As healthcare evolves, providers now must look beyond the well-being of their individual patient populations and take into consideration the collective health outcomes of much larger groups of individuals. Improving health outcomes — rather than simply providing more tests, medications or procedures — is the goal of value-based care, the keystone of healthcare reform. Providers are actively exploring ways of using data, analytics and care coordination tools to manage population health and make value-based care a reality.
Consolidating “big data,” or the massive amount of information needed to improve population health, is difficult. Many healthcare organizations lack the IT infrastructure and staff to gather the required data and transform it into actionable information. Meanwhile, privacy remains a constant concern; there are questions about the ownership of health data, including how and by whom it may be used. Greenway Health’s population health tools are designed to help you overcome these challenges and successfully transition your practice to incorporate the value-based care model.
Population health is the collective health outcomes of a group of individuals. Though patients are still treated individually, population health-focused medicine strives to prevent and manage progression of illness on a large scale to improve the overall health of a group of people.
Improving healthcare delivery and outcomes means more than collecting data; you must be able to practically analyze and apply the data to reduce patient risk and improve delivery of care.
Mining big data enables providers to identify patients at risk for serious health conditions, so they can take appropriate steps to proactively manage care. This can lead to better health outcomes and lower costs by reducing follow-up calls and patient visits.
Big data can also help identify and reduce risk. For example, mapping home addresses of patients who go to a hospital emergency department (ED) for non-emergency conditions — such as a headache or sore throat — can identify neighborhoods where outreach services are needed to aid residents in receiving the appropriate care without visiting an ED. This also enables practices to reduce their area’s healthcare costs, a key component in maximizing value-based program reimbursements.
Individual practices likely can’t produce the amount of claims and clinical data needed on their own; instead, they require access to a larger data set from multiple healthcare organizations. That means a successful population health solution needs to be able to collect and compile data from other electronic health records (EHRs), health information exchanges (HIEs), hospitals and other healthcare systems. The more healthcare providers who contribute data in usable formats through those systems, the more promise big data holds.
Because each value-based program uses different measures to track population health and selected measures vary from contract to contract, participating in those programs can prove difficult and time consuming without the proper tools. Population health and care coordination tools provide insight into established value-based program requirements via a visual analytics dashboard. With this, practices can constantly track their clinical and financial performance and adjust accordingly to meet accountable care organization (ACO), Healthcare Effectiveness Data and Information Set (HEDIS) and patient-centered medical home (PCMH) measure sets to earn maximum incentive payments.
Value-based programs represent the future of compensation in healthcare. Forty percent of all reimbursements are already tied to value-based arrangements, and 90 percent of all payers presently offer value-based contracts. Major insurance companies are currently aiming to have 50 to 70 percent of reimbursements tied to quality care by 2016.
These changes can significantly benefit providers, as value-based reimbursements represent an estimated $200,000 to $300,000 in additional revenue per physician. Medicare’s Shared Savings Program, private PCMHs and ACOs, Medicare’s value modifier and other programs such as the Comprehensive Primary Care Initiative (CPCI) all demonstrate the present and future importance of value-based payments.