The beginning of 2017 marked the start of the first MACRA reporting period and a step forward for value-based healthcare. Because of MACRA—the law behind the Quality Payment Program (QPP)—from this point on, quality and efficiency will be even bigger drivers of reimbursements.

For physicians and their teams, the focus now needs to be on finding economical ways to do the most good for the most people, making population health management a critical strategy. According to the American Academy of Family Physicians, practices that implement population health programs can more easily identify chronic and preventive care needs, provide planned care and outreach based on diseases or conditions, offer patients self-management support, monitor health and recommend changes to care plans, and evaluate practice performance by tracking patient data and comparing it with national guidelines and internal benchmarks.

The key to achieving these and other population health benefits is data that enables healthcare teams to focus on the various factors impacting their patients, and then work to create proactive care programs for different patient groups.

Electronic health records (EHRs) hold much of the data necessary for effective population health management. From EHRs, providers can draw information about the makeup of their overall patient population. They can also stratify risks and organize patients into subpopulations based on their conditions and care needs, which enables healthcare teams to provide groups of patients with targeted support.

When EHR systems are optimized, each patient’s electronic record contains a comprehensive health history that can be used to signal next steps in individual patient care and also population health management.

In the six or so years since the healthcare industry really began to get serious about adopting EHRs, one of the benefits is avoiding payment reductions, while obtaining data for population health management is another.

Payment penalties and incentives tied to EHR use were previously dictated by the Meaningful Use program. Starting this year, incentives for EHR use will be linked to one of the categories in the Merit-Based Incentive Payment System (MIPS). The MIPS bases payment adjustments on a composite score from four categories: quality, improvement, advancing care information, and cost. The advancing care information category relates to EHR use, and it makes up 25 percent of each provider’s MIPS score in 2017.

As Meaningful Use ends and MIPs begins, incentives for advancing EHR use will continue to offer motivation for providers to push for better and more complete use of electronic health records in the future. Additionally, MIPS and MACRA’s entire Quality Payment Program—which rewards quality, cost and patient experience—will make using data to improve healthcare a must for all physicians. So, clinicians, IT healthcare professionals and EHR vendors must work together to find solutions to EHR challenges and not let current frustrations derail progress.

While EHRs are an essential component of population health management, simply having an EHR system does not constitute population health management. To get started with a population health program, healthcare teams need to make sure they have a way to collect and analyze data from EHRs, along with patient claims data and geographical data.

From there, teams need to assess their overall patient population, stratify risks, segment patients into groups, and develop and assign appropriate care management programs to each of those groups.

A basic strategy for using data to support population health management is:

  • Learn how to use an EHR system to collect patient data
  • Use data to thoroughly assess the overall patient population
  • Apply multiple filters and segment patients into groups based on clinical, claims, and demographic data
  • Match groups of people to care management programs that meet their clinical needs and are operationally efficient

Practices that execute population health strategies are more data driven and evidence based. They also offer more personalized care to patients. They can match people into care management programs that are aligned with their particular needs, so patients are able to get the right care at the right time. This can translate into a reduction in the need for acute care, because population health management creates opportunities for proactive interventions that help prevent serious health complications.

Understanding the health risks of all the patients within a practice is nearly impossible without reliable data. Getting that data can be challenging for practices that do not have the experience or resources they need to collect it. If practices are not able to effectively leverage data, there will be a whole variety of problems as they try to manage the health of their greater patient population. Support from the outside may be essential if providers are not equipped to do data collection and analysis.

Now that MACRA is a reality, healthcare teams can no longer afford to treat population health as an abstract concept. Therefore, learning to optimize EHRs, work with data, and adopt proactive population management strategies are actions that should be on every healthcare team’s to-do list if they want to be successful under evolving value-based payment models.

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Richard A. Royer

Richard A. Royer

Richard A. Royer has served as the chief executive officer of Primaris.