Population Health or Bust!

There is a new kid in town and his name is population health. While accountable care organizations (ACOs) are the risk-sharing, value-based reimbursement model that people are talking about, it will be population health management which helps fuel the innovative care models of the future and allow organizations to be successful as reimbursement evolves.

However, there is still a lot of confusion as to what this term means and what tools can help organizations succeed in this space. Additionally, the marketplace for population health tools is like EHRs circa 1998—lots of activity and optimism, but no one really fully knows what we are doing yet, since we are just starting to roll them out. Let me share some basic thoughts to give you a foundation upon which you can start analyzing what is going on and what you should be thinking about moving forward.

First, population health management means that you (1) define a specific population and (2) manage that population in the most efficient, cost-effective and highest quality manner possible.  In other words, instead of treating everyone the same, you provide the right care to the right people in the right time and in the right format. This helps to ensure that we focus our limited resources on the people who need them most, while using innovative strategies and technologies to leverage care for others.

Second, be on the lookout for some key functionalities when choosing your population management tools. These include risk stratification, impactability analysis, care gap identification, outreach capabilities, care coordination dashboard, patient engagement systems and analytics reporting.

Third, population health tools are everywhere right now, including offerings from your EHR vendor, your insurance companies and various third parties. Factors to help guide your decision will include not just the strength of their offering, but their ability to integrate into your workflow, their ability to work with multiple data sources, and their future visions. Additionally, we are starting to see interesting gain-sharing business models that may make initial investments free or cheap.

Finally, it’s important to blow up one of the most important fallacies permeating the arena of population health: The sickest 5 to 10 percent of patients need the most innovative care models.  Actually, I’d suggest just the opposite. Studies have shown that these patients really need our very traditional model of face-to-face care with their physicians, who are better than any IT system in figuring out complex cases in real-world individuals with multiple problems.

The real care innovations need to happen with the chronic disease patients and the healthy populations. These folks represent 90 percent of our patients, but still take up more than half of our resources due to a reimbursement system and care model which emphasize face-to-face office visits.

The future of ACOs and population management is an exciting rethinking of how we can best manage these less complex patients via telemedicine, protocol-based nurse care and computerized self-care. The result will be easier, cheaper and more consistent care for the population with simpler health needs, which then allows physicians to provide the more intense care required by our sicker patients, all empowered by sophisticated workflow technologies integrating clinical decision support with our EHR systems.