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Will Risk-Based Population Health Management Take Off in 2017?

As value-based care starts to take over the industry, risk-based population health management arrangements may see an uptick in adoption.

- Population health management is a top priority for the majority of healthcare organizations, especially those who acknowledge that risk-based, value-driven reimbursements may soon be the dominant form of payment across the industry. 

Risk-based population health management and value-based care

According to a new HIMSS Analytics Essentials Brief, risk-based population health management programs are gaining ground in the hospital community, and could continue to grow in importance and scope in 2017 and beyond.

Population health management programs in general are becoming more popular, the survey of 104 hospitals found.  While only two-thirds of providers had population health programs in place during 2015, that number increased to 75 percent in 2016.

“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.  “However, organizations still face challenges with these programs on a number of levels, including data and solution integration, knowledge and expertise, and cost of sustaining these programs long term.”

Most providers focus on chronic disease management, targeting conditions such as diabetes, heart failure, and COPD which are responsible for large down-stream costs.  Eighty-three percent of participants had chronic disease initiatives in 2015 – but surprisingly, that figure decreased to 77.2 percent in 2016. 

Wellness and prevention programs, including smoking cessation, weight loss, and health programs in workplaces and schools, also saw a slight drop over the past year from 79.8 percent to 72.2 percent, but the patient-centered medical home is gaining in popularity, moving from 50 percent adoption in 2015 to 51.9 percent in 2016. 

Clinically integrated network development also rose by nearly two percentage points, perhaps indicating a shift away from piecemeal population health programs towards the implementation of more cohesive, holistic approaches to care coordination and patient management.

The rise in adoption of the PCMH and other integrated care frameworks may also hint at increased comfort and familiarity with health IT tools. 

A separate ONC and CDC survey published in April of 2016 found that PCMH and ACO participants are significantly more likely than other providers to have been early adopters of electronic health records and are more reliant on data-driven approaches to care management than their peers.

They are also 12 percent more likely than other practices to perform population health management services, and 6 percent more likely to conduct care coordination tasks for their patients.  Compared to non-EHR users, PCMHs and ACOs are 27 percent more likely to engage in population health programs and delivered care coordination services 40 percent more often than paper-based practices.

As providers optimize their health IT suites and continue to build out additional data-driven population health management capabilities, the industry may see a continued uptick in the number of organizations adopting a more structured approach to population health.

“Performing population health is still in its infancy and it will take time for many organizations to work out a sustainable and effective approach,” FitzGerald added.

The changing incentive landscape may also be driving more regimented practice transformation efforts. At-risk payment and cost structures are seeing higher levels of interest, says the HIMSS Analytics brief. 

Just under 29 percent of respondents engaged in risk-based payment arrangements in 2015 compared to 32.9 percent in 2016.  These initiatives may include accountable care organizations, the Medicare Shared Savings Program, bundled payment options, or employer contracts. 

If this trend continues in 2017, approximately 37 percent of hospitals may be shouldering some degree of risk by the end of the year, mirroring data from a recent study in the American Journal of Managed Care, which found that a third of organizations already receive more than half of their revenue from a risk-based arrangement.

A survey from the Health Care Transformation Task Force also shows widespread adoption of pay-for-performance reimbursements, with 41 percent of providers and payers operated under some form of value-based reimbursement in 2015, up from 30 percent the year before. 

Not all of these payments included provider risk for quality shortcomings, however, and the care community is generally reluctant to place larger proportions of their revenue under do-or-die financial models. 

But the dual growth of population health management and risk-based contracting, even if the latter is relatively slow, shows a promising trend for 2017 and beyond – especially as MACRA forces increased accountability for costs, quality, and outcomes. 

Population health management competencies are critical for success under value-based arrangements, and the willingness of hospitals and other providers to start developing these skills indicates a broader recognition that the healthcare industry will continue to move towards risk-based performance payments. 


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