The Importance of Population Health Management in the Era of Value-Based Care

AUG 31

The evolution of the population health market is something we’re constantly tracking at TripleTree. In this blog, we revisit our core framework for successful population health management (PHM) strategies, explore how vendors are positioning themselves in the market, and review findings from several discussions we’ve had with health systems working to establish their PHM strategic plan as they expand value-based care (VBC) arrangements. In our upcoming Industry Perspective, Population Health Management Capabilities Required to Succeed in Value-based Care, we explore in greater detail the tools and capabilities required to participate in today’s VBC models.

While there has been a tremendous amount of noise created in the competitive landscape as companies jockey to participate in the excitement surrounding PHM, we believe there remains a distinct framework upon which PHM vendors are designing their core capabilities and should be evaluated. Consistent with previous research we’ve published on the topic, we break this framework into four main categories:

  • Data Integration – the incorporation and compartmentalization of clinical, financial, social and environmental (among other) data to support analysis on patient populations
  • Clinical Analytics – the capture and use of discrete data to identify treatment interventions, measure clinical effectiveness, and reduce variability in care delivery
  • Care Coordination – provider and patient facing solutions to manage patients and interventions
  • Patient Engagement – tools to engage the patient and caregiver/family to take responsibility in the management of their care and deliver interventions designed to increase activation and promote positive patient behavior

While the capabilities of an effective PHM strategy are distinct, the reality is that an integrated PHM solution should be designed to meet a cross section of objectives to properly position provider organizations to execute according to VBC contracts:

  • Creation of a longitudinal view of the patient
  • Seamlessly connect provider and patient/caregiver
  • Deliver personalized interventions to reduce the occurrence of adverse events
  • Manage patient flow across the care continuum
  • Support the delivery of the right care, at the right time, in the right setting (which often occurs outside of a facility setting)

On a broader scale, providers are still navigating a complex environment of VBC models and are at various stages of adoption, with many still trying to determine which programs they are best suited to participate in, what additional capabilities are required, and if those capabilities should be insourced or outsourced. We spoke with several health systems to get their views on where they see themselves along the continuum of VBC, where the market is heading in the shift to value, and where they are making investments to be successful in a VBC environment. While each had unique needs as it relates to the implementation of strategies that work best for their organization, several common themes emerged:

  • Regardless of size, many health systems are early in the development of appropriate PHM strategy implementation
  • Aggregating various data sets into a common platform is creating a heavy lift
  • Assimilation into the typical clinician workflow is important
  • Technology tools are being combined with modifications to organizational behavior to deliver care according to VBC contracts
  • Leadership alignment and physician buy-in are critical
  • Some provider organizations that have been operating in risk sharing relationships have highly sophisticated PHM capabilities and cultures
  • A formal structure for clinician accountability and performance standards is required to drive adoption and organizational change

Our conversations with providers continued to validate the strategic prioritization that a well-designed PHM strategy holds within an organization. The complexion of that strategy will be different for everyone and will reflect the VBC model participation, financial resources, and patient population characteristics of that organization. Despite uncertainty regarding the ultimate path of the Affordable Care Act, population health initiatives remain a top priority for providers, as evidenced by a recent Health Catalyst study. From TripleTree’s perspective, we believe we find ourselves at an important inflection point in the adoption of PHM tools, where solution capabilities are aligning with financial returns and we remain excited about the prospects for innovation within the sector. Watch for our Industry Perspective in the coming weeks, where we’ll explore this level of innovation in greater detail. In the meantime, let us know what you think.
Brian Thomas
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