Editor’s Note: Bradley Hunter is the Research Director of Population Health at KLAS Research.
As population health management goes mainstream, providers need robust, integrated software solutions to aggregate and analyze data, coordinate care, engage patients and clinicians, and provide full administrative and financial functionality. Providers report that vendors fall short of what they need, according to the recently published KLAS Research 2016 Population Health Management Perception Report. However, providers also report a need to improve their own processes, systems and definitions related to population health.
Fortunately, vendors and providers have agreed on a population health framework – worked out in late 2016 at a KLAS Keystone Summit, that provides a clear roadmap to guide and measure vendor improvements and overall progress.
As the industry moves to value-based care, providers have spent the last few years preparing, practicing on their employees, taking on a few payer contracts, and selectively implementing a few tools. Now, many are taking off the training wheels and assuming more risk. But providers report that few vendors meet their needs for integrating and maintaining data feeds, being flexible to changing conditions, and having the breadth and depth of tools for both the program administrators and care managers.
A decision is only as good as the data it is based on, and providers say the best data comes from combining a variety of sources. Data aggregation is at the core of this effort. Most providers believe their vendor can handle clinical EMR data feeds. However, when it comes to establishing and maintaining both pre- and post-adjudicated claims data, few of the vendors profiled could show more than half of their customers being successful in bringing in that data.
For flexibility and meeting the needs of all caregivers in the spectrum of care, only half of vendors in the study could meet a rating threshold of 7 or higher on a scale of 1-9, and only 25% rated between an 8 and 9.
While this indicates a huge opportunity for the vendors to improve their services and products, providers also see a need to improve their own systems and processes. One provider CMO, commenting about Optum, said,
“Optum’s team is very competent and engaging, and the team members have a lot of expertise. Our implementation process has taken a long time, but that is less Optum’s fault than ours. It was hard for Optum to get the files they needed in the right format so that Optum could upload those into their system. It took more than six months to get anything out of the tool because it took us that long to get things connected. I am not really happy with how long the process took, but I am quite certain that most of the delays were our fault.
As vendors and healthcare providers work harder to become partners in services and solutions, the need to align definitions of population health is critical.
Keystone Summit and Framework
In September of 2016, executives from 16 healthcare IT vendor companies, three healthcare services firms, 31 provider organizations, and two payer organizations met just outside of Salt Lake City to define population health and create a framework for technology that can support a successful population health strategy. The framework is summarized in a whitepaper available at no charge from KLAS.
A team of four respected healthcare providers led the summit:
– Shawn Griffin, Chief Quality Officer for Memorial Hermann Physician Network
– Richard Vath, MD; Chief Clinical Transformation officer at Franciscan Missionaries of Our Lady Health System
– Keith Fernandez, MD; Senior Physician Executive at Privia Health
– Rick Schooler, VP and CIO at Orlando Health.
The group identified six key layers of functionality that need to exist to support an effective population health strategy: data aggregation, data analysis, care coordination/health improvement, administrative/financial, patient engagement, and clinician engagement.
The summit also defined what constitutes basic and advanced functionality under each vertical. Summit participants charged KLAS to measure the state of the market against these six pillars and how basic or advanced the different solutions are in the market. The participants asked KLAS to report back their findings at a re-convened conference in September of this year.
Additionally, as part of the conference, vendors and healthcare providers had an opportunity to share what each side could do better to work as partners toward progress. Some of the suggestions from vendors to providers were to make sure change management extends beyond the IT department.
Many vendors agree that a key predictor of success in provider organizations is the relationship that CIOs, CMIOs and CEOs share. Vendors agree that when a sale is mostly to a CEO or mostly to a CIO, it often ends in failure. The CEO leads up culture while the CIO leads up technology. A combination of culture and technology comes from CIOs, CMIOs and CEOs working together.
Conversely, providers’ advice to vendors was to better understand complexity. Vendor organizations tend to underestimate complexity in two key areas: (1) data aggregation and (2) clinical workflows. Vendors could do better in helping provider organizations locate and identify the scope of available data sources. Great vendors also accept the invitation to go on-site, “in the trenches,” and learn the complexity of clinical workflows.
Facilitating success in population health management requires a shared vision and close cooperation between providers, vendors, service firms and payers. A shared framework and consistent measurement of progress will help population health management move to the healthcare mainstream effectively.