Population Health Management: A Value-Based Approach

Population Health Management (PHM) is a preemptive, data-driven approach aimed to improve the health of a specific demographic through the participation of a specified network of financially related healthcare professionals. PHM has emerged as a key priority for healthcare organizations as they gear up for value-based financial compensation and risk contracting.

Population Health Management Platform stratagems have advanced steadily over the years, from PHM 1.0 (mid-1990s) through PHM 2.0 (about 2012) to PHM 3.0 (2020 and onwards). PHM 3.0 has moved beyond insurers and providers to a marketplace in which PHM is a free and open application programming interface that integrates the whole care continuum.

What PHM Challenges Must Be Addressed?

Even with the PHM progression to 3.0, fundamental hurdles in implementing a demographically focused approach persist:

1.  Creating a clinically integrated network is critical for obtaining insights from the outpatient perspective. 

2.   Earning end-user satisfaction necessitates data analysis transparency. Effectively conveying the optimum strategy for a specific patient or demographic to an end-user (e.g., practitioner) involves insights traceability.

3.  Troubleshooting data accuracy and latency solutions aren't competent enough to properly gather, filter, and standardize data.

When developing PHM skill sets, healthcare organizations should evaluate a variety of elements, including informatics, care practices, and practitioner ethos.

What is the impact of Population Health Management on healthcare?

By researching the patient population and identifying the most appropriate and efficient ways of treating them, Population Health management Platform enables the shift to value-based care.

PHM allows healthcare transition by facilitating telehealth/telemedicine, remote patient monitoring, and altering strategies and procedures linked with various levels of health risk. The goal is to reduce the population's vulnerability to an acute onset of treatment and chronic health issues.

Population Health Management evolves through the successful use of software for data acquisition, data management, predictive modeling, and business intelligence.

Obtaining and interpreting data helps clinicians to discover the patient population's most pressing requirements. For example, if a significant proportion of a patient group has a specific condition, such as hyperglycemia, hypertension, and the accompanying socioeconomic determinants of health. PHM enables healthcare professionals to forecast and evaluate patients at risk of hospitalization, design treatment plans, and comprehend the health patterns of the patient group.

In the face of uncertainty, healthcare organizations can move forward with Pop Health by adopting the standard practices of value-based care:

• Begin with Medicare Advantage, which offers enormous potential and little entry hurdles.
• Prioritize outpatient services over critical care due to cost-effectiveness.
• Employ registries to find influential participants.
• Concentrate on realistic strategies to relieve clinicians' stress.

 

Best Population Health Management Software in 2022

The healthcare ecosystem is pursuing its Value-Based Care approach to increase care quality and outcomes while lowering costs. These attempts to attain the Triple Aim are driven by Population Health Management (PHM) practices.

Healthcare professionals utilize Population Health Management Platform to design treatment plans better, track healthcare outcomes, and generate quantifiable enhancements in a group's healthcare outcomes.

Population Health Management Software

The most effective Population Health Management technologies integrate clinical, financial, and operational information to produce substantial healthcare analytics for practitioners to increase performance and care delivery. Successful Population Health Management necessitates competent care administration, risk management, and an efficient delivery process.

A PHM software typically fits the Population Health Management Platform's following criteria:

• Provide care coordination tools to practitioners.
• Lead to increasing patient participation.
• Evaluate health records to detect, track, and monitor patients, treatment procedures, and diseases.
• Make data interchange between EHRs and other record databases easy.

 

Innovative Population Health Management Software in 2022

Efficient and productive Population Health Management Platform accumulates data from several healthcare settings, stores patient information for analysis, and manages care quality across the population by employing advanced analytics.

However, to overcome new challenges in the healthcare industry in 2022, healthcare organizations and providers will need augmented Intelligence, Internet of Things (IoT), patient-portal, wearable technologies data, and information from multiple sources other than EHRs to reinforce structural, data-driven decision-making.

Augmented Intelligence

Healthcare leaders will rely on Augmented Intelligence to steer their decisions to prevent the severe risk of flawed, contradictory, and ambiguous interpretation of medical files. The sophisticated algorithms will make data accessible and understandable. 

Augmented Intelligence has the potential to expose previously hidden insights. It will improve the accuracy, consistency, transparency, and accessibility of insights to promote organizational, real-time decision making.

Internet of Things, Patient Portal and Wearables Data

Telehealth necessitates the development of a data approach that integrates new IoT, patient portals, wearables data, and the governance and orchestration necessary to incorporate this data into care delivery.

While organizations have moved to the cloud, new storing and curation requirements are propelling the rise of the data "lakehouse," a hybrid of contemporary and existing abilities that can govern and orchestrate data.

Info Not Found in EHRs

As a result of a shift in financial risk to providers and legislative reforms, access to data and products is rising, and information asymmetry is lessening. Consequently, population-based data becomes more critical.

With this accurate data, population health professionals will bend the cost curve in spots ripe for disruption, such as the nexus of behavioral health and chronic conditions.

 

Helpful Tips for Bridging HCC Care Gaps in Medicare Advantage (MA) Plans

 The Centers for Medicare and Medicaid Services (CMS) pays MedicareAdvantage (MA) Plans for each insured participant, giving preference to older and disabled adults who meet the criteria. Apart from hospice care, the MA coverage is the same as Part A hospital, Part B medical, and Part D prescription medication coverage.

Instead of being provided by the federal government, the Medicare Advantage Plans, often known as Part C or MA Plans, are provided by Medicare-approved private organizations that must adhere to Medicare's regulations. They often include hospitalization, medical care, and prescription medication coverage. Healthcare companies get a predetermined monthly premium for insurance coverage and charge enrollees for out-of-pocket expenditures.

MA Plans and Hierarchical Condition Categories (HCC Coding)

CMS-HCC Coding system compensates Medicare Advantage Organizations (MAOs) differently depending on condition prevalence and demography. Approximately 9,000 ICD-10 codes are classified with a risk factor. Weighting or a stratification assigns higher scores to more severe issues. Must report conditions annually under the HCC Coding framework.

Bridging HCC Care Gaps and Ensuring Effective Code Tracking

It is critical to document all HCC codes for the ascribed members to provide correct risk adjustment scores and total payer allocations.

Healthcare organizations can close HCC Care Gaps by following these helpful tips: 

1)      Check Patients once a year

Diagnoses must be obtained through face-to-face consultations and reported on an annual basis. Plan ahead of time and develop comprehensive outreach strategies.

2)       Plan ahead of time for patient visits

Assist physicians in identifying HCC patients ahead of time so that activities like chart prep, issue list reviews, and morning huddles can be more impactful and focused.

 3)     Use Appropriate Forms

Use Patient Assessment Forms (PAFS) or Comprehensive Health Assessments (CHAs) to collect comprehensive and accurate diagnoses at the point of care.

 

4)      Automated chart review process 

Utilize techniques to monitor high-value interactions that require coder review, optimize your workflow, and guarantee that HCC coding is completed before claim submission.

 

5)      Determine Performance Indicators

Evaluate the Key performance indicators and data that the team should monitor to operate successfully, and then develop timely, consistent reports on important reimbursement drivers like:

 a. Recapture rate of HCC (by location and provider)

 b. Patient risk adjustment score trending

 c. Patients with severe illnesses that must be scheduled

  

6)      Assemble the Correct Team

Healthcare providers must receive assistance to finish the documentation and HCC data analysis. If required, consider hiring additional support personnel.

 

Best Population Health Management Tools in the USA

 Population Health Management (PHM) is increasingly becoming a must-have strategy for healthcare organizations. The PHM aims to improve general health issues, assist healthcare providers and public utilities in identifying unreported patient needs, formulating essential healthcare priorities, making effective use of public funds, preventing illnesses, and forecasting care requirements.

The Population Health Management Platform accumulates patient data from numerous health informatics and then interprets it into implementable patient data. Healthcare organizations invest heavily in the Population Health Management Platform to benefit from predictive advising, clinical decision making, patient association management ability, and other performance characteristics that complement the Triple Aim.

Functions of Population Health Management Tools:

The Population Health Management Platform offers an extensive patient data repository and a set of analytic tools for better predicting and managing illnesses. Another use of PHM tools is to make care delivery more efficient throughout the population.

The PHM tools strive to raise the organization's efficiency and cost-effectiveness while also improving the quality of tailored care delivery. Data aggregation and interoperability contribute to more accurate patient health risks and a more precise picture evaluation of public health patterns.

The data analytics' characteristics of the PHM tools can be used to optimize the value and expenditure of care and investigate health behaviors in a population.

Population Health Management Platform and Value-Based Care

compared to traditional fee-for-service models, Pop Health tools are becoming more synchronized with value-based care delivery methods, also known as CMS pay-for-performance mechanisms.

When calculating cost analysis, the value-based care delivery model estimates the quality of service or treatment is delivered and the patient's health outcomes. This healthcare strategy emphasizes treating patients with coordination and communication among clinicians across all patient care stages.

Healthcare practitioners that employ the best Population Health Management tools to facilitate effective treatments and improved care quality will be qualified for incentive payments under this value-based care paradigm.

Population Health Management Companies in the USA

The Population Health Management Companies in the USA provide PHM solutions that combine care administration, a thorough grasp of risk management, and a well-managed delivery method to decrease costs while providing patients with increased participation.

Among the most outstanding PHM tools and capabilities are Data Capabilities, Financial Services, and Care Management. Their further classification is as follows:

Data Capabilities

• Data analytics
• Predictive analytics
• Business intelligence
• Integration with EMR and EHR software

Financial Services

• Cost-of-care analysis
• Payment bundling
• Dashboard feature

Care Management

• Predictive alerts
• Patient-reported data
• Patient risk stratification
• Reminders for testing and treatment
• Patient involvement and outreach