HIMSS News

Three keys to population health management and value-based healthcare

Legislation and regulations continue to hit the healthcare industry faster than it can keep up. Top of mind for many right now is the Centers for Medicare & Medicaid Services (CMS) mandate that 50 percent of payments be value-based by 2018, meaning healthcare providers will be compensated for healthy outcomes rather than the volume of services rendered.

According to new research from Xerox[1], healthcare decision makers are not ready for this switch:

  • 43 percent say value-based contracts currently make up less than 10 percent of their current portfolio. While recognizing that Fee-for-Service (FFS) will continue to be a predominant form of payment for a while longer, the amount of value-based contracts in a provider’s portfolio points to their level of participation in Medicare programs and commitment to outcome-based therapies.
  • 77 percent agree that some providers who take a value-based approach can actually lose money. While a learning curve is to be expected, we are beginning to see that investments needed for successful value-based arrangements are not yet at par, as organizations hedge their bets.

Population health management has been widely discussed as the solution to help healthcare organizations reach value-based care goals. There are three keys to a successful program: data analytics, technology adoption and the inclusion of the patient as a partner.

Definitions of population health management vary, but most of the industry agrees that real-time data and predictive analytics are important pieces. Real-time data enables clinical decision support which can help payers and providers address at-risk populations, and provide timelier interventions. Analytics help us find gaps in care and determine whether healthy outcomes were achieved.

It’s also important to look for partners that support people, processes and workflows. We often think of healthcare transformation in terms of technology implementation, but the reality is that people and processes are at least half the equation. If technology is improperly used, we can’t expect meaningful results. Providers and payers need to work with partners who can help them prioritize adoption, education and training so technology is used consistently and accurately.

Third, it’s critical we remember patients are our most valued partners. They too often don’t have a seat at the table with payers and providers. Xerox’s research found that an overwhelming 91 percent of all consumers want to be more proactive in their healthcare, so payers and providers should take advantage of this opportunity to engage with patients and achieve mutual health goals.

The transition to value-based care is a work-in-progress, but the industry is optimistic about achieving its goals. Payers and providers need to partner with all key stakeholders to make value-based care and population health management a reality.

About the author:  As vice president of healthcare strategy and portfolio at Xerox Healthcare Business Group, Rohan  designs and drives the identification and pursuit of strategic business opportunities within the healthcare market to drive profitable growth.

 


[1] Survey conducted online by Harris Poll on behalf of Xerox in May 2016 among 2,033 U.S. adults 18+.