Since healthcare has moved to value-based reimbursement and downside risk, provider and payer organizations have named population health management (PHM) a top priority. Benefits of true PHM include, delivering high-quality care while reducing costs and preventing unnecessary admissions for defined patient groups. Such groups may be based on contracts, chronic conditions, event types, or any other commonality.
Executing PHM is only possible with complete visibility. Visibility into what’s going on outside the exam room is such a high priority that, “Ninety-three percent of healthcare providers believe population health will have a significant impact on their organization within the next two years, according to a recent HIMSS Analytics Survey, sponsored by Intel. Providers are preparing for that impact by planning for, and implementing, various initiatives focused on population health.” These numbers clearly suggest large healthcare organizations plan to invest in technology and advisory services to help their providers effectively engage with patients to achieve success in population health management and value-based arrangements.
Over the last few years, healthcare IT vendors have responded by introducing new applications and capabilities to the marketplace that enable providers to deliver high-quality care to high-cost, high-risk populations at scale. Population health management has become a key role in strategic planning for healthcare organizations, from leveraging data for staff hires to improving care delivery methods, these areas are being built around insights derived from PHM technology.
I believe that population health management is hitting its tipping point as evidenced by the following market dynamics:
- Population health management technology is spreading from executive and analyst reports to the entire healthcare organization, including front of office, back of office, and the point of care. New c-level and director titles with “Population Health” are being created around the industry.
- More traditional healthcare organizations (not just early adopters) are evaluating and purchasing population health technology to support their provider and patient engagement efforts.
- Large vendors, such as Apple, Salesforce, and Microsoft, are entering the healthcare IT space.
What is Population Health Management?
Population health management consists of the variety of interactions that providers have with their patients and executive teams in concert with managing value-based contracts with payers. Population health management enables provider and payer organizations to efficiently deliver high-quality care to different groups of patients. There are three major areas that make up population health management as defined above.
The technology, where data insights are uncovered, is fundamental in determining the other major areas of strategy and people. Population health management technology (sometimes referred to as “platform”) is essentially an enterprise data warehouse which stores and organizes data from multiple sources so it can be transformed into insights and then acted upon with the intents of improving patient outcomes.
What Makes a Population Health Management Platform Work?
The population health management platform consists of six key areas, each building on the preceding area.
- Data Sources — Data sources is where population health efforts start. When considering all interactions a patient has with the healthcare system, the primary data sources include both clinical data (mostly from electronic medical records) and claims data (from commercial and government payers).
- Interfaces — This technology is responsible for pulling data from the various sources and putting it into a staging area, where it will later be merged and normalized. Interfaces are important because they are the highway system for data to flow from one database (original source system) to the PHM platform. What makes PHM vendors stand out is their ability to consume data from different sources.
- Data Processing — This is the area where all the data that has been collected is harmonized and merged to create a single patient profile that includes insights from all available sources. This is the most important part of the process because it determines the quality of reports and information that the end-user has access to.
- Internal Rules — Internal rules organize data for action. Now that the data has been collected, aggregated, and cleansed, the PHM platform can run internal algorithms to stratify the patient population by cost, risk, condition, etc. Virtually any combination of search criteria can be applied to the patient data to create custom lists or find insights, otherwise impossible without combining all data available on a single patient.
- Enterprise Data Warehouse — This is a second staging database where the cleansed patient data is copied to. Now, the end-user applications can populate with information and insights based on their role.
- User Applications — User applications drive engagement between providers, patients, care managers, and analysts. These are the applications the end-user will leverage to identify, assign, engage, and measure their population health strategy. This kind of platform is the key driver of performance in the value-based care market.
Insights generated by a PHM platform must also be aimed towards a target, be it clinical, financial, or administrative. This is where a population health strategy comes in to play. In my next post, I will review population health strategy and dive into the various population health initiatives healthcare organizations are deploying to deliver proactive care to their high-cost, high-need patients.