As reimbursement increasingly shifts away from treating specific conditions and toward value-based care, considering a patient’s holistic health journey via population health management (PHM) is paramount. In recent months especially, with the pandemic forcing more and more people to rethink the normal delivery of care, health systems have been challenged to balance scaling access to care while reducing strain on facilities. For many healthcare systems, however, transitioning to value-based care is easier said than done. This is largely due to the fact that today’s healthcare business model is still mainly built within the brick-and-mortar blueprint and is not set up to easily deploy engagement outside of clinical environments – an essential cornerstone of achieving quality, continuous care.
When compared to payers, providers are particularly behind in their transition to value-based care – 87% of payer organizations offer alternative payer arrangements or full capitation, compared to only 50% of provider organizations. This disconnect tells us that while these risk-based contract options are growing, provider organizations may not have a clear idea of where to begin their journey.
Understandably, there are many unknowns that come with kick-starting a PHM program, making it seem complex and disruptive. Rather than approaching it as a complete overhaul of operations, organizations should take small, manageable steps toward this new care approach. For example, incorporating more telemedicine and virtual care initiatives into programs to manage Covid-19 patients may have been a starting point for many organizations. Successful navigation of value-based care will happen when health systems start making smart investments in PHM programs and moreover, examining healthcare through a different lens – one defined by enhanced visibility and collaborative care.
Unsure how to implement PHM as a foundational piece of a value-based care transition? Below are three pieces of guidance to find which PHM tactics work best to help ensure a clear destination is top of mind.
Jump in With a Targeted Approach, but Be Ready to Pivot
To avoid being overwhelmed by PHM, take a targeted approach with a clear quality metric improvement in mind. Identifying one niche patient population at a time will keep a PHM program focused and create a baseline where simple changes can be easily implemented and tweaked, or success can be built upon in a “snowball effect.”
Take reducing admissions among a diabetic population for example. One targeted way to approach this could be to create a centralized role at an organization in charge of conducting patient outreach to this population to help them manage their insulin levels. Organizations can also leverage community health data to appropriately deploy new resources and technology and flip one’s mindset from “come to me” to “I’ll come to you.” Similarly, for recently discharged Covid-19 patients, post-discharge education and access to important resources as well as in-home remote monitoring can be important factors in helping to keep them from being readmitted.
The reality is that some initiatives will not work as intended – and that is OK. Remain open to failure and expect to tailor a patient engagement strategy or shift target populations along the way. Any obstacles will only provide jumping off points to discovering what will actually work. Moving on from those mistakes at an early stage, rather than losing faith or trying to force a square peg into a round hole, will ultimately provide value for future PHM initiatives as well as lessons learned for the future.
Approach PHM from a Financial Perspective to the C-SuiteWhile C-suite leaders largely understand the importance of moving toward value-based care, they can still be weary of anything outside of traditional fee-for-service, where the financial gains are cut-and-dry. Therefore, approaching a program from a financial perspective – outlining proposed initiatives that will reduce cost – and proving the potential return on investment (ROI) will be critical in order to avoid skepticism from the C-suite and explain value to stakeholders.
The fee-for-service method has trained C-suites to value quantifiable, short-term return, such as admissions, ED visits, and full hospital beds. PHM advocates need to demonstrate how redefining care management by adopting a holistic viewpoint to include what’s happening outside the hospital will help systems influence health at scale and improve care at a lower cost. For example, by better managing the patient outside of the hospital and ensuring the right care in the right setting, one can prevent unnecessary, costly admissions.
At the height of the Covid-19 pandemic, decreasing unnecessary ED visits was critical for both patient safety and hospital capacity. Remote Patient Monitoring (RPM) programs can help target and manage older adults with underlying medical conditions like heart or lung disease who are at higher risk for illness related to Covid-19. By leveraging protocols that monitor patient populations remotely regarding potential COVID-19 exposure and symptoms – alongside protocols that track their existing underlying conditions, care teams are able to intervene timely and appropriately as a patient’s condition changes. Leveraging the use of mobile devices and tablets to monitor symptoms via connected devices, patients and their care providers can help manage their underlying diseases at home, and in turn, potentially reduce avoidable hospital admissions. Showcasing these long-term cost-saving opportunities to the C-suite will be helpful in implementing and expanding a PHM program.
Form Strategic and Unlikely Partnerships
PHM is not a solo-journey – it takes a team. Expanding influence on certain patient populations means forming unlikely partnerships, even with entities that might have been viewed as competitors in the past, such as home health agencies, pharmacies, or urgent care centers. For example, payers are increasingly collaborating with vendors and other proven experts in the space to help identify vulnerable populations and deliver meaningful insights into patient conditions. As payers realize the value of PHM and the impact remote patient monitoring or access to fitness and nutrition – such as fresh produce or walking trails – has on health outcomes, they will spearhead PHM efforts more. Partnering with these forward-thinking payers will ultimately help an organization and the industry at large realize at-scale financial return.
Collaboration could also mean leveraging relationships within a health system’s community to kick-start a PHM program without investing many resources. Thinking strategically about the needs of the community, an organization could partner with a local food pantry to offer healthy alternatives, or a transportation center for disabled patients or seniors who may have trouble traveling to doctor’s appointments.
It Takes Risk to Achieve Risk-Based Contracts
Today’s consumerization of healthcare – and rise of virtual care due to Covid-19 – means there are endless avenues to engage patients in their own health and help them build healthy habits, making it an opportune time for successful PHM. Take time now to define PHM on individual terms and experiment with different initiatives and patient populations that will ultimately ease the transition when the time comes for an organization to shift to a value-based care contract. As we move away from transactional care to collaborative, longitudinal care, applying these tips will help activate members on a care journey defined by prevention, patient engagement and intervention.
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