collaboration and targeted incentives
Payers and providers must work together and, in particular, must find ways to effectively share their different types of data. Collaboration is needed to achieve shared goals such as understanding and improving the health of a population and enhancing the patient experience, all while constraining costs.
A key issue between payers and providers is agreement on the quality measures that will be incentivized. PHM places an unfair, high burden on providers if required quality measures vary widely across payers or if the measure does not clearly reflect a meaningful quality of care indicator. In the latter situation, a provider’s time and effort are used for inefficient purposes adding to a physician’s frustration with the healthcare system. Conversely, payers have additional data that can often help providers significantly with their population health management needs.
Fragmentation of care poses a challenge for health systems globally, and there is research to suggest that this problem is more persistent in the U.S. than its international peer countries. Studies have highlighted the major consequences of a poorly coordinated health system, including delays in care, incorrect care, and unnecessary complications, tests and procedures. Frequently, poor communication, difficulty sharing care plans and challenges coordinating actions by multiple caregivers across organizations results in confusion, delays in care and even incorrect care actions, putting the patient’s health on the line. A health system that is not well coordinated cannot deliver high quality care at lower costs.
Physician involvement in preventive care and the social determinants of health
For physicians, finding ways to move care from the acute setting toward health promotion, disease prevention and addressing the social determinants of health is quite difficult and not something they are necessarily empowered to do today. Currently, the majority of physicians do not have the tools to solve major intractable social issues such as poverty, so involving physicians and patients in the strategic design of a social determinants of health program is an essential step toward resolution of these types of concerns.
Adequate funding for technology and change management
Population health programs have the ability to “bend the cost curve” as providers adjust to new incentives to control costs and improve quality. Inevitably, there is an initial investment in technology and change management required that needs to be adequately funded or risk failure of the entire model. In particular the need for ever more data is very clear, and that brings associated costs.
Enabling technology to access data
High quality interoperability and rapid access to data is essential to population health, and to achieve that, healthcare needs to embrace new technology. Data coming from a range of sources needs to be cleaned, normalized, standardized and mapped to enable successful aggregation and clinical use in team-based care of patients. Interoperability is also a necessity for successful analytics relating to care quality.
Healthcare’s transformation to value-based models is accelerating but success entails addressing challenges in care delivery. At its core, PHM is about changing the behavior of engaged consumers to lead healthier lives and of physicians to focus on preventive care. Those tasks demand payers and providers collaboratively address whole populations. In short, they must orchestrate healthcare at scale to be successful in the years to come.