5 Common Reasons Population Health Management Fails In Value-Based Care And What It Takes To Be Successful

Trying to manage the care of an entire population effectively presents a significant challenge for providers working in value-based care. To tackle these challenges, Healthcare organizations need to work with specialized companies that offer technologies with robust data analytics designed to improve care coordination and maximize incentives. This article will highlight five common reasons population health management fails in value-based care and what it takes to be successful.

1. Poor Data Management

Making sense of the sheer volume of data involved in healthcare is one reason population health management fails in value-based care. Data collected from electronic health records, claims data, and other sources can provide valuable clinical insights, but only if the data is accurate, complete, and accessible when needed. Many healthcare systems still rely on models that are siloed within their structure, clunky, and uncommunicative. With outdated technology, communication isn’t as fluid as it needs to be to meet growing demands. These systems cause delays and errors which isn’t just frustrating for providers but can have a negative impact on patient outcomes.

Success here requires aggregating data from multiple settings and presenting it in a clear, concise format that is easy for practitioners to understand. A comprehensive solution must be able to receive and interpret data in many different formats and unify records into a single patient view. Advanced IT capabilities, including a robust population health platform, are crucial to enabling all providers involved in a patient’s care to make the most informed clinical decisions possible.

2. Lack of Infrastructure for Health Information Exchange

A lack of infrastructure to support health information exchange is another reason population health management fails in value-based care programs. Again, this requires direct experience and sophisticated software that precious few organizations possess.

Trusted Data Sharing

A health information exchange is an organization that allows healthcare providers and patients to access and share critical clinical information electronically. The purpose of an HIE is to improve the coordination of care. Health Information Exchange can also be used as a verb that describes the process of sharing health information. Health Information Exchanges – MiHIN. https://mihin.org/exchanges/

This barrier to population health management was highlighted in a study published by the Milbank Memorial Fund in 2022. This study examined the Impact of Population Health Analytics on Health Care Quality and Efficacy among primary care practices participating in a federally funded program. This study asked whether robust population health platforms could help practices achieve better outcomes in a multi-payer program.

Participants included 37 PC practices in NY. Results showed that practices with membership in the federal program and who used a robust pop health platform with HIE integration saw 24.1% lower risk-adjusted hospital admission rates and 21.0% lower risk-adjusted outpatient surgery rates. In addition, the average lengths of stay in hospitals were 32.7% lower, and readmission rates were 30.4% lower. Given the results, the authors encouraged medical practices engaged in multi-payer advanced primary care opportunities to subscribe to population health management information technologies. The Impact of Population Health Analytics on Health Care Quality and Efficacy Among CPC+ Participants | Milbank Memorial Fund. https://www.milbank.org/publications/the-impact-of-population-health-analytics-on-health-care-quality-and-efficacy-among-cpc-participants/

3. Acceptance of New Workflows

Changing from a fee-for-service model to a value-based care model requires a shift in how practitioners approach their panels. Success means a change in habits and culture, which providers can be resistant to. With strict regulations in the industry, change can feel understandably risky. However, outdated technologies support outdated workflows and are a significant productivity drain. The persistence of old habits poses a genuine risk to an organization’s financial health and quality of care.

To facilitate this shift in practice, providers need help knowing where to direct their time and attention. Value-based care requires providers to spend more time focusing on high-risk patients while simultaneously reducing the cost of care. With such large populations to manage, providers need to be empowered to adopt new strategies for success. This involves supplying the infrastructure, education, and insights needed to adjust and succeed. https://pearlhealth.com/blog/healthcare-insights/why-isnt-value-based-care-working/

4. Getting paid

Providers and networks don’t understand how to achieve financial success under value-based care models.

In a traditional fee-for-service model, a healthcare provider is paid a fee for each service rendered. Financially, a fee-for-service model is straightforward: more services = more money. This model, however, can have the unintended consequence of rewarding medical providers for the volume of services provided instead of the quality of those services.

We are seeing a big shift in healthcare to value-based care models in which payments are tied to the quality of care. Reimbursement for Value-based care is more complicated and based on the idea that physicians should be paid more for achieving quality outcomes while reducing overall costs. Ideally, this model incentivizes practitioners for efficiency and effectiveness.

While this change in reimbursement structure can be lucrative, providers are wary of risk and increased work demands. Maximizing financial opportunities in value-based care depends on practitioners proactively managing risk in their patient populations. Providers must be able to identify gaps in care and track patients across the entire care continuum. Success here goes hand-in-hand with effective population health management, ensuring fair and appropriate compensation through robust data analytics at the provider level. Otherwise, you leave money on the table.

5. Fractured Healthcare

Fractured healthcare delivery systems are another reason population health management fails in value-based care.

For most patients, comprehensive healthcare is not provided in a single setting or by a single provider. For this reason, attempting to account for all patient interactions in a clear, complete, and concise way is a major task. Errors and gaps in a patient’s record can lead to disorganized care and poor communication, resulting in medical errors, repeat testing, and missed opportunities, all of which can negatively impact patient outcomes. Population Healthcare Management: Challenges, Opportunities, and Solutions. https://www.shiftmed.com/blog/population-healthcare-management-challenges-opportunities-and-solutions/

Success here requires tracking patients and forming a clear and complete picture of patient care across the entire care continuum.


How can we help patients, providers, and networks succeed in value-based care?

It takes analytics to turn data into something useful.

Providers have the expertise, clinical knowledge, and direct patient engagement to affect care. However, many lack the right technological capabilities to achieve high-performance outcomes even if they provide exceptional service.

Value-based care can only be successful with the right technology. Specifically, success requires robust data analytics, health information exchange, intuitive, easy-to-use interfaces, and supportive environments that can provide strong guidance to practitioners.

HealthFocus is a comprehensive, purpose-built solution to population health management. We specialize in assisting organizations that engage in value-based care. The benefits of our platform include

  • reducing the burden of manual labor by automating processes
  • helping providers maximize their incentive opportunities through advanced tracking and reporting capabilities
  • improving outcomes for patients, providers, and networks.

We provide each of our clients with continuous one-on-one support and training to ensure they receive the full benefit of our platform. In short, we provide the tools organizations need to be successful in value-based care and allow providers to focus on what matters most…their patients.