The journey to value: Handling risk means understanding your patient population

In our last Journey to Value post, we discussed how having all key players in alignment allows a provider organization to better manage risk. There’s one element still to consider: the patient. To get a true handle on risk, health care providers must first understand the needs of the populations they’re serving. Here are four areas to consider:

  • Identify market dynamics — Provider organizations must understand the external and internal market dynamics that will impact their pace of change. Critical factors include determining the speed at which the market will change, projected growth changes in population, health coverage shifts and population and market care needs. Organizations also must examine their own capabilities, including whether they have the three most important capabilities in place: data analytics, care management infrastructure and a system for internal compensation.
  • Conduct a financial impact assessment — This is a critical step in determining the pace of change and how it ultimately will impact the organization’s bottom line. This assessment should determine the effect of converting commercial, Medicare and Medicaid contracts to bonus structures or risk, as well as the appropriate timing. The appraisal should also ascertain how and when to implement care management programs to reduce unnecessary utilization. Additionally, the assessment should establish the investment required for population health management, including infrastructure and resources.
  • Define the needs of your population — Organizations need to define the population health needs of their market segments and identify associated care delivery and care management models to ensure they deliver on value-based contracts. Understanding the needs of each market allows an organization to define macro-level strategies and associated micro-level processes.
  • Assess your provider network — Value-based organizations need to assess their provider network to ensure they have the optimal mix of primary care providers and specialists. This includes evaluating new business structures, including clinically integrated networks (CIN), independent practice associations (IPA) and the employed versus non-employed model.

In the end, the performance of physicians — primarily specialists — will determine success. Organization leaders must distinguish between high- and low-performing physicians. Data will show which specialists produce the best outcomes in the most efficient manner and with the greatest patient satisfaction. With such data, providers can understand which physicians act in a way that aligns with organizational goals and take appropriate steps to deal with those who don’t.

For more on this topic, download our latest white paper The journey from providing care to managing health.

In our next post, we’ll discuss two areas where provider organizations can invest for present and future profitability.

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