The population health management conundrum: Overcoming challenges to sustainable PHM strategies

The stakes are increasingly high for healthcare organizations to deliver better patient outcomes at lower costs.

Along with increased economic pressures, heightened regulatory requirements and patient demands, these factors continue to raise the bar on care quality and value.

Although population health management (PHM) has been identified as a critical tactic for developing sustainable healthcare models, few healthcare organizations have successfully implemented an effective program to manage patient populations in a way that actually moves the needle on performance. As the industry continues to grapple with best practices, the first step to fulfilling PHM initiatives is to identify why it's been so difficult to implement them thus far.

Current Challenges to Effective PHM
According to IDC Health Insights, effective PHM includes three components:
 1. Functionality to identify and/or predict high-risk populations,
 2. Ability to create and monitor care plans, and
 3. Ability to communicate with both individual patients and broader communities.

This evolved definition goes well beyond the initial steps toward risk stratification that form the basis of many PHM activities today. The IDC description also speaks to the need for an advanced technological infrastructure that that can support real-time health information exchange and analytics initiatives.

The reality is that achieving this level of PHM with an electronic health record (EHR) infrastructure alone is virtually impossible. While the industry has been heavily focused on EHR deployment and optimization to meet Meaningful Use requirements, these investments are really just the beginning when it comes to health IT needs.

EHRs are great repositories of the critical patient data necessary to make PHM work, but few are equipped with the proper data analysis functionality needed to support risk stratification and produce actionable information based on predictive analytics. Ultimately, taking PHM to the next level will require organizations to prioritize technology investments to ensure valuable analytics can be done to support PHM goals.

One challenge, however, is the fact that many stakeholders along the care continuum have little appetite for increased IT investment and change. Health IT budgets have been stretched tight amid multiple regulatory initiatives requiring massive technology expenditures. As a result, most healthcare executives are forced to prioritize resource allocation. In addition, provider fatigue with change is at an all-time high; the significant paradigm shifts in care delivery models in recent years have made many providers wary of implementing new technologies.

Limited success at getting solid PHM strategies off the ground also can be tied to a lack of understanding regarding the level of care coordination required for an initiative to produce positive results. While most healthcare executives understand the need to ramp up patient engagement endeavors, many fail to recognize that these efforts do not start and end with a patient portal. Currently, very few healthcare organizations even have a high-functioning patient portal, so patient engagement undertakings must be broadened to address personal outreach and care management via a variety of methods, modalities and technologies.

Equally limiting to PHM is the fact that clinical leaders do not always understand the value of managing and leveraging available data. To realize the desired patient outcomes, data must be used to change patient behavior and encourage process improvement.

Overcoming the Barriers to Effective PHM
Three basic components must exist for PHM to be effective—big data and analytics, business process management and engagement, education and interaction initiatives. Once these are in place, then strategies can be put into play to overcome seven common obstacles:

1. Change management: Change management is a science, and project leaders should expect resistance and delays during PHM technology and process implementations. Since many implementations fail due to low adoption and push-back, a thoughtful approach to change management must be carefully cultivated and followed at every step along the way; one that considers all involved parties, from technical partners to end users, keeping in mind that in the PHM world, end users include providers and consumers/patients/members.

2. Collaboration: All stakeholders along the care continuum must be on board for PHM to succeed. Implementation teams must bring all parties involved to the table to get early buy-in to the process and technology investments that need to be made to realize success.

3. Platform interoperability: Technology and data access are foundational to sustainable PHM. An advanced infrastructure must exist that supports data aggregation, analysis and analytics, and sharing across multiple stakeholder groups. Key to interoperability is a solid foundation of data management from the very beginning, a commitment seldom addressed that becomes a speedbump along the road to success.

4. Competing priorities: Initiatives such as Meaningful Use and ICD-10, among others, are competing for the resources of healthcare organizations. As such, healthcare executives must make PHM a priority for future positioning in order to impact outcomes and lower cost. Leaders should consider that Meaningful Use and ICD-10 can and should contribute to the overall PHM approach and that these initiatives are aligned to meet the Triple Aim of improving care quality, reducing costs and engaging the patient.

5. Technology limits: Vendor readiness is highly variable today. Clinical and IT leaders must be cautious when determining whether a solution can support PHM for the long-term. An even greater challenge is defining the PHM organizational short and long term plan; finding a platform that can support the needs of today as well as the strategies of tomorrow should be considered top priority. Many technologies exist that meet a niche need, but do not fulfill the full PHM needs of an organization.

6. Patient engagement: PHM plans should emphasize patient engagement by leveraging a variety of technologies and collaborative care models to communicate with patients, putting them squarely in the center of their healthcare. Patients, as well as their caregivers and others involved in their circle of care, should be addressed in an organization's comprehensive PHM strategy.

7. Measure outcomes: No PHM strategy is complete without analytic to support process improvement, quality of care and outcomes management—clinical, operational and financial. Report mechanisms must include the capability to drill down by group, provider, member episode and more to measure successes and weaknesses for constant improvement, as well as empower organizations to effectively measure and manage their risk.

The road to PHM success
Most healthcare organizations acknowledge the potential and value of PHM, but few have been able to achieve these goals across all demographics. With the right technology platform partner and methodical, consultative approach, however, the challenges of PHM can be overcome to realize improved outcomes, increased patient engagement and lowered care costs.

Mary Sirois is the Managing Director, Healthcare Consulting Services at Medecision.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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