Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

44% of Payers, Providers Find Population Health Tools Effective

Population health management tools seem to be helping payers and providers make the leap to value-based reimbursements, KPMG says.

Population health management tools

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- Population health management tools are getting a high approval rating from 44 percent of the payers and healthcare providers as they slowly embrace value-based payments and a more coordinated, preventive approach to patient care.

Population health tools are “efficient and effective” for this segment of the industry, found a survey by KPMG, and the use of health IT to manage patients is likely to continue its steady rise.

While data siloes and aggregation issue still plague the majority of organizations looking to integrate big data analytics into their care strategies, stakeholders seem generally convinced that risk stratification and other population health principles can help them succeed with pay-for-performance initiatives.

“The move to population health is very encouraging given that nearly half of providers and payers are seeing the benefits,” said Michael Beaty, a principal at KPMG’s Healthcare & Life Sciences practice. “Providers are taking on more financial risk from these programs, but they have a greater opportunity to share from savings. Payers gain from administrative efficiencies and letting providers take on that risk.”

The poll, conducted during a recent webcast, found that providers and payers are cautiously inching towards the value-based reimbursement environment, with 26 percent stating their intention to start pay-for-performance contracting within the next one to three years.

Thirty-six percent of participants already receive some of their reimbursement through value-based arrangements, but only 14 percent said that the majority of their revenue comes from innovative payment models.

The slow but steady movement away from fee-for-service appears to be accompanied by an increasing interest in population health management technologies that allow providers and payers to take a proactive approach to managing outcomes.

“Various parts of the country are transitioning at a slower pace,” said Joe Kuehn, partner at KPMG. “The vast majority of health plans and providers, however are moving this way, particularly after CMS had set some aggressive targets in January 2015, followed by some of the national health plans, to shift their reimbursement in this direction.”

Twenty-four percent of respondents said they would be adopting population health management tools within the next three years, closely mirroring the proportion of participants looking to take on more risk-based payments during that same time frame.

As they do so, however, they will need to contend with data integration issues and workflow problems.  Thirty percent of participants cited difficulties with data aggregation from multiple sources, while stakeholder adoption of new tools and challenges developing intuitive new workflows concerned an additional ten percent each. 

Thirty-four percent stated that they experienced all of these problems while standing up population health management infrastructure.

“The complaints about incorporating technology into clinical workflows are fairly common and have many doctors and others involved with care delivery dissatisfied with electronic health records and other tools,” said Todd Ellis, principal at KPMG. “This can be remedied by better training and incorporating clinicians into the process of selecting technology.”

The survey findings are very similar to those of a HIMSS Analytics poll conducted in September 2016, which charted a comparable rise in the adoption of population health management tools to help organizations cope with changing reimbursement structures.

The poll highlighted a notable jump in health IT adoption between 2015 and 2016, during which time close to ten percent of providers decided to implement population health management tools. 

“It is encouraging to see the level of population health programs and initiatives increase in 2016 from our previous 2015 study,” says HIMSS Analytics Director of Research, Brendan FitzGerald.  “Performing population health is still in its infancy and it will take time for many organizations to work out a sustainable and effective approach,”

Hospitals responding to the HIMSS Analytics survey also experienced difficulties with data integration and workflow development while they architected chronic disease management programs and improved communication between business partners.

Overcoming these barriers may be challenging, but the rewards can be worth the trouble.  Providers and payers that are able to marry data-driven population health strategies with value-based reimbursements are likely to see cost reductions, higher patient satisfaction rates, better outcomes, and lower levels of expensive events like hospital readmissions or emergency department use.

Humana, for example, saw a 19 percent improvement on HEDIS measure performance in 2015 for their value-based populations compared to patients still in a traditional payment system.  Screening rates for certain cancers role between 6 and 8 percent, while emergency department visits dropped by 6 percent.

“All of these improvements have helped us see a 20 percent reduction in medical cost versus traditional Medicare,” said Chip Howard, Vice President of Payment Innovation.  “We’ve consistently seen positive results year over year in the value-based world versus the non-value-based system.”

Such positive results may take several years to show themselves, acknowledged KPMG in a 2015 survey, but more than half of providers who had invested in population health management infrastructure at the time expected to see a full return on their investments within four years.

“Healthcare providers are facing a seismic shift in the coming years, largely because government and commercial payers will increasingly decline to pay for avoidable hospital visits,” Kuehn said at the time. “Providers and other participants in the care delivery system need the real time data and analytic tools to not only manage and improve the quality of care provided, but also the ability to measure costs to operate efficiently.”

With 44 percent of providers and payers in the new poll expressing satisfaction with the way their population health tools are working for their organizations, it is likely that organizations are getting more comfortable with the analytics competencies and process improvements required to see that return on their efforts sooner rather than later.

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