We’re all aware that healthcare reform and The Centers for Medicare & Medicaid Services (CMS) are causing a major shift from a fee-for-service model to a value-based, pay-for-performance paradigm. To face these changes, health plans, physicians, hospitals, and other healthcare providers need better, more actionable data delivered through accurate, dependable population health management (PHM). A professional PHM consultant can help your organization understand how to improve clinical, financial, and operational ROI.
What is population health management?
According to the Health Management and Information Systems Society (HIMSS), “A population health management program strives to address health needs at all points along the continuum of health and well-being through participation of, engagement with and targeted interventions for the population. HIMSS goes on to say that the goal of PHM is to, “Maintain or improve the physical and psychosocial well-being of individuals through cost-effective and tailored health solutions.”
PHM come down to preventing diseases, prolonging life, and promoting health through organized efforts and informed choices of society, public and private organizations, communities, and individuals. It is at the center of engaging patients, improving care delivery, lowering costs, and facilitating strategies to better manage the health of the communities you serve.
In order to prepare for this vast transformation, you should consider changes that impact care delivery, physician compensation, and the ways you leverage patient data (and PHM data in particular).
When doctors can access the data that reports details for participating physicians and their patients, physicians can use those visual analytics to help improve patient health, improve the care experience, and save money on the per-patient cost of care. These three benefits add up to a major leap forward in value-based, pay-for-performance healthcare.
Why PHM data is especially noteworthy:
- It helps your organization deal with CMS’s regulations… and avoid penalties. Physicians will soon start to feel the financial pinch of not meeting CMS mandates. In fact, CMS revealed that over 200,000 eligible professional providers who are not meaningful users of certified EHR technology will have their Medicare Fee Schedule cut if they don’t comply with value-based regulations.
- It efficiently puts “big data” at your fingertips. The analytics are self-service. All the separate EHR data is available in one place. It’s all yours to delve into and explore to help you make more insightful decisions and engage patients, whether you’re a doctor or business analyst. The reports are standardized across financial, operational, supply chain, and clinical functions (including physician scorecards), allowing you to monitor your organizations’s financial health, evaluate supply chain efficiencies, and benchmark physician utilization and performance. That means access in one place to claims data, EHR data, social and community data, patient generated health data, medication, and prescription data, and more.
- It can help improve community health. The Centers for Disease Control and Prevention (CDC) reaffirms that, “Having an agreed upon set of metrics can galvanize partners to work together to improve community health.” Segmenting your data will help to gain deep insights into your population’s health and deliver the highest quality care at the lowest cost.
- It helps coordinate care across teams, providers, and outpatient services. Unlike traditional spreadsheets alone, PHM delivers real-time, interactive data to help most efficiently coordinate care. PHM’s visualization tools help you harness data so doctors can see, track, and even hone in on high-risk patients.
- It helps you take control of your risks. That means, for example, that a hospital can proactively identify their most vulnerable patients, set up appointments, and manage costs and risks. Both clinicians and administrators can valuable data to help them make more educated decisions and planning. Plus, controlling risks is more important than ever to participate in CMS’s bundled payment arrangements.
- It helps you build strong patient relationships. Physicians, nurses, technicians, physician assistants, and social workers can tap into PHM data to collaborate and optimize the quality and level of services offered both online and offline. Data-driven triggers can automate various communications to involve patients, including outbound calls, secure text messaging, social media, and emails to ensure regular patient engagement with care teams and doctors. Plus, PHM programs can tap into evolving healthcare changes, including wearable technology that tracks calories, exercise, sleep patterns and more.
- It helps you get and keep patients. When Medicare reduces payments, the names of affected hospitals are publicly listed. Patients search online for public information and patient reviews before selecting where to receive care. If you want your organization to be one patients choose, you need to keep your reputation on the up-and-up.
- It helps you collaborate. Partnership and collaboration will help your organization survive the shift to value-based healthcare. These new partnerships cross industries and include companies outside of healthcare.
The future of PHM (PHM 2.0)
While many healthcare organizations are still trying to grasp what PHM 1.0 is, the 2.0 version is gaining momentum, according to HIMSS and Healthcare IT News. The publication goes on to say that, “…hospitals and networks already embarking on population health management initiatives today focus on people with one or more chronic conditions, such as diabetes, kidney disease, congestive heart failure and chronic obstructive pulmonary disease, to name a few…The shift from volume to value has been called population health’s secret sauce.”
The publication tells us that PHM promises to, “…more precisely quantify the quality of care delivered, as measured by the results, and thereby become increasingly efficient in terms of time, effort and cost of achieving better outcomes.”
But, technology alone will not advance PHM into a more mature state. You need to have the tools and data in place to leverage this growing and changing paradigm. Equally important, you need to also have the highly trained and knowledgeable consulting resources that specialize in using and getting the most value from the population module/tool for each EHR/EMR vendor.