ACA & The New Normal

Population Health Management: Essential for Helping Clients Control Healthcare Costs

A new, key strategy for lowering the total cost of health care

by Michael Jordan

Mr. Jordan is president of labor and strategic accounts division for MagnaCare, an administrator of self-insured health plans for employers in New York and New Jersey.

Implementing an effective care management program offers employers the best solution to rein in healthcare costs.

In particular, population health management (PHM) – the aggregation of patient data across multiple health information technology resources – provides a view of the entire continuum of care, defines the patient population, identifies gaps in care, stratifies risk and engages the patient.

With this in mind, brokers should share critical information about how PHM has become a key strategy for lowering the total cost of care, especially for self-insured clients.

With PHM, the objective is to minimize costly, yet often unnecessary or redundant interventions, such as emergency department visits, hospitalizations, imaging tests and surgery. To be effective, healthcare must not only focus on high-risk patients, but also strive to connect data silos and enhance transparency. This means using the most effective strategies available to meet the needs of every patient.

How Does PHM Work?

PHM helps to identify high-risk patients to determine which ones require individualized attention. Individualized outreach programs evaluate the overall health of a plan population and identify participants who have, or are at risk for developing, common and costly chronic health conditions.

Successful healthcare and long-term service delivery models must involve a team of providers to meet individual needs, improve healthcare access and outcomes, and synchronize the various services and supports.

In the ideal PHM program, a care coordinator works closely with patients, primary care providers, and other healthcare professionals to aid communication, improve individual well-being and enhance outcomes.

The most optimized PHM programs encompass thoughtful, patient-centric, quality healthcare strategies that rely upon predictive modeling and individualized outreach programs. Predictive analytics turns data into a single, actionable patient record, enabling the care team to take actions that lead to improved clinical and financial outcomes.

What Trends Influence the Uptake of PHM Among Employers?

PHM continues to gain recognition among employers. Automation has become a critical PHM tool for staying ahead of factors that affect population health and the fluctuating distribution of health risks.

PHM trends include:

  • Greater commitment to population health
    Population-health spending has increased in health systems for 2015, with many healthcare executives anticipating a return on investment within three to four years.
  • Providers assuming more risk
    Experts predict a six-percent shift away from fee-for-service to value-based revenues in 2015, with providers taking on more risk through commercial incentives, partnerships with health plans, bundling, full or partial capitation, and participation in an accountable care organization (ACO).
  • Improved infrastructure for managing risk
    The rise of electronic medical records (EMRs) enables providers to create and capture new data sources to manage population health. But adoption of these systems requires executive buy-in and a powerful culture of analytics tools in order to capitalize on the potential advantages.
The future of managing risk will be contingent upon collecting and synthesizing large amounts of data into actionable improvements in care delivery.

The future of managing risk will be contingent upon collecting and synthesizing large amounts of data into actionable improvements in care delivery. By collecting and tracking data about plan members with their informed consent, health systems can proactively build relationships and develop tailored prevention and wellness services customized for each individual.

What Are Key Roadblocks?

Data management is essential for PHM to be effective because it enables a full analysis of risk among patient populations. Without the ability to automatically aggregate and consolidate data from a variety of disparate systems and sources, including inpatient, ambulatory and home sites, improving continuity of patient care and efficiency becomes highly challenging.

To overcome this, employers can partner with health systems that are organized around effective PHM strategies, with every component shifting toward a value-based care model.

Furthermore, health IT systems must be able to integrate the new consumer-driven model with quality data, clinical decision support, and patient-engagement strategies to create the best possible patient experience.
What Should Employers Look for in a PHM Strategy?

Ideally, employers should seek healthcare systems and PHM managers that work to gain a clear health picture of each plan member, and strive to help shape better health behaviors, encourage prevention and achieve the most optimal outcomes. A growing number of providers give high importance to systems integration and applications that allow stakeholders to access transparent patient information.

What’s more, performance measures enable all stakeholders to assess the value of healthcare services and compare quality, cost and patient experience across healthcare providers. In addition, tracking healthcare data can serve as the foundation for quality improvements and changes in clinical behaviors.

A study by The Wisconsin Collaborative for Healthcare Quality found that tracking the quality of care encourages physicians to change the way they practice medicine, increasing the likelihood of them following guidelines more strictly, contacting patients due for tests, and other improvements to the care they render. Clinical quality is also higher among health plans that measure and publicly report on their performance, according to the National Committee for Quality Assurance.

With the revolution toward payment models that compensate physicians based on patient care and outcomes rather than services, brokers must communicate to clients that the U.S. healthcare system is moving toward quality care and cost reduction. Traditional fee-for-service payment models, which offered no real incentive for providers to reduce unnecessary care, no longer work.

Today, data measuring healthcare prices and quality can be used to demonstrate: value, treatment outcomes and access to care. Strategies designed to optimize this opportunity have the potential to help close the gap between the unsustainably high rate of U.S. healthcare spending and unbalanced levels of quality and access.