In our last blog, we talked about what it takes — a combination of claims and clinical data — to lay a solid foundation for population health management, or PHM.
Now let’s take a look at the four steps of PHM, starting with the first step, optimizing network management.
Value-based organizations should consider the referral network their physicians use. Patient referrals nearly doubled in the previous decade, and often these referrals are not based on the quality or cost of the care specialists’ provide, but rather patient experience or physician communication (meaning they worked in the same clinic or shared an EMR).
In value-based contracts, it’s in a physician’s best interest to refer to specialists who provide high-quality, cost-effective care. By analyzing their patients’ claims and clinical data, physicians can identify specialists who provide the best care at the best value.
Optimizing network management through data transparency can have a significant impact on individual patients — and whole populations.
An Optum study found that when patients are redirected to providers who exhibit lower cost and higher quality care, they see 10 percent fewer spine, hip and knee surgeries, saving as much as $15,000 in health care costs per redirection. At the population level, complication rates among the provider’s patients for implantable cardiac device surgeries have dropped by 60 percent when performed by quality-designated cardiothoracic surgeons.
In our next blog, we’ll examine the second step in PHM, managing care transitions.
For an in-depth discussion on the four steps to population health management, download our white paper The Four Steps of Population Health Management.