Imagine a system in which all health care stakeholders – providers, payers and consumers – share risk in clinical and financial outcomes. Then imagine that they also all have the tools they need to contain this risk. The result? Everyone wins, especially consumers!
The problem? Our health care system today fails on both these accounts. Most of the risk for financial outcomes is shouldered by payers. Consumers share a small fraction of risk, while providers share little to no risk. And even in situations where the financial risk is more evenly shared, individuals and providers don’t have meaningful ways to actively manage their risk.
When providers share in risk, they’re quicker to adopt tools and processes that mitigate that risk, such as population health management. By incorporating these tools and assuming ownership of some of the payers’ best practices, they in turn offer the most effective way to empower individuals to manage their own health risk. Recent evidence underscores these findings:
- A 2010 Optum® study documented what happens when physicians in a community actively directed traditional population health management services. These physicians determined which of their patients would receive health improvement coaching, what kind and when. The outcome? On average a 10-fold greater improvement in measurable biometrics for participating individuals compared to patients receiving only traditional services.
- A Congressional Budget Office analysis of the Centers for Medicare & Medicaid Services Demonstration Project On Disease Management And Care Coordination released earlier this year found that the greatest cost savings came when the treating physician in the community had a direct role in determining what type of health coaching services their patients received, and when and where they received the services. In fact, physician-directed population health management resulted in medical cost savings as high as 7 percent.
It’s critical that we build on these experiences. By creating more opportunities for stakeholders to share risk – and giving them the tools to manage that risk well – we can truly create a health care system that works better for everyone.