The push towards value-based delivery models has resulted in an increasing interest in population health management. The proliferation of digitized data resulting from the adoption of electronic systems represents a potential gold mine of information needed to achieve IHI’s triple aim of improved patient care, improved population health, and lower per capita costs. Unfortunately, the volume and disparate nature of this data makes it difficult for organizations to glean meaningful insights about their populations from it, resulting in critical care gaps and the unnecessary utilization of resources.
To successfully compete in a shifting market landscape, healthcare organizations are considering:
Population Health Management
Identifies and risk-stratifies patient populations based on actionable care gaps to design effective programs. This greatly improves patient health while reducing avoidable expenses. Some important components of population health management are:
- ID/Stratification of patient populations to expose gaps in care
- Risk and Impact - Risk adjusted analytics provides actionable information in identifying and managing patient populations and their related RAF scores, thus driving CMS revenue. Risk scores impact the monthly revenue of health plans and providers and risk score analytics targets both objectives: better health and lower costs.
- Disease and Case Management - Gaps in care reveal areas where intervention can prevent costly hospitalizations and unnecessary complications. It shows which patients need to be targeted and what steps need to be taken to close gaps
- Consumer Behavior and Adherence - Assesses the effectiveness of existing incentives as well as their impact on member engagement by tracking population segments and measuring improvements in compliance. By aligning consumer characteristics and needs, clients can create an intelligent blueprint for engagement and care planning with new populations.
- Member/Patient Engagement - Effective outreach programs and timely alerts prompt individuals to access care and close critical care gaps by scheduling preventive care appointments, refilling prescriptions, and following through with their care programs.
- Provider Engagement – Notifying providers of care gaps and providing them with insights to address those gaps while the patient is in the office.
HEDIS/Stars/P4P Performance Monitoring is crucial for both health plans and providers as these quality measures have a significant impact on revenue from payers (including CMS), competitive differentiation, and buying decisions from consumers more attuned to these ratings as they are being asked to bear an increasing share of the costs of their healthcare. Quality measurement includes:
- Care Gaps
- HEDIS/Stars - In addition to gap information, calculating the number of members needed to reach the next rating threshold, helps identify members with the largest number of outstanding assessments, and evaluate provider performance.
- P4P or Pay for Performance involves rewarding providers for meeting performance measures of quality and efficiency by measuring process outcomes.
- Outcomes Trends
- Decision Support