Population health management programs require goal alignment

As demand for value-based healthcare rises, so does the need for population health management programs that enable providers to focus on groups of patients rather than individuals.

To wit: One trend is driving the other, according to Bradley Hunter, population researcher at health IT research outfit KLAS Enterprises LLC. Population health management programs analyze data, often collected in EHRs, on groups of patients, which then helps healthcare workers provide better care for the individual -- and provide better care, in general. Because value-based care models reimburse providers based on the quality of care, population health management programs are a natural fit.

In this Q&A, Hunter touches on how population health management is tied to value-based care, common challenges providers face when implementing population health programs and what success looks like.

Editor's note: Responses have been edited for clarity and brevity.

How does population health management connect to value-based care?

Bradley Hunter: The value-based care and population health worlds are tied at the hip. Every population health program is tied to a value-based contract, whether it is a contract with Medicare or CMS [The Centers for Medicare and Medicaid Services] in some form or through multiple payer contracts.

With every value-based contract, there are quality incentives you need to hit. Typically, there will be incentives to take care of the population in different ways. Providers can look at that and say, 'Let's take a look at what our population looks like.'

The value-based care and population health worlds are tied at the hip.

They might find that their most expensive patients are, for example, diabetics. They look at that and can say, 'Our diabetics are our highest cost. Why is that?' Then, looking deeper into it, they can find out that a lot of them went to the emergency department last year, and that's something they can help prevent if they are proactive. They can decrease their costs as a health system, which will help them save money on their contract and also take better care of the patients.

Then you have your population health program, which is being supported by this value-based contract.

But it's really about helping to take care of the population so they can live a better life. That's really the end goal -- patients are better taken care of with population health and value-based care.

Bradley Hunter

What should providers keep in mind when considering population health management programs?

Hunter: You want to look at what your goals are as an organization ... and then go into population health when you have that alignment with your team. When you have those goals, you know what data elements you need to capture so that you can understand the populations that are a part of your goals.

You can also take a look at a vendor through the lens of what your goals are and who can help you with those particular goals. In vendor selection, in general, look for a vendor that is going to be a good partner for you. You want someone who is going to be walking the road with you, not someone who is just going to drop off a tool.

Providers say those partnerships with vendors can be extremely valuable because vendors can see across multiple clients of things that work and things that don't work and share those best practices.

What challenges will providers face if they implement a population health management plan?

Hunter: One is just getting the data. Knowing what data you need upfront helps a lot with that. But if you are, let's say, an [Accountable Care Organization] that has 100 different sites and 25 different EHRs because you have several single or small doctor practices, bringing in all of those data elements can be a challenge.

The other part is understanding the roadmap of what they want to do, how much risk they want to take on, the different levels of risk and having that open relationship with their payer. That can be very helpful to providers, but that's a roadblock they face. They may not understand their contracts fully; there could be a gotcha in there they don't understand.

What drives a successful population health management plan?

Hunter: It comes down to a couple of factors, most of it centering around alignment between several factions. You have your provider alignment, so within the provider organization at an executive level, is the CEO on the same page as the CIO, the CMIO, the CFO? Are they all working in concert? Are they aligned in saying these are the things we're working on together?

Then there's alignment between the provider and the vendor. Are they aligned on the same goals? Are they working together? Are they working in partnership or are they just in a transactional relationship?

The third alignment needs to be with the payer. The payer with the value-based care contract is really trying to drive behavior with financial incentives. Is there alignment between payer and provider on what things are best for them to pursue and how they're going to do it?