Let’s face it – if we want to encourage a healthy society, then we need to provide the correct systems for healthcare that not only enable patients to obtain assistance for their needs, but also pay for the treatment they’re given.
The concept behind population health management of late, has been to drive changes to the way that the United States is offering health care to its citizens. Through careful analytics and evaluation, population health management has the capacity to align provider and payer incentives in the healthcare sphere – meaning satisfied patients, and better quality care for all.
So how exactly can population health interact with health system data management and cloud migration in order to provide a more efficient, and effective environment for patients and providers? Let’s take a look.
What is Population Health?
Back in 2003, Stoddart and Kindig identified population health as:
“An approach [that] focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and wellbeing of these populations.”
Simply put, the term “population health” refers to the measures taken to define and evaluate health outcomes and the things that impact it – such as public health interventions, medical care, social components, and more.
What is Population Health Management?
Population Health Management has been defined by the founder of the Yale Department of Public Health, C.-E.A. Winslow as:
“The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Basically, it’s a system for making healthcare better for the population as a whole, and part of this process needs to be focused on the amount that is spent on healthcare, in comparison to the quality of care that is given. After all, the U.S. currently spends more on healthcare than any other high-income nation, yet it has worse health outcomes, and a lower life expectancy. This tells us that the encounter-based approach to medicine just isn’t working to promote population health. We need to start looking at better options for population health management, and this is why the traditional fee-for-service model is disappearing in favor of “value based” purchasing options. This change means that patient outcomes must be tracked by every provider to minimize risk and maximize performance.
The Pros and Cons of Various Payment Strategies
There have been a number of models for healthcare payment introduced over the years – and in each, quality has been an essential component. Some of the most common healthcare payment models used in the past have included:
- Fee for Service
This is the most traditional healthcare payment model, wherein patients are required to reimburse healthcare providers for any service they perform. There’s no incentive here to implement preventative care strategies or anything else.
- Upside Shared Savings
These methods provide incentives in regards to certain patient populations. This is the most common option with Medicare Shared Savings Programs, but most participants move to a downside model within three years.
- Downside Shared Savings
Downside shared savings offer the gain share potential that comes with an upside model, along with a risk for sharing excess costs between payer and provider for healthcare delivery.
In contrast to the above options, the “pay-for-performance”, or value-based scheme for reimbursement ensures that healthcare providers are only compensated when they meet particular efficiency and quality metrics. Currently, the Department of Health and Human Services aims to have 50% of Medicare contracts governed using alternative payment models by the close of 2018.
The Misalignment of Payers and Providers
Perhaps one of the biggest problems with population health management today, is that payers and health providers aren’t on the same page – one wants to pay less, while the other wants to charge more. However, in order for quality and satisfaction within the healthcare industry to flourish, there needs to be a building relationship between both parts of the healthcare sector.
Organizations will need to start investing in their patients, then measure how their investments are having an impact on the health of that patient, and how much care that patient puts into managing their own health.
How Analytics Can Help
With the new form of health population management moving ever closer – analytics has never been more important. After all, in order to save money and improve healthcare quality overall, the industry will need to start looking closely at the areas where development needs to be accelerated, while identifying expensive and wasteful choices.
Part of this will mean collecting information on patient outcome data, and begin to recognize the meaning of cost at a patient level – instead of guessing at overall cost for healthcare by looking at a large sum of patients. In other words, the value-based payment method will require healthcare industries to examine the needs of each patient on an individual level – and for that, analytics is crucial.