Triple Aim, Triple Aim, Triple Aim
We are beating that term to death. But whether we are tired of it or not, the core concepts of patient engagement, quality improvement, and population health are the new paradigm in healthcare. We have barely gotten our collective arms around EHR adoption and meaningful use requirements, let alone efficient and effective use of the enabling technologies. And now we collectively are being nudged down the path toward value with the finalization of the MACRA/Quality Payment Program regulation.
While MACRA presents a new environment for value-based care delivery and the business of healthcare, it is not new. As noted in a recent HIMSS Clinical & Business Intelligence (C&BI) blog, the recent push to implement value-based care models and population health management is compelling health systems to look at innovative ways to design interventions that takes into account the medical needs with the unmet social and economic needs of their population. And data is the foundation for improving decision-making in this new world of value-driven care and payment.
As an industry, we have already had some experience with federal value- and population-based payment programs, such as the End-Stage Renal Disease Program (ESRD) under CMS, which is now included in the alternative payment program section under MACRA. A speaker at one of our recent HIMSS C&BI Community events shared the novel approach of using various non-traditional sets of data, including weather data from NOAA, to build a predictive analytics program to determine when dialysis patients may miss their appointments. From this, they took steps to make alternative transportation or other arrangements to ensure those patients got the care they needed. This has resulted in a 29% reduction in 90-day hospitalization rates.
How ready are you for value-based population care?
HIMSS Analytics has built an Adoption Model for Analytics Maturity (AMAM) to help organizations become a data-ready provider. For example, Stage 5 organizations are enhancing quality of care and population health, and understanding the economics of care. HIMSS Analytics focused the AMAM on four (4) critical and foundational areas so that the model is adaptable and useful to serve as a roadmap and benchmark for all shapes, sizes, and geographies of healthcare organizations that we serve around the world.
These 4 areas are:
- Data content
- Analytics competency
- Data Governance
Crossing the chasm from a fee-for-service world to a value-based healthcare ecosystem will take a lot of hard work. There will be challenges along with the successes. HIMSS’s mission to transform health and healthcare through the best use of IT includes helping the industry march to new drum beat of value through population health management. We have many great tools, resources, and examples from the sector to help you on your path to the triple-aim.
- What areas in population health do you think need additional focus to deliver on the promise of the triple aim through population care management?
- On the business-side of delivering care, what are some of the challenges of moving from fee-for-service to fee-for-value models, and has population health helped to cross that chasm or produced additional challenges?