What is responsible population health management? Wellcentive’s Mason Beard explains.
The term population health management (PHM) is abuzz right now. Surely, you’ve heard it. But apart from the white noise, do you understand the importance of PHM? Better yet, do you understand its impact?
We asked Mason Beard, co-founder and vice president of product strategy at Wellcentive, to break this subject wide open for us. Turns out, understanding why PHM is essential is easy—but employing a PHM system that produces optimal results—therein lays the challenge.
Still, with the right tools in hand, responsible PHM is well within reach, according to Beard. Since Wellcentive’s formation in 2005, he and his colleagues have been developing those tools. The Atlanta, GA-based company began by making inroads in data management for physician organizations looking to optimize their pay-for-performance programs. Today, it serves a variety of healthcare organizations with its comprehensive population management solutions.
We asked Beard to draw from his experience and share his insights on how organizations should embrace and employ PHM. He kicked off our conversation with understanding “the why” behind the PHM movement.
“PHM is a hot-button topic right now, but it’s far from a fad,” said Beard. “It is evidence of the paradigm shift taking place within the US healthcare system. For years, our system has been geared towards rewarding quantity over quality and volume over value. Its economic infrastructure and reimbursement engines haven’t been geared or optimized to take care of populations, and neither have our HIT systems.”
Beard further explained that an encounter-based methodology is to blame. In other words, a don’t-fix-it-until-it’s-broken mentality has resulted in a healthcare system that’s bound to break. And with the aging baby booming population now taxing that system at an alarming rate, its flaws are starting to show.
“The system isn’t sustainable the way it is; it’s cracking under the pressure,” said Beard. “A more proactive, cost-effective methodology must be put in place to provide relief by improving outcomes. We have to do a better job with chronic disease management and preventive health. That is the end goal of what we call responsible PHM and the technology that tethers it together.”
Keeping that end goal in mind, we asked Beard where to begin when sizing up a responsible PHM system. Beard said there are six essential components or pillars to keep an eye out for. They are as follows:
1. Data Management Platform
There may be six parts to the PHM pie, but if you’re only going to walk away with one slice, it has to be the data piece. Why? Well, according to Beard, a responsible PHM system lives and breathes in the transmission, translation, and delivery of reliable data.
You may be thinking that with an established EMR or EHR system, you already have that piece in place. However, Beard cautions if that’s all you have, that’s probably not the case.
“To reach those touch points in the community you have to go beyond the confines of your office,” he said. “The data is your lifeline in accomplishing that, and to do that properly, you have to tie together disparate systems.”
Tying together systems isn’t just about data transmission. After all, Health Information Exchanges (HIEs) have been transmitting and routing data for years. However, by failing to translate those transmissions into an intercommunicative language, or what is known as normalizing the data, those data routes are nothing more than a series of dead ends.
“Effective data must be accurate and actionable,” said Beard. “For example, if one organization classifies a lab for their diabetes patients as HbA1c and another cites it as hemoglobin A1C, someone has to normalize that data to turn it into a communal, active data point. Without normalizing the data, you will be missing key pieces that create the complete picture of your population.”
So how do you avoid data delivery from getting lost in translation? It requires investing in a data aggregation platform. Beard explained:
“Responsibility begins at the data layer. So, having a solution that aims to aggregate accurate, actionable data is the first fundamental piece.”
Turning up the dial on data quality also requires turning the data out into the community. The only way to accomplish that is through a cloud-based PHM solution that enables data contributors to engage in the organizations’ data quality efforts. “Once that foundation is laid, you’re able to rally a community around improving data quality and outcomes,” Beard said. Why the cloud? It keeps operational costs low, creates ubiquitous access for any entity with a web browser, and has ample room for scalable growth.
Still not sure if your data platform is up to snuff? Here’s Wellcentive’s quick litmus test:
- Is your data platform capturing everything you are trying to measure?
- Do you have trust in it?
2. Quality Program and Initiative Management
Questions pertaining to measurement also play a key role in establishing this next pillar. What’s your rule set by which you measure? Better yet, what is the rule set of those measuring you? These are the questions that need to be answered by your PHM solution, according to Beard.
That requires not only having a comprehensive registry tied to enhancing workflow and promoting physician engagement, but a system that allows you to present those measures in a consumable fashion.
“For years, doctors have thrown payer quality score cards into the trash. The reason: There isn’t a lot of trust in the data since it’s based on payers’ claims data, which again, places priority on data aggregation,” said Beard. “The other problem is those measures are not tied to a workflow solution. Your system has to connect those dots. If it doesn’t, then your doctor can’t act on it, and you don’t have a comprehensive PHM solution.”
3. Care Management
Gathering and measuring the data is essential—but it’s only as valuable as what you do with it. If you and your solutions provider are stopping at the analytics, then you may be missing the point of PHM to begin with.
Care management is the arm that reaches out and turns the dial up on outcomes by taking population health and making it personal. The data lets you identify room for improvement within your community, but it’s those individual interventions driven by care management that create the impact, said Beard.
“Having a care manager make follow up phone calls, or secure transportation for a patient’s next appointment, may seem insignificant. However, it’s those simple actions that can lead to sizable improvements down the line. That’s what makes the care management component of a PHM solution so vital— it’s the tool set your care managers are going to rely on.”
4. Patient Engagement
You may think this next pillar falls underneath the umbrella of care management, but a well-rounded and responsible PHM system will have additional, automated forms of patient engagement.
Does your PHM system enable you to send letters, email, text messages, or voice-over IP calls? According to Beard, it should.
“You have to approach it like you would a marketing venture,” he said. “If you were marketing a product, you wouldn’t just send out one flyer and hope it made an impact. No, you would look for other avenues to express your message and have your audience absorb it. That’s the same mindset you need when it comes to patient engagement tools.”
That being said, it’s important to recognize that there are applications out there that may be too green to garner much attention. “We’re starting to see engagement applications that offer personalization and ‘gamification’ features similar to Foursquare, Facebook, or Yelp,” said Beard. “They show a great deal of promise, but I don’t think those tools are embraceable just yet since provider engagement is where the focus of PHM is right now.”
5. Risk Stratification/ Predictive Modeling
Prioritizing your outreach and patient engagement is certainly important, which is why risk stratification and predictive modeling also play a key role in responsible PHM, according to Beard. Organizations are using risk stratification and predictive modeling to focus their resources in areas where they can make the biggest impact.
“This goes back to the importance of measurement,” said Beard.
“Your PHM system has to promote and inspire improvement, and nothing does that better than showing someone where they fall on a spectrum. That’s the piece that taps into the central nerve of PHM for providers. It’s those measures that not only allow them to see what’s possible if they make improvements, but what’s inevitable and truly at stake if they don’t.”
6. Provider Engagement
Naturally, provider engagement is essential for any PHM system; in fact, it’s is critical to the success of any quality improvement program. It’s an easy goal to establish but not nearly as simple to fulfill.
“Today, providers are busier than ever and they are fielding so much pressure from stakeholders who are measuring them from a quality standpoint,” Beard said.
“Your system has to have the integrity to create a high level of trust in the data, as well as the intuition to present that data in a consumable fashion. If you can place those tools at the fingertips of your provider, you will earn their engagement and your PHM system will be complete.”
Still not ready to embrace a PHM system? Take your time. However, you may want to keep this checklist handy for future reference.
Beard predicts the buzz circling PHM will inspire some companies to tap into the market by transforming existing, antiquated technologies into PHM solutions, hence reinventing themselves as PHM solutions providers. This may intrigue many hasty health organizations to acquire those so-called solutions. Although some companies are bound to get it right, most won’t. Beard’s advice: “Don’t take the bait.”