How do you define population health management (PHM)? If you’re like most health care leaders, you believe that PHM is the practice of improving health outcomes of a large population of patients and identifying groups that are most at risk and need additional care by applying clinical analytics. That’s correct, but execution against this is complex and requires systemic changes.
Frost & Sullivan, a national consulting firm focused on growth strategy, defined PHM as a discipline that encompasses data governance and management, financial risk management, quality and clinical integration, network management and contract optimization. According to Frost & Sullivan, most organizations haven’t adopted true population health management due to a lack of strategic preparedness and direction.
But they have purchased analytics tools. The PHM market has been valued at $11.3 billion for 2015 and is expected to grow to $31.6 billion by 2020. Hospitals, medical groups and payers may not be getting the most value out of those data and analytics solutions because of the incremental approach to adopting value-based care contracts and the resulting limited scope of their population health management programs. In addition a lack of expertise in using the analytics tools and the framework needed to identify opportunities to drive value further impacts the ability to achieve care transformation.
Providers and payers can derive the most value of PHM– for consumers (patients) and for themselves – by engaging with what Frost & Sullivan term “pure-play” PHM vendors. These vendors offer advanced functions that go far above typical EHR and analytics technology. Best-in-class vendors offer service and technology capabilities that include:
- Analytics that power the shift to value-based models
- Payer contract performance evaluation
- Provider network management
- Care coordination and patient engagement
- EHR-integrated patient condition monitoring
- Network wide utilization benchmarking
To get all of these benefits takes more than just software. It takes comprehensive data, enterprise-grade analytics and most importantly, the expertise and strategic experience to make sense of it. Pure-play vendors provide all the above.
To learn more about pure-play PHM vendors, download an executive summary of the Frost & Sullivan report. For additional resources on developing a strategic approach to value-based care and risk optimization visit www.Optum.com.
About the author
Amanda Skinner, VP and General Manager
Amanda Skinner joined Optum Analytics in August 2016 as vice-president and general manager, Managed Value and Risk Analytics. Before joining Optum Amanda served as executive director, Clinical Integration and Population Health for Yale New Haven Health System, responsible for developing and implementing a clinically integrated network for Yale New Haven Health System and strategic initiatives for value-based care and population health management.