Recently on the blog, we introduced the topic of population health management (PHM). In the previous post, we discussed how the concept of PHM emerged from the Affordable Care Act (ACA) legislation. Furthermore, we shared statistics that revealed no matter what happens to the ACA – hospitals and providers will continue to place importance on PHM through policies and initiatives. This is the second article in our series about population health. Join us as we take a deeper dive and look at how data is used; what industry leaders are doing to address PHM; and where healthcare organizations go wrong.

image of a strong man with muscles made up of people that symbolizes population health

Effective population health care management can decrease unnecessary healthcare spending and improve outcomes.

Want to hear a shocking figure?

According to a report from the National Academy of Medicine (NAM), only a mere five percent of patients account for approximately one-half of all the healthcare spending nationwide. However, this means that health systems and hospitals have an opportunity to lower spending by focusing on the improvement of population health of a relatively small number of patients.

How Can Hospitals Use Data to Improve Population Health?

First of all, healthcare organizations will need to develop population healthcare management interventions designed to improve the health of their highest-risk patients. These high-risk patients include those who are considered “super-users” and those with a host of chronic conditions, as reported in RevCycle Intelligence. According to the article:

“Real-time clinical data access is the foundation for patient interventions that reduce both unnecessary utilization and overall care spending. Providers must use the data to stratify their patients by risk, and then leverage that information to establish targeted care plans that help them cut costs.”

A comprehensive approach to preventative care and an effective population healthcare management strategy are both needed to make a difference. Together, this combination holds the potential to improve the quality of care; maximize payer spending; and slow the progression of chronic health conditions that account for much healthcare spending (i.e. diabetes and cardiovascular disease).

Failure to identify high-risk patients and implement initiatives to improve their health sets the stage for the continuation of unnecessary emergency room visits, frequent provider interactions, hospital admissions, and avoidable readmissions with 30 days of discharge.

Investments Made to Improve Population Health Care Management

Thomas McKinley is an investor for Cardinal Partners that recently launched Cardinal Analytx – a population health management company. Mobi Health News recently reported that this company has raised $6.1M to go toward initiatives to improve population health. The article quotes Afsana Akhter, EVP of sales at Cardinal Analytx, who said:

“The next question is really, for those people, what can we do to improve care and decrease costs. Today, in most environments, translating the outputs of algorithms to an effective clinical action is a big gap. So the way we’re bridging that gap is … we are creating actionable care plans that we are handing to care management organizations, and we will also be delivering to physicians and provider groups. And they can take those very precise care plans and clinical recommendations and apply them to their members and patients to improve care and thereby better manage the cost.”

What is Missing from Your Population Health Strategy?

Population health management is a key driver needed to fulfill the promises of value-based care according to an article in Managed Care. However, the article points out how often PHM programs fail because “they treat populations as a homogeneous whole rather than a collection of heterogeneous individuals.”

The Managed Care article continues to explain that while often these groups of patients might have the same diagnosis or even comorbidities, they are dealing with a diverse set of cognitive, environmental, and socioeconomic factors. All of which contribute to how, when, and where they seek healthcare. The article points out the following three components that could be missing from your current population health care management strategy:

  1. Patient-Centered Education: in order for your PHM strategy to be successful, each patient needs to have a thorough understanding of their health needs, goals, and interventions. Insight as to whether the patient understands and retains this information is needed.
  2. Patient-Centered Social Indicators: Often PHM programs will put two people of the same age and diagnosis in the same category. However, let’s imagine there are two 60-year old patients who were recently diagnosed with high blood pressure. One patient has strong family support, high-speed internet access, and lives within walking distance to his doctor’s office and pharmacy. Now, the other patient lives by himself, has no support from family, no transportation to make it to appointments, and does not own a computer. The inclusion of environmental and social factors can help identify individual needs and improve your PHM strategy on a case-by-case basis.
  3. Patient-Centered Technology: While many Medicaid managed care organizations offer their patients online member portals – they are hardly used. The reason is that most people enrolled in Medicaid plans access internet with a smartphone and therefore need an app – not a web portal. Knowing how your patients will engage with your organization is an important step toward configuring technology that is tailored to these channels.

In the next population health article in this series, we will discuss in greater detail, technology. We will explore how in-depth analytics and other IT solutions can help you create and implement a winning population health management strategy.