Payers are finding it necessary to define their approach to population health management in response to certain factors, most of which are driven by the Affordable Care Act (ACA). These factors include economic pressures, increased regulatory requirements, shifting membership profiles, trends in program optimization and the transition to value-based reimbursement.
As risk shifts from payers to providers, more payers are engaging providers to take on broader roles in population health management. New population health models embedded in the community are one such example. But for these programs to be cost-effective and successful, plans must have IT systems and analytics capable of supporting the new model and engaging the right people.
Enabling effective collaboration
Depending on who is defining it, population health management can mean many things. Compartmentalizing its different components is easier when you base it on payer functions and the membership mix supported by population health goals.
Categorizing a health continuum from lowest risk to highest risk — healthy, chronic, catastrophic, terminal — will help you categorize potential cohorts based on inputs such as claims, pharmacy, lab, behavioral assessment and clinical data. You can then develop programs to address each cohort, but such programs must address the Triple Aim: provide better care for individuals, improve health for populations and lower per capita costs.
Achieving the Triple Aim doesn’t happen in a vacuum — it takes diverse capabilities and each program must be robust, optimized and integrate well across other programs.
The components needed to promote successful population health management start with strategy and continue through to provider engagement.
Strategy and governance:
What investments do we make? Where do we start? What is the value of the new strategy?
How are initiatives governed?
How do we best engage consumers in managing their health?
Technology and related functions:
What technology do we need to manage our populations?
How do we transform physician care to become standard, evidence-based and higher quality?
For extended content on population health management strategy development, enjoy a complimentary download of “Building and optimizing a population health management strategy.”