Population health management (PHM) is arguably one of the hottest topics in healthcare today—it even took center stage at the HIMSS15 conference. Still, even though PHM is what organizations are talking about, few are actually defining the term and acting on it.
One reason: Defining PHM precisely and consistently is a challenge unto itself. The payers segment is a major player in influencing the PHM definition. Payers define the quality measures that healthcare providers must achieve—and report—in order to receive incentives. However, each payer defines its own quality measures, creating a lack of agreement about exactly what constitutes “quality,” which makes reporting, and using that reporting to achieve PHM, difficult.
American Health Network (AHN) uses the power of analytics to give our physicians visibility into every measure that applies to the patients they see. Broadly speaking, analytics is the primary technology tool that drives our PHM and Accountable Care Organization (ACO) programs. We launched our CMS ACO in 2012. Today, it includes 70 locations across AHN of Indiana, LLC and AHN of Ohio, PC that work with 250 physicians, 130 mid-levels, and approximately 30,000 patients. Our three-pronged PHM strategy may provide some helpful insight for others as they work toward defining and achieving PHM:
- Determine the lowest common denominator for all quality measures. Our Best Practices Committee compares every payer measure and determines the lowest common denominator. For example, if one payer requires blood pressure to be 140/90 or less while another mandates below 140/90, we standardize the metric that’s the lower of the two. This allows us to give our physicians a single measure to work against that satisfies all payers. To inform care plans in the ACO, we leverage NextGen® technology to show our physicians a dashboard-like view of payer measures in the form of red, yellow, or green lights to help them meet and track these measures at the point of care.
- Build a team of case managers. Our case managers are embedded in practice locations to allow face-to-face contact with patients and collaboration with providers. By using CMS claims data, we can identify our highest risk patients. Robust analytics and risk stratification allow us to find patients who are falling short on any given payer’s metrics. From there, our case managers can prioritize reaching out to these patients and ensuring their needs are met, as well as metrics from payers.
- Create a centralized contact center to conduct significant outreach. Tools, including direct mail and calls to bring in patients, help AHN better manage at-risk patients from unexpected care episodes. Again, analytics allow us to develop reports on higher-risk patients who are not coming in regularly, while physician templates optimize care for those patients who are seen.
Healthcare organizations can make significant progress toward PHM today by harmonizing diverse payer measures and leveraging analytics to help meet them. Until payers reach consensus and establish standardized quality measures, finding the lowest common denominator may be the best approach to achieve success in value-based care.