The Role of Population Health in Value-Based Care

As value-based care gains momentum, healthcare systems and insurers are looking at care with a new lens. Reimbursement is dependent on positive patient outcomes, not the volume of services rendered. As a result, providers must take a team-based approach to care that focuses on the whole person, not just the conditions that patients present at a given point in time. 

Within five years, value-based care could be the norm for most patient populations. The Health Care Payment Learning and Action Network, a public-private partnership established by the Centers for Medicare and Medicaid Services, has set aggressive goals. By 2025, they expect 50% of Medicaid and commercial insurance payments and 100% of traditional Medicare and Medicare Advantage payments to be tied to quality and value.
 
Value-based care organizations recognize that a significant key to success is getting the treatment plans right the first time for the right individuals. However, delivering the right care to the right people at the right time, requires providers to have comprehensive knowledge about their patients. 

To deliver true value-based care, healthcare providers need insight into the characteristics of both individuals and larger groups of patients. 

Population health management replaces "one size fits all" care with tailored, cost-effective interventions based on patients' risk levels. This approach is well aligned with the goals of value-based care. 

Adopting population health management enables organizations to:

• Consider the physical, social and economic conditions that may affect health. Untreated behavioral health issues, for example, can become a catalyst for serious physical health issues. Nonclinical risk factors like physical environment, income status or availability of basic resources can also affect a person's ability to access care and maintain healthy habits. 
• Focus on prevention. Preventive care is an essential component of value-based care. Focusing on "well care" can prevent patients from developing serious illnesses. The goal is to identify risks and arrest risk progression by proactively getting ahead of health issues. 
   

To deliver coordinated care efficiently, healthcare systems must eliminate data silos, unleash the power of information through analytics, and communicate in frictionless ways with providers and patients. Three keys to achieving this vision include:

• Interoperability. To make value-based care a reality, physicians need comprehensive patient data, including information about social determinants of health. Access to this level of patient data will only be possible when healthcare information systems are integrated. When healthcare systems become truly interoperable, they provide a multi-layered understanding of patients which enables clinicians to care for the whole person. 
• Predictive and prescriptive analytics. These are essential for identifying hidden and rising patient risks in real-time. Artificial intelligence-driven prescriptive analytics and other advanced analytical techniques can process hundreds of predictors from claims, self-reported consumer data, electronic health records, census, and social determinant data. Thanks to advances in technology, predictive and prescriptive data analytics are no longer limited to healthcare organizations with deep pockets and PhD-level data scientists on staff. The return on investment is clear, based on the cost savings that analytics can deliver.
• Patient engagement solutions. These technology platforms consider the underlying factors that often inhibit people from practicing healthy habits. With this information in mind, communications and other outreach campaigns are designed which motivate patients to take positive actions for their health. 

Thanks to population health technologies, healthcare providers have insight into patients' unique needs and the power to create care plans that are tailored to those needs in real-time. The result is healthier communities and lower cost services – the very definition of value-based care.

To learn more about HMS’ Population Health Management solution, visit our website to discover how HMS can help you move toward value-based care.
 

HMS advances the healthcare system by helping organizations reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of dollars annually while helping consumers lead healthier lives. HMS provides a broad range of coordination of benefits, payment integrity and population health management solutions.