In theory, using population health data allows medical professionals to assess ways to best target gaps in care and improve health outcomes, while also lowering medical costs. However, for many providers, the rewards of population health remain a goal to reach.
To accomplish it, providers need to further understand how to weave together population health approaches, accurate patient data and value-based care.
"You can’t achieve value-based care without population health management," said David Nash, M.D., founding dean of Jefferson College of Population Health, part of Philadelphia University and Thomas Jefferson University. In 2018, the college received an endowment of $2 million from a technology vendor to establish a population health professorship.
Recognizing gaps leads to prevention
Population health management enhances healthcare delivery in the general population or a specific subset of at-risk individuals. A key piece of the method is to use business intelligence and analytics on clinical, financial and operational information to uncover useful data and identify care gaps in patient populations.
Population health approaches also aim to alleviate costs through prevention and management of chronic diseases while improving clinical proficiency and patient engagement. Nash likes to think of this notion in starker terms: "no outcome, no income." In other words, under a value-based model, if healthcare treatments don't improve results, Medicare and insurance reimbursements drop.
"Care coordination, risk stratification [and then] moving upstream to practicing prevention, nutrition, exercise -- all of those [are] population health basics," Nash said. "When you manage the population, you are getting closer to a no-outcome, no-income world.”
David NashM.D., founding dean, Jefferson College of Population Health
Risk stratification -- a process of dividing a population of patients into groups based on health, lifestyle, medical histories, demographics and socioeconomic characteristics -- creates a more comprehensive patient profile. According to the National Association of Community Health Centers, the use of risk stratification enables providers to identify the appropriate level of services for a distinct subset of patients, upon which population health approaches can be applied.
Managing chronic diseases and conditions, like cancer and diabetes, is expensive. Therefore, value-based care focuses on helping patients recover quickly and engaging in chronic disease prevention, with those results tied directly to reimbursements.
Value-based outcomes go beyond immediate patient health, too, including reductions in medical errors and increased public accountability for healthcare policies, Nash said.
"If you don’t achieve those outcomes, you are not going to get paid, or you’ll get paid significantly less," he added. Successful value-based care relies on population health approaches and the technology behind them.
ACO sees $2 million in savings
New Jersey-based Allegiance Health Group and ACO offers a case study in successful population health management. Population health analytics technology bought by the accountable care organization helped save $2 million in healthcare spending among its Medicare patients in 2015, according to the company.
The creation of a population health strategy was in response to the rising costs that chronic care management squeezed from the ACO’s budget. Supplied with data detailing care delivery gaps, Allegiance was able to adjust its focus onto patients who required more immediate attention, resulting in the savings, the group said.
Meanwhile, Humana, a major for-profit health insurance company based in Louisville, Ky., released study results in November 2018 that showed lower Medicare costs among clinicians whom had shifted to value-based care. Humana determined that costs among senior citizens enrolled in its Humana Advantage plan, which reimburses physicians on a value-based model, were 15.6% lower in 2017 when compared to the expenses of similar patients in traditional fee-for-service Medicare plans.
Also, the expansion of population health management data helped better manage the health of patients and improved the direction of their outreach and care, according to study results.