On The Issues

July 9th, 2015

Population Health Management Best Practices for Today and Tomorrow’s Healthcare System

Testaments to Leadership, Collaboration, Innovation and Commitment

The transition to value-based care is not an easy one. Organizations will face numerous challenges on their journey towards population health management.

We believe there are five key elements and best practices to consider when transitioning from volume to value-based care: managing multiple quality programs; supporting both employed and affiliated physicians and effectively managing your network and referrals; managing organizational risk and utilization patterns; implementing care management programs; and ensuring success with value-based reimbursement.

When considering the best way to proactively and concurrently manage multiple quality programs, such as pay for performance, accountable care and/ or patient-centered medical home initiatives, you must rally your organization around a wide variety of outcomes-based programs. This requires a solution that supports quality program automation. Your platform must aggregate data from disparate sources, analyze that data through the lens of a program’s specific measures, and effectively enable the actions required to make improvements. Although this is a highly technical and complicated process, when done well it enables care teams to utilize real-time dashboards to monitor progress and identify focus areas for improving outcomes.

In order to provide support to both employed and affiliated physicians, and effectively manage your network and referrals, an organization must demonstrate its value to healthcare providers. Organizations that do this successfully are best positioned to engage and align with their healthcare providers. This means providing community-wide solutions for value-based care delivery. This must include technology and innovation, transformation services and support, care coordination processes, referral management, and savvy representation with employers and payers based on experience and accurate insight into population health management as well as risk.

To effectively manage organization risk and utilization patterns, it is imperative to optimize episodic and longitudinal risk, which requires the application of vetted algorithms to your patient populations using a high quality data set. In order to understand the difference in risk and utilization patterns you need to aggregate and normalize data from various clinical and administrative sources, and then ensure that the data quality is as high as possible. You must own your data and processes to be successful. And importantly, do not rely entirely on data received from payers.

It is also important to consider the implementation of care management programs to improve individual patient outcomes. More and more organizations are creating care management initiatives for improving outcomes during transitions of care and for complicated, chronically ill patients. These initiatives can be very effective. It is important to leverage technology, innovation and processes across the continuum of care, while encompassing both primary and specialty care providers and care teams in the workflows. Accurate insight into your risk helps define your areas of focus. A scheduled, trended outcomes report can effectively identify what’s working and where areas of improvement remain.

Finally, your organization can ensure success with value-based reimbursement when the transition is navigated correctly. The shift to value-based reimbursement is a critical and complicated transformation—oftentimes a reinvention—of an organization. Ultimately, it boils down to leadership, experience, technology and commitment. The key to success is working with team members, consultants and vendor partners who understand the myriad details and programs, and who thrive in a culture of communication, collaboration, execution and accountability.

Whether it’s PCMH or PCMH-N, PQRS or GPRO, CIN or ACO, PFP or DSRIP, TCM or CCM, HEDIS or NQF, ACG’s or HCC’s, care management or provider engagement, governance or network tiering, or payer or employer contracting, you can find partners with the right experience to match your organizations unique needs. Because much is at stake, it is necessary to ensure that you partner with the very best to help navigate your transition to value-based care.

Co-authored by Justin Barnes and Mason Beard

Justin is a corporate, board and policy advisor as well as host of the weekly syndicated radio show, “This Just In

Mason Beard is Co-Founder and Chief Product Officer for Wellcentive. Wellcentive delivers population health solutions that enable healthcare organizations to focus on high quality care, while maximizing revenue and transforming to support value-based models