From Canadian Healthcare Technology, July 2014
By Scott Herrmann, Director of Mobile Solutions
From my research and understanding, Population Health Management can be defined as broadly as a method of lowering the cost of care though early intervention, utilizing programs focused on the individual’s responsibility to make the right choices in managing their own health, and health monitoring and analyzing of health data analytics. Population Health Management applies a patient-centric method to improving overall health outcomes at a lower cost, without impacting the quality of healthcare by addressing health issues before they become higher-cost critical care situations.
Population Health Management aligns with Triple Aim of the Affordable Care Act (used by ACO’s) in the United States. The Triple Aim states these three items:
- Improve the health of patient populations
- Improve patients’ experience of healthcare
- Reduce per capita costs of healthcare
To make these three points a reality, this formula needs to be applied: in the first year the cost of care needs to be reduced, in succeeding years per capita costs need to be reduced, all the while improving the experience of the patient and improving the health of the population being managed.
So, can this be achieved?
Absolutely; we begin with data collection on both the healthy and the unwell, and chronicle the data from the claims based systems of hospitals and doctors that are already in place today. These elements of little data are sent and aggregated as “Big Data.” From the analysis and measurement of this information, personalized programs or services for patients can be determined.
While some provider groups across the USA have been managing risk for years as part of capitation programs, most providers do not have the technology or infrastructure, or the processes within their organizations to maximize the financial benefit of managing risk through proactive population management. A key component of providers’ financial upside in taking on risk will be their ability to implement effective population health management programs in order to manage their highest cost patients.
Population Health Management can be broken down to three areas where we can begin to collect health information for the population we need to mange. Those areas include: technology, new processes and organization changes.
Technology: software companies and system integrators are staking their claim in this new and rapidly growing market, Procura being one of them. Many providers are looking for varying capabilities to deliver care at less cost, but there is no interoperability between systems. The lack of interoperability means information cannot be shared for overall population health management. Companies are building analytic tools and dashboards to collect clinical data from EMRs in order to create information that providers could use to manage their patient population. But they are costly and still look at claims based data in many cases.
New Processes: Providers must develop new practices around who should be actively managed, what they will do with these patients, and how they will do it. Health plans have traditionally attempted to enroll segments of their members into specific programs tailored to help manage certain health conditions. Providers have an opportunity to be more successful due to their relationships with their patients and the potential to manage the patient as a whole person instead of trying to address only a single health condition.
Organization Changes: While some processes are easy to conceptualize, the biggest unknown related to provider based population health management is ‘who is going to do it’. I have seen firsthand, nurses and case managers in organizations interacting regularly with clients by phone. For example, this is happening today for home care in Ontario. This concept can be used by nurses in the physicians’ office that are asked to schedule health coaching appointments with patients or analyze results from remote monitoring devices, or smart phones or tablets with applications, to determine when interventions may be needed. What is needed is the ability to sort capabilities or ways to analyze their inputs of data that do not exist today, which is often where a solution like Procura steps in.
We are in the earliest stages of data inputs for better care. Providers looking for opportunities in their population health efforts will likely go through several evolutions before any best practices, processes and technologies are established. I see opportunities for better health technology platforms arising from this data input requirement, to collect and analyze a client’s health data and prevent them from becoming acute or critical. These initial roots may begin from our own personal applications on our personal devices but eventually together with our providers of technology, and you the providers of care, will be able to design, implement and deliver the systems required to manage their programs for Population Health Management.