Healthcare organizations adopting population health management often don’t ask a simple question before diving in: What is the specific problem we’re trying to solve?

Organizations need to start by focusing on the most significant issue, says Tricia Nguyen, MD, executive vice president for population health at Texas Health Resources. After that problem is addressed, others can be attacked.

During this time, organizations must learn how to use claims data that insurers increasingly are making available to aid providers in conducting analyses, Nguyen says. Many providers believe they need predictive modeling tools to apply risk to individuals, but claims data can provide insights into costs, disease burdens and utilization, such as where patients are going to get care and whether they getting the right care.

Utilization is a key metric, Nguyen believes. That data enables an organization to know which patients frequently visit an emergency department because they can’t get in to see their primary care doctor. Or it can show who is being hospitalized because they can’t get care at home; which asthma patients should be on cortisone inhalers but are not; and whether cardiologists are prescribing multiple stress tests to every patient when that may not be necessary. The ability to manage claims data and gain insights is a relatively new skill that organizations can master, Nguyen says.

Using the right technology tools is another challenge for population health management because of internal issues. The business side of a healthcare organization does not understand population health problems that need addressing; often, the information technology department sees a shiny new tool and decides that will solve the problem. For example, a touted predictive modeling tool may do a good job identifying patients with high-risk scores, but not tell why their risks are high, Nguyen says.

“Everyone is looking for a single perfect solution, which doesn’t exist,” she adds. “If you know data and leverage it, you can decide if current technology meets business and workflow needs. Do you build it out or do you buy it?”

The most important factor in population health management is to engage consumers. Organizations may believe that if they invest in disease management programs, patients will love them. But while a program may work for the organization, it’s not clear that patients will be enthusiastic participants.

Healthcare consumers want convenience, Nguyen says. They want self-scheduling, same-day appointments, extended hours of access, pricing information and a single bundled payment for an encounter covering multiple providers who render treatment during an encounter, she asserts.

Texas Health Resources currently is trying a soft rollout of bundled pricing, but because payers are not yet able to deal with claims from this type of approach, the task is being done manually. Payers are not able to identify which claims belong to a bundled payment provider or member, or a fee-for-service member.

In a major new initiative, Texas Health has aligned with University of Texas Southwest Medical Center in Dallas to create a joint technology structure. Options include building off existing EHR platforms to better manage integration, workflows and reporting, selecting a different EHR and adding population health and integration tools or investing in best-of-breed applications, which would be very expensive.
“We are facing the market as one and taking on risk together,” Nguyen says.

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