HIMSS Population Health Management and Capabilities Model

As ubiquitous as population health is across the industry, variation and uncertainty persists.  Industry literature is filled with numerous population health management models from academia, government, and vendors.  Population health management programs are as varied as the populations they serve.  There is little agreement on definitions or alignment with specific payment arrangements and populations.  Stakeholders groups engaging in population health management are seeking answers as they develop their population health strategies:

  • Providers: “What capabilities do I need to develop/acquire as I’m engaging in value-based contracts?”
  • Vendors: “What capabilities are important for stakeholders engaged in value-based contracting so I can prioritize feature development?”
  • Payers: “How can I assess the readiness of providers in my network to engage in value-based contracting?”
  • Government: “What policies do I need to develop to facilitate adoption of value-based reimbursement?”
  • Trade organizations: “What tools/programs do we need to develop to support our members?”

To help bring clarity to your population health efforts, the HIMSS Clinical & Business Intelligence Committee’s Population Health Task Force has created a population health management model that identifies population health domains and capabilities, and maps nearly 500 functions to Value-Based Care (VBC) payment models. The model

  • defines the pillars of population health management,
  • identifies core functionality associated with each pillar, and
  • distinguishes between essential and non-essential population health management capabilities for the various Value-Based Care payment models.

Like a Rubik’s cube, the capabilities and payment model grid is manipulatable, and can sort and filter across the domains, functions, and payment models to help you define the population health capabilities required when deploying a specific payment model.

The HIMSS Population Health Model is on the second tab of the attached document. It includes three pillars supported by foundational elements.

  • The three pillars of population health management are: Know Your Population, Optimize Health Status, and Protect From Harm.
  • The VBC foundation elements are: People & Culture, Business Functions, and Actionable Analytics & Technology.

On the third tab, the model is organized into ten (10) domains, each includes numerous functions. Some functions span multiple domains, which highlights the concept that population health is a continuum of interdependent activities and a complex system of people, processes, and technologies that together contribute to achieving the quadruple aim of better care at lower cost while increasing patient and provider satisfaction.

The nearly 400 features across the ten domains are crosswalked to payment models. Some are required by specific payment models programs. Others, while not required, are considered best practices for the success of the program. These requirements have been numerically codified as:

  • 1 for "hard requirement,"
  • 2 for "best practice," and
  • 3 for "not applicable."

Like a Rubik’s cube, the capabilities and payment model grid is manipulatable to sort and filter across the domains, functions, and payment models to help you define the population health capabilities required when deploying a specific payment model.

We are seeking input and comments from the public for this draft version of the HIMSS Population Health Management and Capabilities Model. Like a Rubik’s Cube, this tool will help you define the population health capabilities required when deploying a specific payment model.

Once finalized, the HIMSS population health management model and corresponding capabilities grid will be used to construct an industry collaborative resource with tools and resources relative to each population health management domain available on the HIMSS website. These population health management model resources will include items such as

  • domain summaries and guidance;
  • blogs, articles, and white papers sharing "best practices;"
  • ROI templates and examples; sample RFP language; and virtual Lunch n’ Learns (short 20 minute recorded webinars).

The model can also inform the development of education resources and pathways for population health management career development.

HIMSS will share and collaborate with industry partners to further refine this population health management model as the requirements of the value-based payment models evolve.


Instructions

Please download and insert your comments and edits in the column for the edits on the third tab of this document. E-mail your suggestions to HIMSS Staff.

For more information

If you are interested in learning more or participating in the development of the HIMSS Population Health Management and Capabilties Model, please contact HIMSS staff by clicking here.

Thank you to the many knowledgeable, dedicated members of the C&BI Population Health Task Force.

 

Contributors

This project is a product of the HIMSS C&BI for Population Health Task Force of the HIMSS Clinical & Business Intelligence Committee.

 

C&BI for Population Health Task Force Task Force Co-Chairs

Marius Petruc, MD, MS
Co-Chair, Population Health Task Force
CMIO
Informatics Solutions

Michelle Vislosky, MBA, FACHE
Co-Chair, Population Health Task Force
Director of Health System Partnerships
Syapse

 

Domain Capabilities Work Group

Marius Petruc, MD, MS
Co-Chair, Population Health Task Force
CMIO
Informatics Solutions

Michelle Vislosky, MBA, FACHE
Co-Chair, Population Health Task Force
Director of Health System Partnerships
Syapse

Phil Cartagena, MBA, PMP, CPHIMS
Sr. Project Director
Partners Healthcare

Ty Faulkner
Professor
Lawrence Technology University

Rupa Ghosh
Sr. Project Manager Business Analyst
Independent IT Consultant

Bill Hoberecht
Sr. Director, Clinical Programs & Operations
Pinnacle Medical Holdings

Robert Kagarise, MBA
Director of Population Health Informatics
Delaware Valley ACO

Mitchell Kwiatkowski
Sr. Director, Informatics
Gateway Health Plan

Simon Lin, MD, MBA
Chief Research Information Officer
Nationwide Childrens Hospital

Antonio Linares, MD
RVP and Medical Director
Anthem

Angel Macaluso, BSN
Clinical Data Analyst
Community Healthcare System

Claudia Miller
Sr. Senior Manager
The Chartis Group

Amy Minnich, RN, MHSA
Senior Clinical Informaticist
Geisinger Health System

Balaji Rao Pinjala, MS, MBA, PMP
Member, Population Health Task Force

Kevin Rapp
Founding Partner
Stratascend

Lee Remen
Sr. VP, Sales & Marketing
Tapcloud

Rich Ross
Chief Operations Officer
CancerLinQ

Ramesh Sakiri
Advisory, Data and Analytics
KPMG

Bharat Sutariya, FACEP, MD
VP & Chief Medical Officer
Cerner

Joan Topper
Vice President, Clinical Informatics
Geisinger Health System

Portia Towns, MHA, LPN, PCMH CCE
Strategist, Clinical Informatics
Northwell Health

Arvind Vasan
Device Outcomes Consultant
University of Washington

Gay Wehrli
Associate Chief Medical Information Officer
University of Virginia Health System

Deborah Wells, MS, CPHIMS
Sm. Clinical Informaticist
Childrens Hospital of Philadelphia

Andrew Weniger, RN
Managing Partner
Firstview, LLC

Katie Wilkinson
Director, Information Management & Population Health
Tiger Institute for Health

Kalyani Yerra, MBA, MHA, PMP, CPHIMS
Senior Software Architect
Premier, Inc.

 

Payment Models Work Group

Michelle Vislosky, MBA, FACHE
Co-Chair, Population Health Task Force
Director of Health System Partnerships
Syapse

Marius Petruc, MD, MS
Co-Chair, Population Health Task Force
CMIO
Informatics Solutions

Rupa Ghosh
Sr. Project Manager Business Analyst
Independent IT Consultant

Sharon Harrell, BSN, RN
Population Health Coordinator
Care Delivery Alliance, Central Florida Health

Bill Hoberecht
Sr. Director, Clinical Programs & Operations
Pinnacle Medical Holdings

Robert Kagarise, MBA
Director of Population Health Informatics
Delaware Valley ACO

Linda Kincaid
Project Director
Discern Health

Claudia Miller
Sr. Senior Manager
The Chartis Group

Portia Towns, MHA, LPN, PCMH CCE
Strategist, Clinical Informatics
Northwell Health

Arvind Vasan
Device Outcomes Consultant
University of Washington

John Weis, MS
Director Data & Analytics
KPMG

Andrew Weniger, RN
Managing Partner
Firstview, LLC

 

HIMSS Staff

Shelley Price, MS, FHIMSS
Director, Payer and Life Sciences
HIMSS North America

Joanne Bartley, CAE
Manager, Health Business Solutions
HIMSS North America

 

Let us know what you think. Please send your comments and feedback to Shelley Price, Director, HIMSS at sprice@himss.org.

Keywords: 
Population Health, model, IT Capabilties, Data, analytics, engagement, payment models, health plans, Clinical & Business Intelligence, HIMSS