As I walked the aisles of the America’s Health Insurance Plans’ (AHIP) Institute and Expo earlier this summer, I was not surprised to see the words population health management (PHM) stretched along the banners at the various booths. After all, PHM remains a hot topic in the fast-changing healthcare landscape.
What surprised me was that the conclusion of many conversations I had on the topic focused primarily on the use of analytics to identify targeted populations. This makes sense because the foundation of PHM advancement is increased access to data and improved analytic tools; however, an emphasis on identification alone ignores the critical effort of what to do with those expanded insights. In particular, it ignores how to operationalize the data to drive what healthcare teams are doing, how to effectively engage members and how to measure resulting outcomes.
The task of operationalizing data will be key to evolving PHM models. That being said, it won’t be without its challenges. For one, organizations often run their data through multiple analytics solutions to achieve their desired population identification results. There will be a need to both act on targeted algorithms from specialty solutions and to also aggregate results into broader, actionable insights.
While PHM is the latest phase in what has been a rapidly evolving world of care management, it maintains a focus on the Triple Aim of improving the health of the population, enhancing the experience and outcomes of the member and reducing the cost of care. Because of this, it is critical to incorporate the success and lessons learned from previous member care management and engagement models.
I define the four phases of evolution within population health management as:
- Chronic case management, high-touch engagement with the sickest, highest-cost members.
- Coordinated care management, seeking the elimination of internal functional team silos using a 360-degree member view and integrated care plan.
- Integrated care management, an expansion of coordinated care management that includes external stakeholders across payers, providers and the member.
- Population health management, which involves an expansion of integrated care management and utilizes enhanced engagement across the entire population.
Executing PHM programs is challenging not simply because of the difficulty of identifying care management opportunities but from balancing human- and automation-based touchpoints. For example, PHM programs must still incorporate chronic case management methods to engage the sickest, highest-cost members through high-touch, direct interactions. This must be done efficiently and done well.
However, PHM programs also must leverage the operational, coordination and engagement benefits of integrated care management and coordinated care management, including automated outreach. Building these concepts into the PHM model and execution discussion will help providers and health plans better engage the populations they are targeting with analytics.
If an organization’s PHM initiative focuses too much on identifying targeted populations and not enough on what to do and how to measure outcomes, it will fail to reach its full potential. For PHM to progress, the healthcare industry must expand discussions to leverage the technological advances in analytics, access to expanding data sources, and the evolution of care management systems enabling complex multi-role processes and engagement methods.
PHM will eventually morph into a health engagement model and away from the “management” theme the industry has traditionally embraced. But the first step must be to properly define and execute PHM so new learnings around member activation, team coordination and automation can unite together to form the future models of care.
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