Population health management: A technology perspective
INSIGHT ARTICLE |
The shift away from volume or episodic care delivery, and a focus on a comprehensive standards-driven approach that results in lower costs and improves health care outcomes, requires a rethinking of the health information technology platform. This also necessitates a paradigm shift in the way the patient population is served by health care providers and how this care is reimbursed by health care payers. This article addresses this new approach to health management of a patient population with insight on the tools, process and market observations that are pertinent to this discussion.
Previous regulatory mandates, specifically the Health Information Technology for Economic and Clinical Health Act and the Medicare and Medicaid electronic health record (EHR) incentive programs, have laid the foundation for technological innovation by digitizing patient health records across the country. According to a study by the Office of the National Coordinator for Health Information Technology (ONC), since 2008 there has been a nine-fold increase in the number of providers utilizing EHRs.
New regulations, like the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), have created an environment where providers are further incentivized to change the approach to care delivery. This is a seismic shift from the model of care in which the incentives were to increase volume and throughput within a fee-for-service framework to one that challenges the provider organizations to approach care with the results in mind—in a fee-for-performance framework—be it qualitative patient outcomes or reduced health care expenditure in comparison to established peer and contractual benchmarks.
The technology evolution over the last decade has provided a treasure trove of information to create a data-rich knowledge base about a patient population which is hosted and curated within the provider domains. The advancement of the health information technology platform enables providers to build actionable insights based on this data that will contribute to understanding the patient population better, predicting care demands, and suggesting care processes geared towards improving patient health outcomes while reducing costs.
The result will enable the triple aim of better care, smarter spending and healthier people as health care dollars are spent towards prevention, and care models are geared toward collaborative, targeted and return-on-investment-driven care management with a focus on outcomes. Ultimately, this will lead to a healthier population.
Population health and technology’s impact
Most fundamentally, one can define population health as an effort to provide the most informed care for a patient population through a comprehensive care delivery approach with a goal of improving overall health care outcomes in a cost-efficient manner. Technology will be critical in the successful achievement of these goals.
As health care moves away from volume, care venues will become less relevant than actual management of care. Innovation in technology is driving this change with telemedicine and mobile and web-based applications that can bridge the gap between physicians and patients. Thus, it has become critical that health care information is safely and meaningfully shared between disparate systems and solutions. Interoperability is more critical today than ever, and it will continue to be the biggest lever in health care innovation in the future. It is essential to managing the health of a population and it is a key element to the overall transformation of health care.
The ONC released a nationwide interoperability road map in 2014 to promote appropriate health information exchange as it pertains to improving health and care. Furthermore, interoperability is an essential component of the learning health system framework. According to the ONC, the intent of the learning health system is to function in an interoperable environment of health care IT solutions to enable lower costs, improve health, drive innovation and empower the consumers (see illustration below).
The health IT ecosystem as a learning health system
The Learning Healthcare System: Workshop Summary. Leigh Anne Olsen, Dara Aisner and J. Michael McGinnis.
A successful population health management platform cannot be achieved without a focus on system interoperability. As much as any organization might try to standardize around a single health information technology or EHR platform, the complete picture of a managed population of patients will require integration and system interoperability. The intelligence within clinical insights to drive data-driven decision support needs access to contextual data. The artificial siloes of data need to be broken and with the proliferation of health information technology, this data may reside in a combination of several different systems.
A mechanism to seek, identify and reconcile this data for the benefit of clinicians and patients requires intention and commitment of health care organizations, plus the necessary tools and strategy to enable an interoperable environment.