Financial incentives, information technology advances and new care models have created fertile soil for population health management programs to grow.

But for these efforts to flourish healthcare organizations need more sophisticated analytics, patient stratification, community involvement and care management, according to a May 2016 report from PwC Health Research Institute.

“So far, most efforts have been narrow, with promising results. These early results signal the full potential of population health if scaled across geographies, diseases and the continuum of care,” PwC’s “Population Health: Scaling Up,” report noted.

“Yet many organizations still struggle to scale their efforts – an essential step as they take on more risk in value-based payment contracts.”

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Seventy percent of clinicians do not participate in risk-based, incentive-based or shared-savings reimbursement models, PwC said, even though adoption of these payment models is a major goal of the Centers for Medicare and Medicaid Services. Healthcare organizations with evidence that population health programs are working well on a large scale are more likely to be rewarded under these reimbursement models.

The PwC report suggested six steps healthcare organizations can take to advance population health programs to highly effective levels.

First, healthcare organizations should “pick a major,” PwC said. So, for instance, carrying on the university area of study example, an academic medical center might “minor” in population-based care at the community level and “major” in acute and chronic health population health.

Second, healthcare organizations need to “think retail,” the report continued. “Today’s consumers are expecting health providers to offer the personalized levels of service and convenience they receive from other industries,” PwC said. More than 80 percent of consumers are open to non-traditional ways of receiving care, PwC added, such as virtual visits, at-home diagnostic monitoring and home care visits.

Establishing a funding mechanism is a third step healthcare organizations must take to achieve success in population health management, PwC advised. “Organizations should design a payer strategy for population health to manage risk and sustain operations,” the report said. “Some providers are partnering with insurers to outsource activities such as risk score optimization, actuarial analysis and claims administration. Others are on their way to becoming licensed health plans, a growing trend in a value-based health economy.”

Healthcare organizations also should plan for early losses and contract accordingly, the PwC report suggested as a fourth step. “Organizations should evaluate their abilities to tolerate risk and assess their capital positions to support population health strategies,” the report said. “Organizations should structure partnership contracts so that risk is shared appropriately among all partners in their population health delivery networks.” 

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Fifth, healthcare organizations should be prepared to redirect pent-up demand. “Organizations with excess demand may have smoother transitions as they operate more efficiently,” PwC said. “They can replace lost volume, continue to operate at high capacity and improve their returns on fixed costs.”

Finally, to succeed in population health, providers must evaluate programs often and make adjustments promptly, the PwC report advised

“Population health programs require heavy operations investments and have high fixed costs,” the report said. “Organizations should build care services around patient cohorts and actively monitor health outcomes. They should regularly reevaluate whether patients assigned to each group still belong there.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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