Managing population health involves several important goals. They include improving population health, reducing healthcare costs, and providing a perfect fit between payers and providers.
Provider engagement and payer engagement
Increasing payer engagement is an important goal of population health management companies. However, there are some common obstacles to this goal. It’s necessary to understand them to achieve tremendous success.
One common obstacle to payer engagement is that payers are often excluded from the clinical data exchange. It can lead to concerns about the data’s potential use against provider interests.
Another obstacle is that payers are often asked to contribute financially to HIE efforts. However, they are also concerned that the investment will yield short-term value.
Payers have identified five principles for achieving optimal HIE. These principles include:
The first principle relates to the value of HIE efforts. HIE efforts must provide a strong foundation for a sustainable business model. It is also necessary that HIE efforts offer a single connection to networks. It is possible if the correct information is provided at the right time.
The second principle relates to the need for transparency. Payers should provide the data that providers need to make clinically sound decisions. They should also provide information on protocols and incentive programs.
Understanding costs and patient outcomes
Getting comprehensive health data is one of the biggest challenges faced by healthcare organizations today. Luckily, the industry is making strides toward improving access to information. As a result, healthcare organizations can use various data sources to improve the quality of care and reduce unnecessary costs.
While healthcare organizations traditionally start with claims data, claims information is only sometimes enough to identify high-risk patients. Often, claims data lack clinical details. As a result, it makes it difficult to find and assess risk and even more challenging to use population health data to improve outcomes.
A fully integrated BI tool can combine claims, prescriptions, and clinical data to provide a complete picture of a patient’s health. This tool can also help close gaps in care.
Population health management programs can reduce unnecessary emergency department visits and hospitalizations when appropriately used. It can save hospitals and providers a significant amount of money. For example, researchers estimate that in a single year, $25 to 45 billion is spent on avoidable hospital readmissions and complications.
The best population health management programs use data-driven approaches to identify individuals at risk for poor health outcomes. These programs are aimed at specific populations and may include care coordination, disease prevention, and patient education.
Improve population health
Developing and improving population health goals is a goal that can be achieved through a variety of means. Making a successful care management program is one approach. This method involves involving people in their health utilizing the most recent technology and data. Additionally, support groups and education are effective ways to achieve it.
Another option is to develop a value-based payment model. This model reimburses clinicians based on the quality of care they deliver. It can help reduce unnecessary tests, procedures, and hospitalizations. The goal is to improve quality while lowering costs for Medicare patients.
The Affordable Care Act aims to reward value-based care, which is an excellent place to start. However, it also requires clinicians to develop and manage practice-based population health. In addition, it requires a solid understanding of risk management and delivery systems.
Providers must stay abreast of the latest clinical research and trends. It’s also vital to identify areas to target. For example, developing a care management program is essential for patients with chronic illnesses.
Reduce healthcare costs
Increasingly, healthcare providers are looking to reduce healthcare costs through population health management. It is one way to improve healthcare quality and outcomes while mitigating risks. It involves engaging various stakeholders, including patients, to increase health outcomes.
A program involving population health management can reduce avoidable hospitalizations, improve care for chronic conditions, and mitigate claims risk. However, it requires investment in data, technology, and people.
The majority of the American healthcare system is fee-for-service, which contributes significantly to the high expense of healthcare. These model rewards providers for treating sick people.
However, if we reduce the utilization of effective services, we may see a reduction in costs. It could make American health care costs compared to those of other countries.
In addition, an effective population health management program can improve health outcomes by moving the population to better health. It can be done by engaging employers, consumers, and communities in the effort. It can also be accomplished through education and support groups.
Healthcare organizations are also turning to population health management because of the increasing demand for improved revenue streams. In addition, it can increase population health data, which can help shift one-size-fits-all care to value-based care.