Four ways pop health management will change over the next 12 months

Experts weigh in on the top population health management changes managed care executives should be watching.

As demands for more cost accountability continue to rise for healthcare organization, having a robust population health strategy is no longer an ancillary option-it will have to be an integral part of an organization’s business strategy.

Sarah Thomas, managing director of the Deloitte Center for Health Solutions, says that a May 2017 survey of hospital CEOs found that investments in population health analytics is the highest rated analytics priority for healthcare organizations.

“In the next year, investments in population health and in the tools necessary for effective population health management are expected to increase,” Thomas says. “As traditional fee-for-service payments give way to value-based care reimbursement models, health systems and health plans will increasingly focus on population health.”

Here are four more changes to expect on the population health front:

1. Pop health collaborations will increase

Thomas says the incentive for health plans and health systems to collaborate will increase due to a common goal-lowering healthcare costs.

“We expect more collaboration on population health between health systems and health plans as they jointly develop benefit design, financial incentives, and technology to promote better population health,” Thomas says.

2. More organizations will use pop health data to cut costs

Healthcare organizations that have been utilizing EHRs for years will be realizing the best ways to utilize patient data, says David Hom, chief evangelist of SCIO Health Analytics.

“Providers have only begun to understand patient risk based on financial implications. The value of claims data is now important as both the Center for Medicare and Medicaid Services (CMS) and health plans use this data to determine the patient’s risk and the financial impact of the services that they will prescribe for the member,” Hom says. “Providers will now begin their journey of how they should use data to improve their finances.”

In the next year, Hom says that healthcare organization should be able to answer two key questions with existing patient data to determine financial risk:

  • Can the data be used to help manage some of my risk contracts with CMS or with my health plans?

  • Am I being paid correctly for the patients I manage based on the claims I file with CMS?

“Providers will need to understand exactly what data is of value to help them manage risk,” Hom says. “For example, household data such as income, education, distance to the provider, and spending habits will be critical to determine if a service prescribed by the provider will be completed.”

Next: Changes three and four

 

 

3. More organizations will use pop health data to understand patient behavior

Being able to synthesize data outside of healthcare data will allow healthcare organizations to measure the ability of a patient to complete a service, such as refilling medications or taking lab test, Hom says.

“We also think that within the EHR, there are more important data to measure the patient’s risk, such as fasting sugar test vs. HBa1C test to determine if the patient is a diabetic or a pre-diabetic. This type of thinking will lead to ‘trumping logic’ to prioritize one lab over another to impact the patient’s future costs,” Hom says.

4. More organizations will use pop health to predict patient behavior

Thomas agrees that more varied data from claims, pharmacies, labs, behavioral health, medical devices, patient-generated data, social determinants of health, and even retail data will be included in population health analytics. Beyond the next year, predictive analytics will play a major part in advancing population health management capabilities, says Thomas.

“More real-time data collected from more sources can result in greater insight into patient motivations and behaviors, which can be used to reach and treat patients in the most effective manner,” Thomas says. “By leveraging current and historical data to make predictions about the future, predictive analytics can help healthcare stakeholders understand which patients are at risk, how to prioritize them, anticipate what interventions are most likely to work on whom, and provide action steps for the care team.”