Population health management (PHM) models are difficult to develop and replicate due in large part to unique, local market circumstances. This is forcing healthcare organizations (HCO) to begin their PHM journey from different starting points in a complex, diverse, and competitive market. The fragmented, regionalized nature of the healthcare market creates challenges for HCOs and their supporting vendors to deliver consistent, replicable PHM solutions that are scalable across the industry. The PHM road they travel varies accordingly.
Amidst the challenges, HCOs are taking a variety of approaches to deploy PHM strategies and models that are producing positive results. Recognizing there will never be a one-size-fits-all model that generates positive outcomes across all metrics, there is much to be learned from these early adopters now that they have been implementing PHM strategies for five or more years.
The latest report from Chilmark Research, Driving Speed to Value: Three Diverse Approaches to PHM, delves into three case studies to examine the clinical and technology models in force to enable a PHM strategy. We tackled this research project with a lens toward increasing PHM speed to value and helping to identify optimal health IT (HIT) enablement. This report combines the findings from these case studies with additional primary and secondary research to distill common themes and provide recommendations for other HCOs considering or already deploying a PHM strategy of their own.
The approaches taken by our three case study HCOs to PHM highlight a stark contrast in PHM strategies and technology models.
· Trenton Health Team: Community collaborative and health information exchange that relies on a single-sourced HIT vendor
· Partners Healthcare: Large regional health system that has taken an extremely broad build-and-buy HIT portfolio approach
· Marshfield Clinical Health System: Vertically integrated health system that has developed and deployed a proprietary electronic health record and PHM integrated technology platform
The report takes an in-depth look into the enabling PHM technology solutions at each organization, reviewing both the timeline for, and the drivers of, technology and vendor decisions that each organization made along their journey. Each case study concludes with the critical lessons learned by each organization.
While many factors are external and outside the HCO’s power to influence, there are steps an HCO can take to drive speed to value in PHM deployments. HCO recommendations are consolidated in this report around two general themes:
1. Develop Enterprise-Level Thinking
Enterprise-level thinking enables HCOs to develop and utilize a wider breadth of capabilities to reduce variations, thereby improving quality and cost structure.
Clinical and Business Recommendations
– People: Focus on all points of entry into your healthcare organization and hold PCPs, specialists, and ancillary services all equally accountable for patient results
– Design: Coordinate care for patients to ensure minimal disruption and need for multiple office visits; work as a care team to address all open gaps possible during any patient encounter
– Deploy an end to end strategy encompassing all PHM components to realize optimal gains
– Deploy centrally guided strategies, but ensure local input and leadership to reduce local variation
– Definitions and lexicons are everything. Define terms, concepts, tools, and data fields, even basic ones to ensure productive execution against common goals
Technology Recommendations
– Process: Establish business and clinical strategy prior to workflow for modeling and IT adoption
– Vendor Procurement: Expect to find an immature market for PHM technology and realize one vendor is highly unlikely to possess every capability you may currently need
– Data Transparency: Increase provider engagement in PHM by enabling easy ability to drill from population-level results to individual patient list for providers to see their outlier cases
– Cost: Expect to invest in significant management expertise and financing (capital and operating)
– Populations Managed: ensure investment in PHM tools can be utilized regardless of payment model
– Change Management: Be diligent to training pre and post-HIT implementations as a key element of change management success
2. Become a Methodology-Driven Organization
Running a VBC model is truly running a business and it is critical for HCOs to develop a robust business culture to increase certainty of success.
Clinical and Business Recommendations
– Cost Management: Establish cost accounting principles and tactics to understand and better address the true cost of providing care
– Design: integrate human-centered design principles in your program development to ensure consumers and clinicians are always considered in any solutions proposed Look to the payer community in a new light, as a partnership to co-develop PHM programs and enabling platforms. Leverage colleagues, vendors, and other research means to develop your program interventions and measurement methodology. There is no need to figure out PHM strategies from scratch.
– Process: establish detailed process for CM programs, to ensure clear scope of role, as well as reporting to measure compliance to process. Document your PHM product model and processes via formal artifacts in order to establish program goals, a common baseline of knowledge management, a measurement framework, and risk mitigation plans.
Technology Recommendations
– Data Management: clinical, operational, and cost data is the foundation for effective PHM. Develop or acquire the skills to successfully aggregate such data, ask the right questions, and deliver insights dynamically to providers and care managers
– Point of Care: push your IT vendor (or internal department) to bring all expected processes into clinical workflow as closely as possible.
– Vendor Procurement and Management: Vet vendors carefully; it’s much easier to add them than to terminate agreements.
– Have a clear definition of success metrics and priorities prior to beginning any vendor procurement.
– Don’t rely solely on your EHR software for your enabling support and expect your optimal relationship with your vendor to be an iterative process.
Decision Timing: make needed vendor or technology architecture change prior to sinking even more money into a solution you know is obsolete. The cost of change will not subside the longer you wait.
“To balance the challenges of deploying PHM models, there is a growing body of case studies and industry toolkits to help HCOs just beginning to develop their PHM strategy. HCOs need to be aware of this small but emerging collection of best practices, lest they risk reinventing the wheel at their own cost,” said Jennifer Rogers, Chilmark Research analyst and author of this report in a statement. “As an industry, we can increase the socialization of toolkits and case studies so that HCOs can more clearly define all aspects of PHM model design. This will in turn enable HCOs to optimally deploy IT and ultimately increase PHM speed to value.”
