What are the key population health management capabilities?

Like a Rubik’s Cube, the functionality and performance metrics for population health management can be difficult to define, align, and deploy.  The Institute for Healthcare Improvement Triple Aim for healthcare proposes three linked goals for population health management — improving the individual experience of care, reducing per capita cost of care, and improving the health of populations. But what are the key population health management capabilities required to achieve the Triple Aim?  Since the Accountable Care Act legislation and payment models are still evolving, so too have the requirements to perform population health management.  The health care industry has a number of population health management models.   They are often defined by the current capabilities of providers, payors, and vendors, rather than what is needed.  Additionally, the models do not easily translate to the required business models required by the various value based payment arrangements and their combinations.  Further complicating matters is the overlapping responsibility for the overall health improvement of individual patients and populations by both the public and private sector, including payers, providers, and community organizations. 

The HIMSS Clinical & Business Intelligence (CB&I) Committee creates practical and unbiased tools and resources to help healthcare organizations use clinical and business intelligence to execute population health management initiatives.  In 2017, the CB&I Committee’s Population Health Task Force will create a HIMSS population health management model that identifies the various population health domains and their capabilities and map these to the payment schemes.  The payment schemes will include the current payment models from CMS, commercial payers, employer-based, and provider owned health plans.  The model would be the fifth dimension to the HIMSS Healthcare Value Suite.

Once finalized, the HIMSS population health management model will contain a set of resources with content relative to each population health management domain available on the HIMSS website.  Like a Rubik’s Cube, it will be able to define the population health capabilities required if deploying a specific payment scheme or combination.  These population health management model resources will include domain summaries; sharing of “best practices” via blogs and white papers, ROI templates and examples, sample RFP language, and Lunch n’ Learn sessions, (short 20 minute recorded webinars).  The model will help to develop education resources and pathways for career development.  It could also be used in the future as a means of highlighting and mapping the vendors at the annual HIMSS meeting that offer those population health management capabilities.  HIMSS will also share and collaborate with affiliates and the industry at large to further refine the population health management model as the requirements of the Accountable Care Act evolve. 

If you are interested in learning more or participating in the development of the HIMSS population health model, you can sign up here.  

About the author: Michelle is the Co-Chair for the HIMSS CB&I Community’s Population Health Task Force and the Senior Population Health Market Executive for Caradigm in the United States and Canada.