Build & Deploy a Rightsized Population Health Management Program

Each value-based care payment model brings with it a unique set of population health management capability requirements and suggested best practices.  Organizations looking to operate effectively in this payment environment must be able to systematically analyze and act upon the particular requirements and best practices called for in the value-based care payment models in which they choose to participate.  This Value Guide, developed in collaboration with the HIMSS Clinical & Business Intelligence Committee’s Population Health Task Force, is designed to

 

  • Define the pillars of population health management
  • Identify core functionality associated with each pillar, and
  • Distinguish between essential and non-essential population health management capabilities for the various value-based care payment models.

 

This guide supports healthcare stakeholders making decisions on their organization’s population health management strategies.

 

Understand the Organizational Foundations Needed for Value-Based Care

Successfully delivering and accounting for effective value-based care requires a strong organizational foundation.  As healthcare organizations transform their business practices to respond to value-based rather than fee-for-service reimbursement models, they must ensure that a strong organizational culture is present, that your business functions have been designed to account for value-based care delivery, and that you have the technology in place to provide actionable analytics on the health of a given patient population. 

 

  • People & Culture: Is your organizational culture collaborative or competitive?  Does your culture encourage data interoperability or data siloing?  
  • Business Functions: Are your back office functions aligned for a population health under a value-based care model?   
  • Actionable Analytics & Technology: Are you able to effectively track quality outcomes and take action regarding a patient population based on your analysis of the data?

 

Resources

HIMSS Population Health Management and Capabilities Model: This model identifies population health domains and capabilities, and maps these components to Value-Based Care (VBC) payment models.  The payment programs examined in the model include those from the Centers for Medicare and Medicaid Services (CMS), commercial payers, employer-based plans, and provider-owned health plans.  
 

Apply Population Health Management Capability Pillars to Right-size Your Program

With the foundation of people, processes, and technology, effective population health management programs are built around three overarching pillars:

 

  • Know your Population
  • Optimize Health Status
  • Protect from Harm

 

Knowing your population means understanding both the personal and social determinants of health impacting the health state of the patient populations for which you provide care.  Optimize Health Status means that effective population health management seeks to optimize health status proactively rather than responding to changes in health status reactively. Protect from Harm means that the triple aims of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare can be driven by the ability to protect patient populations from the drivers of sub-optimal health status. The HIMSS Population Management and Capabilities model can you help customize the capability checklists you need to right-size your program so that you achieve the tenets of the pillars.  Below are some examples of how the model can support various stakeholders: 

 

For health system executives:

  • New to or building a population health management program for my health system who want an overview of all the components (aka ‘domains’) of a program so that I can align it to my organization’s strategic plans and resources
  • Who wants a shopping list of the population health management functions they need to address their unique program given my payment models and populations so that they can create an efficient and effective program
  • Who wants to know what process changes do they need to make to support care coordination

 

For health system IT-related executives: 

  • Who wants to look at the Security capabilities needed for population health management so I can assess my gaps
  • Who wants to look at the list of technology requirements for creating internal roadmaps based on the domains

 

 

Resources

Population Health – Making It Work: Many physician practices are implementing a population health strategy. The Marshfield Clinic Health System has been on this journey for more than ten years. Through many trials and tribulations, the Health System has identified processes and initiatives that have contributed to success in population health management and the pursuit of success in value-based care.  Learn how this health system has approached implementing system-wide initiatives and engaging physician care teams by using their data to provide insights. The use of informatics continues to evolve and learnings are shared that demonstrate how to make population health work in a practical manner.
 

Distinguish Essential and Non-Essential Population Health Management Capabilities for Various Value-Based Care Payment Models

There are many different value-based care payment models currently available for provider organizations to participate in, including the following:

 

 

Selecting the right value-based care payment model for your organization’s goals and practice requires an understanding of the essential and non-essential population health management capabilities for each of the different reimbursement models.  Here are the population health management capabilities an effective population health management program must exhibit in order to properly account for value-based care according to the myriad of payment models available to participate in:

 

Public Health Management Capabilities/Functions    

  • Activation & Engagement      
  • Care Coordination      
  • Care Management Infrastructure      
  • Clinical Optimization      
  • Compliance      
  • Contract & Risk Management      
  • Culture      
  • Cybersecurity, Security, & Privacy     
  • Financial & Operational    
  • Health Literacy     
  • Health Plan Administration      
  • Human Resources     
  • Human Resources Management     
  • Identity & Access Management     
  • Information Technology      
  • Knowledge Management     
  • Patient Safety      
  • Value-Based Care Transformation     

 

An effective population health management program manages those capabilities across the following domains:

 

Cross-Functional Domains

  • Activation & Engagement 
  • Care Coordination & Delivery 
  • Clinical & Business Intelligence
  • Contract & Risk Management 
  • Culture & People 
  • Cybersecurity, Security, & Privacy 
  • Financial & Operational Management 
  • Health Plan Administration 
  • Patient Experience
  • Patient Safety

 

 

Resources

What are the Key Population Health Management Capabilities?: This blog post from by Michelle Vislosky, M.B.A., FACHE, Senior Population Health Market Executive, Caradigm; Co-Chair, HIMSS Population Health Task Force provides an overview of the need to understand key population health management capabilities.  Read part two of this blog series here.

Define your Organization’s Capabilities Gaps Regarding the Payment Models you Participate In

Depending on your organization's mission and business model, your population health management strategies may have you participating in multiple value-based care payment programs.  In order to understand operational gaps in required population health management capabilities, you have to be able to crosswalk the variety of essential and non-essential capabilities associated with a given value-based care payment model.

In order to meet the organizational capabilities required from across the value-based care payment models your organization participates in, your organization needs to:

 

  • Discover essential population health management organizational capabilities gaps in each of the value-based care payment models you are participating in through checking against the HIMSS’ Population Health Management Capability Model
  • Analyze alignment between essential and non-essential capabilities requirements across all of the value-based care payment models in which you are participating
  • Synthesis your current practices vs. capability gaps discovered
  • Define actions plans to address discovered population health management organizational capabilities gaps  

 

Resources

HIMSS’ Population Health Management & Capabilities Grid: 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 5 functions to Value-Based Care (VBC) payment models to help bring clarity to your population health efforts. Like a Rubik’s cube, the capabilities and payment model grid is adaptable, 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.