Impact of Population Health Management on Value-Based Care

What is Population Health Management?

While the term population health does not have a singular agreed-upon definition, it is often used to describe an approach to healthcare that focuses on the health outcomes of a group of people. It aims to improve the health metrics of an entire population instead of focusing solely on the individual. Population health management has recently gained recognition as a necessary component of accountable care (Kindig, 2003).

Whereas traditional healthcare models are reactive, population health aims to be more proactive. It focuses on value-based reimbursement in place of a more traditional fee-for-service model.

“Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. This form of reimbursement has emerged as an alternative and potential replacement for fee-for-service reimbursement, which pays providers retrospectively for services delivered based on bill charges or annual fee schedules.” Jaqueline LaPointe Senior Editor at Xtelligent Media

Population health management supports value-based services by using aggregated data to highlight health concerns and identify ways providers can use resources to overcome barriers.

This shift from a fee-for-service model to value-based reimbursement presents a significant challenge for providers as healthcare systems must modify workflows to manage the care of an entire population. A population health registry can help automate workflows lessening the burden on providers.

What is the difference between a population health registry and an electronic medical record (EMR)?

An EMR focuses on services rendered in a single setting. In contrast, a health registry aggregates and analyzes data from multiple sources to identify health trends within a community and provide a more comprehensive picture of patient care. Although EMR companies have tried to do this work, it is still difficult for them to aggregate the data in a comprehensive and streamlined manner for physicians.

A robust population health strategy that integrates a data management platform can support the work of transforming from a reactive to a proactive model. For example, it can help identify gaps in care, chronic disease, and high-risk patients. It allows physicians to customize care based on the patient’s unique needs and develop effective treatment interventions to reduce high-cost services such as emergency department visits and hospitalizations while optimizing quality outcomes.

In addition to streamlining workflows, an effective population health registry can potentially impact widespread burnout frequently reported by healthcare workers.

From a Triple to Quadruple Aim of Healthcare

“The Triple Aim (of healthcare) —enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs.” (Bodenheimer, T., Sinsky, C., 2014) The Quadruple Aim of healthcare includes team well-being and productivity as an important additional goal. (Arnetz et al, 2020) Healthcare providers can leverage a population health registry to improve these aims in the following ways.

Enhancing patient experience

The patient service experience is an essential component of the Quadruple Aim and helps drive a patient-centered approach. Implementing the right technology and having real-time access to information helps physicians and clinical teams meet the expectations of their patient populations and can improve patient satisfaction. Population health registries also provide additional opportunities to increase patient engagement.

Improving Population Health

The primary goal of a population health registry is to track a group of people’s health trends and provide practitioners with insights to reduce the overall risk within that population. Analyzing large amounts of data can highlight patterns that may not be noticeable at the individual level.

Reducing the cost of care

The goal of PHM is to slow the progression of risk in the patient population while minimizing the use of costly services, such as emergency department (ED) use and hospitalizations (Institute for Healthcare Transformation 2012). Optimizing service use can lower the cost of care for both patients and providers. For example, a study by Hubbard, Greene, and Parrotta (2017) used population health data to identify patients more likely to be users of avoidable costly care and those more likely to develop new chronic diseases. They concluded that healthcare metrics such as those used in their study could help identify patients who might benefit from additional supports. When care is provided at the right time in the right setting, there is a direct financial benefit to the patient through lower co-pays and out-of-pocket costs.

There is also a financial benefit to providers reflected in payer models that incentivize improved population health metrics. Physicians who can reduce the total cost of care for their patient population can share in the savings of that cost reduction through value-based contracts.

Team Well-being and Productivity

A population health registry can help reduce the burden on healthcare professionals by automating specific processes and improving communication between patients and their providers. Improved communication also aids in the coordination of services between settings and practitioners.

Population health management involves shifting traditional healthcare paradigms from a fee-for-service model to value-based care and implementing systems that support improvements in a population’s overall health. Insights from IT platforms can help reduce the cost of care and improve the quality and service experience for the individual. By aggregating and analyzing large amounts of healthcare data, we can provide physicians with actionable insights and allow them to focus on what matters most: their patients.