The healthcare industry is moving toward population health management. We see that quite a bit, but it’s such a broad concept and construct, that if you put your toe in the water in this field, you may likely earn the job as a population health manager.
Earlier this year, Xerox polled a group of C-level healthcare executives and asked them to provide their perspective on population health management, starting with how it should be defined – and asked them to rank five components of a definition in order of significance.
What is population health management? Definition components were ranked in the following order:
- Facilitates care across the health continuum
- Supports providing the highest quality of care at the lowest cost
- Uses actionable insight for patient care based on a variety of data
- Targets a specific population of individuals
- Enables patient engagement
In my opinion, Population Health Management is the ability to manage clinical information, roles and workflow functions at every level – from administrative to quasi-clinical to clinical [see figure 1 below] – and deliver actionable insights that enable payers and providers to improve both clinical and financial outcomes.
Figure 1 – Please note that the above are just some examples of job functions and roles at various levels.
There are a number of players today that claim to provide population health management services; however, very few have the people power and the level of interoperability needed to support workflow at these various care levels. In fact, these solutions are often provided by a number of different vendors, creating disintegrated, disjointed technology that works in silos – limiting the healthcare service provider’s ability to see the full picture.
Take payers, for example, who have long applied data analytics from billing claims in an attempt to improve quality and reduce costs. Payers leverage this data as a way to stratify populations or groups within a population and identify at-risk groups so they can provide alternate methods of care. While data from billing claims can be used to support and measure the efficacy of the population health management goals in place, the data is not always a clear reflection of the patient’s health situation. Further, the payer’s ability to have a real impact on population health is limited because they don’t have the appropriate relationships with the patients, nor the cross-clinical information sharing capabilities which minimizes their effectiveness in understanding the complete picture.
In the future of population health management, it will be critical to connect these layers where there are specific roles defined. It will require business engineering that integrates the human factor into the technology solutions and end-to-end solutions that support the full population health management workflow with interoperability, information-sharing and real-time data analytics.
Technology partners have an important role to play.
Almost every one of these actions and process components are likely to be able to be automated or enabled by technology to some degree, but technology alone isn’t a solution.
Technology can facilitate cross-physician and patient communication and increase collaboration through information-sharing. It can provide the foundation for capturing clinical data, providing 360-degree patient views and analytics that can quickly and accurately identify at-risk patients. Consumer technologies are equally as important – from detecting and monitoring chronic diseases to driving a new and higher-level of medication adherence.
Automated tools can support workflow, save time and help manage risk as the industry transitions from fee-for-service to value-based care, but there must be some level of insight into the human-centric workflow.
The path to improving care outcomes and reducing costs for an entire population resides within the ability to reduce inefficiencies and improve the work itself.
As the industry continues to take steps toward achieving population health management, it will be equally important to ensure a seamless integration with support functions such as patient acquisition, patient & provider service, claims management, wellness services and revenue cycle management. It will require more machine-to-machine conversation and technology that supports people and processes – not the other way around. Integrated data from consumer technologies will play an equally important role – and will drive a new level of medication adherence and improved care outcomes that we haven’t seen in the past.
But achieving this level of integration and support will require payers and providers to consider a smaller group of highly capable sourcing partners, who are able to provide complete, end-to-end solutions.
Subsequently, this shift in payer/provider focus will have a significant impact on how business process outsourcing vendors develop new solutions and go to market. By developing and integrating more cross-industry solutions and considering new outcome-based compensation for services and solutions that align with value-based care, BPO vendors can enable a differentiated experience that is critical in the new healthcare economy.