By Emmet O’Gara, Group President, Population Health Management, HMS
Twitter: @HMSHealthcare
Population health management (PHM) isn’t a new concept for payers and providers. Thanks to the value-based care movement, healthcare experts have come to realize that treating the whole person is the key to improving health outcomes and reducing costs. As a result, greater attention has been given to providing holistic care across all phases of the patient journey.
Over the past year, the value of population health management has come into sharper focus, as the healthcare sector has grappled with the COVID-19 pandemic. Organizations with a comprehensive and current picture of each member’s or patient’s medical history, chronic conditions and social determinants of health discovered that they are strongly positioned to deliver the best care.
These plans and providers have leveraged predictive and prescriptive analytics to identify which people are at increased risk for severe COVID-19 complications. With this information, they have developed better treatment plans. In addition, organizations with strong PHM programs have engaged in timely data sharing. This is giving healthcare practitioners actionable intelligence to combat the pandemic.
Integration: The Difference Between Effective and Ineffective PHM Initiatives
To drive quality improvements, effective population health management programs rely on feedback loops that analyze current data. Integrated PHM initiatives are the best way to obtain that timely and actionable information about members and patients.
All too many organizations, however, attempt to manage population health using a patchwork of different applications that weren’t designed for interoperability. This leads to a variety of challenges that are detrimental to members and patients, as well as to organizational efficiency:
- An inability to manage populations at scale or at the member-level. Without a holistic view of populations at scale, it’s impossible to easily identify opportunities for improvement. In the absence of integrated systems, organizations also struggle to generate timely advanced risk intelligence about individual members who could benefit from early management and education. All of these elements are crucial for building a robust PHM strategy.
- More resources are required to generate useful information and outcomes. Organizations without integrated PHM systems report that it takes more administrative and IT time to manage populations. This is particularly challenging for plans and providers with limited care management resources. More time is spent identifying who could benefit from care interventions, rather than delivering those interventions at scale.
- The member and patient experience is disjointed. Without an integrated PHM solution, organizations find it difficult to offer a unified customer experience. For example, individuals may receive engagement messages that conflict with their care plans. In contrast, a holistic customer experience strategy based on an integrated system highlights opportunities for engagement and care interventions.
While data is an essential ingredient for population health management, the importance of integrated and interoperable systems can’t be overlooked. When organizations use a single, unified system for PHM, they prevent avoidable costs by identifying specific rising risk individuals, improve quality measures by proactively closing gaps in care, increase the ROI of marketing outreach campaigns through targeted interventions and enhance both individual outcomes and the overall health of their populations.
HMS’ integrated population health management solutions use a whole-person approach that considers all the factors that influence health – including physical, social, economic, behavioral and other key health determinants.
This article was originally published on the HMS blog and is republished here with permission.