Healthcare execs weigh in on population health and value-based care

Oct. 28, 2015 / By Kristine Daynes

There is no common definition for population health. But if you ask enough healthcare executives, you’ll get a clear sense of what it means in terms of how it challenges them. That’s what I discovered at the Value-Based Care Conference hosted by 3M in New York City.

In a conference survey, I asked 42 leaders from health plans, government agencies, health systems, quality review organizations and consulting firms what they thought about population health. Their responses are a good gauge for where these organizations will be investing their efforts in the coming months.

For this payment-oriented audience, population health means the management of clinical and financial risk of an attributed group or population. Over half the respondents (55%) chose this definition over ones that emphasized a common geography (26%), disease or care management (12%), or consumer engagement (5%).

The challenges they cite, however, have less to do with risk and more to do with care management. The top ranked challenges are:

1. No infrastructure for care management to track patients through the continuum of care
2. Lack of PHM expertise and staff (e.g., for consumer engagement)
3. Inadequate healthcare IT infrastructure

In order to meet these challenges, healthcare leaders naturally need data analytics and reporting. Well, that’s the assumption on the part of 3M—we are in the business of healthcare analytics, after all. So I asked what else was needed besides data analytics and reporting to implement value-based care. The most crucial tools are those for data interoperability (58% agreed), care management (47%), workflow interoperability (42%) and consumer engagement (37%).

I gave respondents a short list of data measures and asked which types would help them most to implement, manage and sustain value-based care. Everyone settled on just three types of measures: physician performance on quality and total cost of care (46%), total cost of care trend for an attributed population (27%) and total cost of care associated with high-risk and high-cost populations (27%). Clearly cost is a very important metric to the value-based care crowd. And so is helping physicians and hospitals succeed with new payment models.

During the conference, Stephen Rosenthal, Senior Vice President at Montefiore Health System, told a story that puts the challenges of population health management into perspective. He described Crystal, a woman with poorly managed diabetes who found herself homeless and in a wheelchair at the age of 39. She was assigned to the Montefiore Pioneer ACO population, where a team now manages her care.

In addition to medical care, the Montefiore team advocates for housing, transportation, home health and other services that will help her become a viable member of the community again. It is an effective approach for Crystal. But Mr. Rosenthal noted the complexity it introduces for the provider organizations that are involved.

“Crystal is a Medicare ACO patient who is in a Medicaid long-term care plan and also happens to be health home eligible,” Mr. Rosenthal said. “Do you have three teams managing that patient? Or do you have one team managing the patient, and you work on developing systems that allow you to manage those other silo programs?” For that matter, do you monitor cost and quality for each program separately? Or do you track one program and hope there is enough overlap in objectives for one to serve as a proxy for the others? Ultimately, how do you determine the cost and value of Crystal’s care and attribute it to a primary care physician or patient manager or care team?

Mr. Rosenthal pointed out that providers can’t be expected to understand the mechanics of so many program benefits. Here is the real challenge of population health management. Providers need for payers and policymakers to simplify—not add to—the complexities of multiple benefits, payment systems and performance metrics.

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.

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