ACO Reach Program | An Advanced Value-Based Payment Model

Population Health Management (PHM) is a method of providing Primary Health Care (PHC) that incorporates proactive outreach and community participation in the healthcare system. This methodology transforms PHC service delivery from reactive to proactive supervision of a population group at the lowest possible cost.

The Population Health Management Platform is becoming increasingly important due to the radical transformation in the healthcare system’s service provision and reimbursement techniques. It is compatible with value-based healthcare; a reimbursement structure that public and private payers widely adopt, Accountable Care Organizations (ACOs), and healthcare providers. Both the value-based healthcare paradigm and the PHM prioritize providing quality intervention while reducing the financial load on the healthcare system.

The funds are gradually being focused on outpatient care to reduce rehospitalizations. The payments have become more performance-based, boosting improvements in PHM. The preventive care strategy decreases the probability of patients developing critical (and costly) diseases in the future.

Population Health Management Strategies

Population Health Management strategies not only deliver sustained and customized value-based healthcare to a diversified patient population, but it also decreases the cost of healthcare plans, thus easing providers and payers’ financial load by encouraging proactive care and declining complication rates.

Care facilities, Pop Health outcomes, and health industry features are some of the aspects that affect an organization's PHM strategy. To meet new challenges, the organizations can employ the following PHM strategies to achieve sustained healthcare for the population:

• Population Data Transformation
• Analytic Transformation
• Payment Transformation
• Care Transformation

Population Data Transformation

Integrating a plethora of internal and external data such as clinical data, claims data, cost data, participation data, and socio-economic determinants of health, provides crucial guidance to organizations in regulating their resources, risks prospects, and plans to enhance healthcare effectively.

Analytic Transformation

Organizations need an analytical framework to identify and evaluate the population data to formulate the right PHM strategy for improved activities. Analytical transformation assists in synthesizing and prioritizing possibilities for the target population with the appropriate intervention. It also helps understand the healthcare cost and create plans for evaluation to ensure initiatives impact the right areas.

Payment Transformation

Organizations will be unable to enhance Pop Health if they adopt a value-based care model without the tech-based payment mechanism. Population Health Management for Payers must comprehend the overall healthcare cost by analyzing risk contracts to ensure that they are adequately paid for the services they provide.

Care Transformation

Organizations improve care management processes and outcomes to assist individuals across the healthcare system. Care transformation can be achieved by improving primary healthcare infrastructure, ensuring effective care is delivered at the right time, and increasing patient and provider involvement.

Conclusion

Effective PHM strategies encourage change at all levels of health service provision, including preventive and care management. Data-driven care management helps in lowering healthcare costs and improving patient outcomes.