Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

ACA Uncertainty Won’t Alter Population Health Focus for Hospitals

Hospitals are steadfastly pursuing population health management despite continued uncertainty over the ACA and the insurance marketplace.

Population health in hospitals and the ACA

Source: Thinkstock

By Jennifer Bresnick

- Despite the endless political wrangling over the Affordable Care Act and the uncertainty created by the White House’s obfuscation about continued marketplace funding, population health management isn’t slipping down the priority list for hospitals.

According to a new survey from Health Catalyst, more than 80 percent of hospital executives are holding firm in their commitment to population health. 

Only four percent of respondents said they are pausing their population health initiatives in response to the political climate – although the poll, conducted in June and July, may not reflect the very latest events in the tumultuous debate over the ACA and its principles.

Sixty-eight percent of the 199 executives responding to the poll believe that population health management is “very important” for their long-term care delivery strategies, especially as they persist in their quest to transition to value-based reimbursements. 

"The bottom line is providers see population health management as something they need to do and that they want to do to provide better care for patients,” said Amy Flaster, MD, MBA, vice president of population health management and care management for Health Catalyst.

Long considered a strongly bipartisan goal for healthcare reform, value-based care requires hospitals to make fundamental changes to their role in the delivery system. 

Health systems and hospitals are shifting from reactive acute care facilities to proactive hubs for maintaining wellness by implementing collaborative strategies that reduce admissions and promote lower cost outpatient procedures where appropriate.

The goal for many organizations is to turn the hospital into a population health command center instead of the endpoint of a linear care trajectory for the sickest patients.

Ideally, population health management is accompanied by pay-for-performance reimbursement programs that reward wellness care and replace revenues lost through lower hospital utilization. 

Yet despite the enthusiasm around population health, providers have not been quite as eager to embrace the financial risks that go along with a value-based care environment.

Thirty-seven percent of participants in the survey said “getting paid for our efforts” was their biggest challenge with population health.

Few organizations have yet embraced significant downside risk arrangements that make them responsible to payers for shared losses.  Just 13 percent of respondents said they have successfully moved more than 30 percent of their patients into a downside risk model.

The majority of value-based care contracts in the healthcare industry are still upside-only, in which participants receive bonuses or shared savings payments if they hit their quality benchmarks but are not financially liable if they do not.

Only 37 percent of hospitals believe that they will have at least 30 percent of their patients under downside risk contracts within the next three to five years.  Fourteen percent believe it might take them up to a decade to reach that threshold.

In the meantime, “[hospitals] are struggling with the economics of operating in both the fee-for-service and value-based care worlds – having one foot in each canoe,” said Flaster.

They are also running into issues with planning their initiatives, securing buy-in from participants, and accessing the big data they need to make actionable decisions.

Seventeen percent of participants stated that they are struggling to access the high-quality data and analytics competencies they need to stratify patients by risk and engage in effective care coordination and chronic disease management.

A similar number cited “care model issues” as a top concern, while 12 percent noted that “leadership and governance issues,” including assigning accountability and creating clear strategies for success, were preventing them from moving forward effectively with population health.

"The big picture takeaway from this survey is that healthcare executives view the move to value-based care as inevitable, regardless of the current political situation, and population health management is seen as critical to their success in transitioning to the new reimbursement structure," said Marie Dunn, MPH, vice president of population health strategy for Health Catalyst.

"Despite the momentum, basic competencies related to data aggregation and analysis are still a barrier. Organizations in the pilot phase need to ensure that their investments are not just one-off efforts, but helping them to build a foundation for a broad base of future efforts."


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