Population health management can mean many different things for many different types of organizations. For instance, let’s say you’re a population health program manager looking to address care coordination and your physician and clinician engagement strategies. Maybe you’re participating in a commercial accountable care organization with two-sided risk, as well as in a patient-centered medical home program. You may be wondering what capabilities you need to develop to meet those programs’ requirements to obtain both reimbursement and outcome improvement. To help you make smart planning decisions and determinations about where to focus resources, you also need to first identify which are the core functions required for your program, and which are ‘nice to haves’ that can be developed later pending additional resources or imperatives.
While data and analytics are critical to population health management, there’s a whole foundation beneath which to consider while designing your population health strategy. Shelley Price, director, payer and life sciences, HIMSS, aims to bring more clarity to the topic of population health. “What we were hearing from members and HIMSS conferences and events attendees was that ‘population health’ as a term has become almost ubiquitous, but yet means different things to different people.”
With this in mind, Price worked with the Population Health Task Force of the HIMSS Clinical & Business Intelligence (C&BI) committee to create tools and resources that would help organizations understand and develop their data and analytics’ capabilities, including a population health management and capability model.
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Price acknowledged the unique challenges individual organizations face when it comes to addressing population health. “Our members and the industry were struggling to figure out what they really need to both meet the needs of their populations and their organizational strategic goals,” she explained.
No specific tool is right for managing every population, she noted, but the goal in creating resources like the HIMSS Population Health Management and Capabilities Model is to cut through the noise and help figure out what needs your organization should keep in mind when shopping for solutions. It can also be an effective tool for providers and payers to get on the same page when contracting for value-based programs.
Price worked with the population health taskforce to identify more than 500 capabilities for the model, spanning across 24 different categories under a framework that helps organizations understand their population health needs. Rather than a one-size-fits-all solution, the model incorporates inquiries from various perspectives:
- 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?”
No matter what role you’re in, organizations should be thinking of strategy first before selecting new population health tools. “Organizations need to determine what they need to do to address their population needs under the various payment programs, such as bundled payments, patient-centered medical homes, accountable care organizations, and numerous advanced payment programs. All those payment programs have very specific requirements,” Price explained. “Organizations often have limited resources – including skilled personnel – so they have to make very deliberate choices around how they build their population health management programs to meet the health needs of their patients and align with their organizational strategies.”
“Additionally, you have to make sure there’s privacy and safety protocols and systems in place to protect the organization from cybersecurity breaches,” Price continued. “And of course an organization must consider its organizational culture, staff resources and skills, how you build networks for care coordinators, practitioners, home health, post-acute care facilities, primary care, specialists; the list goes on.”
Price stressed that it’s more than just data and analytics that are critical to population health management. “Certainly there’s a foundation that enables us to turn that data into information into action,” she said. “That’s the core concept of population health management and I’m so proud of HIMSS’s population task force’s hard work to bring this capabilities model to life over the past year.”
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