As the healthcare delivery model shifts towards value based healthcare, the need for effective population health management solutions continues to grow. However, for many providers choosing the right PHM solution is still uncharted territory and the correct path isn’t always clearly marked. According to a recent Chilmark Research report, healthcare organizations are currently struggling with evolving models of reimbursement while PHM vendors have yet to successfully build solutions to fully meet market needs.
Moving forward, it is critical for healthcare leaders to understand the importance of PHM to prepare for their journey ahead to value based health. In a recently published white paper, Tom Becker, senior vice president of Integrated Healthcare Strategies outlined the top four population health management challenges for healthcare leaders:
1. Physician Reluctance
Many medical organizations and practices struggling with entering the PHM market will be affected by divergent internal opinions. According to a recent survey, 25 percent of healthcare executives found getting staff and physicians comfortable with the approach behind population health programs was the second largest challenge, followed by interoperability with other providers (19 percent) and coming to terms with new payer relationships (14 percent).
2. Compensation Concerns
The impact of PHM on physician compensation is one that concerns many healthcare leaders, who envision physicians departing the organization for greater financial opportunities elsewhere. Physicians have expressed concerns about their compensation heavily impacted by PHM business models; however, PHM represents an opportunity to decrease costs while increasing the overall effectiveness of care delivery
3. Expense Control
Physician practices moving towards PHM understands that in an ACO shared risk model, controlling expenses is critical. As a result, it can be challenging to know what areas to focus on in order to maximize expense control (Hospital Inpatient vs. Practice Operations and Patient Flow, etc.).
Healthcare leaders must fully understand the full context of this shared risk model. ACOs operate in a fee-for-service model, so physicians will continue to receive FFS payments, although at substantially discounted levels. Therefore, reducing cost in the hospital setting can mean fewer procedures and services provided by the physicians.
4. Risk Aversion
Healthcare leaders and physicians often view Medicare ACOs participation as too risky from a financial standpoint with less than half of US providers participate in a shared accountability arrangement. For practices concerned about risk aversion, limiting the size of the ACO Medicare Shared Risk business may be, in the long run, a bad idea. Small patient populations patients may not be actuarially stable, which can result in greater risk to healthcare organizations, not less.
For more information, download the white paper here: http://www.integratedhealthcarestrategies.com/pophealth
