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Gaps in Population Health Management?

By Tamara StClaire

By 2018, the Centers for Medicare & Medicaid Services (CMS) will require 50 percent of payments to be value-based, meaning providers are compensated for healthy outcomes rather than each service provided.

Tamara StClaire
Tamara StClaire, chief innovation officer 

Population Health Management strategies can address some of the concerns that payers and providers have about the shift to value-based care. But these strategies often rely on disjointed and non-integrated technology and services, which can make it harder to manage healthy patient populations.

Last Thursday, I explored this topic in depth with four experts:

We discussed the gaps between patients and their healthcare payer/provider, how the relationship between providers and health plans should change in the new healthcare economy, and ways we can ensure the healthcare system works better for consumers.



Below are a few key points made by the Hangout participants.

Mandi Bishop: “I think the definition of population health management depends on your lens. From the provider perspective, population health management is often limited to the data that’s readily available to you within your own [electronic medical records]. Your cohort is very limited because you don’t have access to information outside of your own practice area. Insurance is the thing that binds us to our healthcare.”

Dr. Geeta Nayyar: “There is a difference between population health, and population health management when we talk about community level. When you can see the data on pollen in the area, or things like places where they’ve run out of flu shots you can directly relate back to a certain issue. Population health management is the harder part. The technology is out there – but who’s out there looking at the data and owning it?”

Jennifer Dennard: “It’s important to remember that employers have a role in population health management as well. The question is, how do we get consumers, employers, payers and providers all on the same page?”

David Rauch: “At its core, healthcare is best delivered locally; each state and each population has its own unique characteristics. Some states have bigger problems in obesity or lack of mobility and other populations are made up of an older generation. The needs in each population drive what their success measures are.”

Payers and providers are struggling to balance the need to move to a value-based care model with concerns that there are significant obstacles to its success. There are a number of technology solutions that claim to help manage patient populations and improve outcomes, but they frequently involve point solutions that create more confusion and work for the end-user. Payers and providers need more complete, integrated and end-to-end solutions that can identify and analyze patient populations more holistically.

What do you think can be done to help make the shift to value based care? Let us know in the comment section below!