Successful management of population health depends on efficiency

The key to effectiveness in value-based models of care is a strategic approach to risk stratification.

It’s almost unanimous: 98% of health executives believe that managing the health of the population is important to the future success of their organization, according to the results of a poll released in August. In total, 93% of respondents rated it between moderately and extremely important.

These models of population health care are often linked to some type of payment for value-based care (VBC), which rewards positive health outcomes and control costs. When asked about the ACV, the same executives interviewed expressed concern about the possibility of financial losses when patient outcomes are tied to such payments. Only 31% of respondents said they were at least very prepared to accept the financial risk for managing patient populations.

Much of the concern about population health management may arise from the large number of patients assigned to a responsible care program or some other type of population health management program. ACOs and healthcare systems can suffer significant financial losses in risky ACO payment models when this care is not delivered strategically and efficiently. Certainly every patient deserves the highest quality care, but only a small segment requires the awareness and management of resource-intensive care that can increase the costs and reduce the financial performance of ACV.

Strategic risk stratification

Risk stratification is the key to an effective population health management program. CAOs and healthcare systems understand that their patients most at risk are often the most expensive and the most difficult to manage. This is also true at the national level. A RAND study published in 2017 found that although only 12% of American adults suffer from five or more chronic conditions, they account for 41% of health spending. Likewise, according to data from the Partnership to Fight Chronic Disease, the average annual cost of health care for an American without chronic disease is $ 6,000. For people with five or more chronic conditions, the annual cost per person climbs to $ 45,000.

Multiple chronic diseases do not only affect the frail and elderly population. The RAND study found that although patients aged 65 and older are the most likely to have multiple chronic conditions, about half of patients in their 40s and 60s also fall into this category.

Identifying and allocating care management resources to patients at risk and highest need is a well-established best practice for CCOs and health systems. The key to effectiveness and success in VBC models, however, is a more strategic approach to risk stratification. The strategy is to target non-elderly patients identified in the RAND study between the fifth and the 20th percentile of risk. These “patients at increasing risk” probably have health problems, such as diabetes or high blood pressure, but overall they are in good health. However, if not monitored, one in five patients at increasing risk will move into the high risk category each year. With endemic nursing shortages, an automated, less-contact approach to patients at increasing risk alleviates the burden on care managers while helping to increase adherence to care plans for more patients. In this way, proactive intervention can only be undertaken against patients who need it, avoiding costly emergency department visits and hospitalizations.

Data-driven automated processes

As the manufacturing industry learned decades ago, efficiency comes down to removing unnecessary steps and automating processes where possible. Although patients are not cars or refrigerators, healthcare organizations that want to be successful in population health management and value-based care can still learn from these business principles.

In population health, for example, data management represents a major opportunity to automate processes based on the identification and highlighting of patterns within this data. Collecting, analyzing, and sharing data between disparate sources, including multiple electronic health record systems, claims, public disease registries and elsewhere, can be time consuming and unproductive. In addition, the care managers using this data are often nurse clinicians who are receiving increasingly higher salaries due to the major labor shortage in the industry. Every minute spent on repetitive processes that can be avoided with automation is a minute they aren’t managing patients. Wasting this time is costly to the healthcare system and does not allow optimal patient outcomes to scale.

Fortunately, having started almost from scratch at the dawn of the internet age, the healthcare industry has made strides in eliminating data silos and manual effort historically associated with managing healthcare data. Building on this progress, effective management of population health today requires the right tools in terms of back-end infrastructure (databases and analysis platforms) and “last mile” solutions, such as remote patient monitoring and applications for patient engagement, clinical coordination and Hierarchy Condition Category Coding (HCC).

By using data and engagement capabilities (including SMS, email, and automated phone calls) to monitor and collect information from these patients at increasing risk, providers can assess whether a chronic disease is progressing in the future. the wrong direction and intervene before the patient becomes elevated. risk and high cost. It is an effective and efficient management of the health of the population in action.

Health is a precious resource

When dedicated physicians, nurses and other clinicians waste time and effort, healthcare organizations also waste opportunities to provide high-quality patient care and to improve the financial performance of their populations more broadly. of patients at risk. Since there is a limited supply of health care with ever increasing demand, ACOs and health systems need to adopt automated and effective population health management strategies to help them extend their reach well. beyond their most at-risk patients.

Implementing technology to handle tedious data management tasks enables care managers and other clinicians to exercise their licenses to the max and productively deliver cost-effective preventive care that enhances the experience of the patient and give optimal results.

Patrick burton is Vice President of Business Development at Lightbeam Health Solutions.

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