This content is part of the Conference Coverage: HIMSS 2019 news, trends and analysis

Population health management program growth tied to value-based care

As healthcare organizations lean toward value-based care, population health management programs will continue to grow as they give providers valuable data analytics.

The drive to value-based care will continue to foster population health management programs in the United States, a new report found.

Frost & Sullivan's "U.S. Population Health Management Market, Forecast to 2022" shows that rising demand among healthcare organizations for value-based healthcare models point to the need for customized, proactive programs that focus on the health of a group of patients and not just of a single patient, said Koustav Chatterjee, Frost & Sullivan industry analyst. Value-based healthcare models reimburse healthcare providers based on the quality of care they provide.

A population health management program collects and analyzes clinical data to identify and categorize patients into a group and then monitor and facilitate healthcare delivery to that group. The goal is to improve the clinical outcomes for a population of patients, as well as financial outcomes for the provider. The insights provided by a PHM program are said to help providers address and identify care gaps that exist within the patient population, which in turn helps a healthcare organization save money and improve patient outcomes.

A headshot of Koustav Chatterjee, an industry analyst for Frost & Sullivan.Koustav Chatterjee

"Patient loyalty and patient satisfaction are higher for hospitals that invest in patient solutions and keep them connected," Chatterjee said.

Chatterjee said for healthcare organizations seeking to create a population health management program, CIOs should consider five points from the Frost & Sullivan report:

1. Analytics leads to insights

Chatterjee said one of the key drivers behind continued interest in population health management is the need for better productivity margins, as well as improved clinical outcomes. A population health management program can lead organizations to better coordinated care by helping providers, patients and insurers gather, exchange and analyze patient data.

2. PHM tech needs to focus on both high-risk and at-risk patients

More holistic population health management programs focusing on preventive care for both high-risk and at-risk patients show greater promise for a tangible return on investment and are replacing legacy population health management programs focused solely on high-risk patients, Chatterjee said.

3. Patients aren't the only thing driving the market

Patient loyalty and patient satisfaction are higher for hospitals that invest in patient solutions and keep them connected.
Koustav Chatterjeeindustry analyst, Frost & Sullivan

Medication abuse, physician burnout and mental illness rates among aging patients are only a handful of issues driving the population health management market, Chatterjee said. A population health management program doesn't have to be focused solely on patients, as other populations -- including the employee and physician populations -- also need value-based medical services from providers and payers, according to the analysis.

4. Adoption is growing beyond providers

value-based pricing, which aims to ensure the prices that patients pay for drugs accurately reflect the benefits they provide, and on-demand healthcare services are attracting organizations that aren't providers to adopt a population health management program, according to the report.

5. Potential for financial incentives are real

A population health management program can help Accountable Care Organizations (ACOs) participating in Pathways to Success, an overhaul of the CMS Medicare Shared Savings Program under which a majority of Medicare's ACOs operate, save money. ACOs are groups of healthcare providers that are responsible for the quality and total cost of care, and the Pathways to Success program mandates that ACOs share losses and gains with Medicare. Implementing a population health management program could provide insights that help ACOs assume safer risks.

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