Tackling the complexities of risk-bearing value-based care (VBC) contracts requires the right tools and information. But, knowing what the “right” things are is a challenge all on its own, and demands a three-part strategy:
- Understanding your population: Being armed with the right data is the first step in developing an effective strategy, providing the knowledge you need to establish baselines and track your success against them.
- Helping patients navigate to proactive, coordinated care: Healthcare is a complex ecosystem, and moving a patient toward healthy outcomes requires effective guidance and removal of barriers.
- Activating people to better health: Engaging patients as active members of their care team is critical, but solid PHM must move beyond that, and truly activate consumers to help drive better outcomes.
This post looks at the first step in that process – developing a deep understanding of your population and their risk factors. You need accurate information from a variety of sources to be able to risk-stratify your population, identify care gaps and unmet healthcare needs and coordinate effective care management and care interventions. This helps you positively impact the population’s health while driving down costs and utilization.
KLAS PHM functionalities and understanding your population
This first step of understanding your population ties back to three of the six IT functionalities identified by KLAS as being necessary for successful PHM. These three functionalities are:
- Aggregation – compile and normalize relevant health data across the continuum, regardless of source
- Analysis – stratify your population(s) by their risk factors, based on your specific goals and metrics
- Administrative/Financial – analyze, benchmark and optimize your quality and compliance metrics
Below, we look at each of these three KLAS functionalities and discuss how a PHM solution can help you master them.
To understand your population, your healthcare organization will inevitably need financial, clinical and other data from outside your system. A PHM solution enables your system to collect that data from claims, a variety of electronic medical records, financial sources, socioeconomic databases and other sources. Then, it translates that data into information you can act on.
That’s easier said than done, because about half the data that is received from different EHRs and other sources is custom, driven by the different definitions created by each EHR system. That customization makes aggregating data across different EHRs and other sources highly complex. A robust PHM system can solve this issue by normalizing it so that you can have confidence in your data.
After aggregating and normalizing your data, you need to analyze it so you can stratify your patient population by risk factors that are based on your specific metrics and goals. This step enables you to identify and close care gaps and prioritize your care teams’ interventions so that patients get more proactive, coordinated care.
Some PHM platforms are using machine learning to translate data from the hundreds of existing code sets into high-quality reports that quality managers can use to find, for example, those in a population who are diabetic or who should be taking a statin to manage their hypertension.
Administrative and financial functionalities in a PHM solution then allow you to analyze, benchmark and optimize internal and external strategic programs. These functions enable you to submit compliance and quality metrics to various payers, while permitting you to assess the performance of your providers and of your health system. Dashboards and alerts allow you to quickly get insights about key data, so you can avoid penalties and maximize quality-based and value-based reimbursement.
Those key aspects are all well and good in theory, but implementing them effectively is often easier said than done. It’s not impossible, however, considering how the following organizations were able to leverage a better understanding of their populations to power their success in VBC.
VBC success stories
The Children’s Health Alliance is a not-for-profit association of private practice pediatricians throughout the Portland/Vancouver/Salem metropolitan area that was seeking to better manage the health of its pediatric population. It assessed the health risks of over 80,000 patients to identify which children and families needed the most support from the care team. Using Philips Wellcentive’s PHM platform, they developed a methodology to assess medical complexity, patient functioning and family factors. That enabled them to increase well visits by more than 200% while reducing ED utilization for children with asthma by 20-40%.
Lakeshore Health Network, a 350-physician PHO in Michigan, sought to meet payers’ quality standards and improve patient care. They used the Wellcentive platform to aggregate and normalize their data and populate a PHM registry to facilitate and measure subsequent PHM activities. Then, they applied automation and tools to allow their physician practices to streamline identifying care needs. They used care gap analysis, outcomes reporting and automated patient engagement tools to improve disease management. They also supported physicians with clinical and decision support tools and patient education materials. Within a few months, 90% of their primary care offices had implemented the registry and population health tools.
ColumbiaDoctors, a group of more than 1,800 physicians, surgeons, dentists and nurses affiliated with Columbia University in New York City, used Philips Wellcentive’s PHM solution to avoid significant PQRS penalties. After aggregating, mapping and reporting on over 1,300 physician billing and encounter data streams, it achieved a $1.24 million return on its investment.
Setting up for PHM success
Understanding your population is a critical first step in VBC success. It arms you with the meaningful insights you need to take the next step – helping patients navigate to appropriate care and closing care gaps. Read more on that second step in our next blog post. You can also learn more by reading our white paper, “Beyond frequent fliers: why health organizations need a comprehensive PHM strategy.”
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