Generating a return on a population health investment isn’t an all-or-nothing proposition. Rather, the level of financial return providers see exists on a continuum.
“The bottom line is the higher percent of your revenue that’s coming in through risk, the more it makes sense to do this,” said John Poelman, senior director with consulting firm Leavitt Partners.
Healthcare providers have to be calculated with the pace of their population health transitions. If they go in too quickly and reduce patient volumes while their revenue is still 85% fee-for-service, that could be a problem, Poelman said. But even if revenue is as low as 30% at risk, the investment in population health makes much more sense.
It’s also important to note that some providers aren’t transitioning to risk because commercial insurers or large employers in their particular region simply don't offer those contracts.
Even if population health management doesn’t pay off tomorrow, that doesn’t mean it’s not a good investment for the future. First and foremost, it improves people’s health and well-being, which should be the No. 1 goal of any healthcare provider.
And even if a health system is just toe-dipping, with 5% or less of its revenue at risk, that’s important practice for the industry’s eventual shift to paying for value.
Some experts said they think fee-for-service medicine is on its last legs. The COVID-19 pandemic further exposed weakness in the model when volumes dried up. The shift will finally happen when CMS pushes the issue through payment models with commercial payers following suit. Disrupters who can provide care cheaper will also force the issue.
Policymakers and insurers should work to make fee-for-service medicine less and less profitable, Pham said.
“It’s not good enough to make the population health side attractive, you have to make the alternative really unattractive,” she said, “That has not happened yet because no one has the political will to do that.”
And, yes, there is some evidence population health management saves money. In one case, every dollar a Medicaid plan spent hiring community health workers yielded a $2.47 average return, a 2020 Health Affairs study found.
Such findings show that sometimes doing the right thing for low-income patients can actually help a provider’s bottom line, said Dr. Judith Long, an author on the study and chief of general internal medicine at the University of Pennsylvania’s Perelman School of Medicine. Community health workers not only create meaningful jobs, they address unmet social needs like housing and food insecurity, she said.
“But let’s say you don’t care about any of that,” Long said. “We can say: Besides all of that, you might save money doing this. There are a lot of reasons you should be doing this, and this is one extra reason.”
Liam Bouchier, a principal with Impact Advisors, worked with a six-hospital system in South Florida that saved $15 million in 2018 through a CMS Next Generation ACO after only investing a couple million to get the project up and running.
That said, he’s noticed health systems aren’t always thinking about how such programs jibe with their fee-for-service sides.
“I’ve often seen a disconnect—‘Well, we know we can save some dollars here, but does it fit into the bigger-picture strategy?’ ” he said. “Is this model applicable to our environment? Maybe yes, maybe no.”