With the emergence of value-based care and increasing focus from buyers on outcomes, health plans are feeling the pressure to prove that their population health programs are delivering on the promise to achieve the Triple Aim. Increasingly, reimbursement is tied to quality, utilization, and financial outcomes and health plans need to act now to develop new strategies that align with the new paradigm of value-based care.
Plans need to comprehensively understand the needs of their population and understand the impact of their strategy on cost and utilization. This can be achieved using a comprehensive set of data across medical, pharmacy, lab, behavioral, clinical, and care management data and comparing your results to benchmarks across a number of cost and utilization metrics.
The results of this exercise can inform a data-driven strategy related to your member and provider engagement strategies, including a comprehensive set of care programs that align with the value-based care agenda that health plans demand.
Developing an effective PHM strategy is complex and requires a methodical and data-driven exercise to:
- Identify stakeholder goals and assess the current state. Is value being driven by current programs?
- Using best practices and benchmark data, identify and prioritize opportunities and confirm that these opportunities are in line with business strategic objectives
- Develop a strategic road map by grouping opportunities into logical initiatives, estimating resources needed and potential obstacles, and sequencing initiatives into high-level timeline.
With a data-driven population health strategy in place, payers can align people, processes and technology, and unite departments across the organization to improve quality and meet population health management (PHM) program goals.
To learn more about solutions to improve PHM programs, download the latest issue of OnTrend: Population Health Management.
About the Author:
Population Health Management Consulting lead, Optum.
Andrew has 16 years of health care management consulting experience, focused on assessing, designing, implementing, and launching Population Health Management, Quality, and Provider Engagement system and business solutions for payers and providers