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7 population health management strategies that reduce risk in performance-based contracts

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Population health management (PHM) strives for the Triple Aim of higher quality, lower cost and better patient experience. As healthcare providers transition to value-based care models, PHM plays a critical role in financial risk arrangements with public and private payers.

To qualify for reimbursements, providers must demonstrate how they are achieving PHM goals. Part of the equation is to help patients manage chronic diseases and seek preventative care. But, that’s not all. Health systems must also control the cost of care, or risk losing money on risk-based models.

Optimizing patient outcomes is a complex endeavor. Organizations need many forms of health IT to integrate data across all care settings, analyze health risks and care gaps, and generate insights for better financial management.

Key population health management considerations and strategies
To get a handle on PHM, healthcare systems should consider the following:

  1. Build an IT infrastructure based on a data lake – this advanced type of data warehouse dynamically taps and integrates clinical, claims and other kinds of data to generate reports, comprehensive dashboards and virtual charts to demonstrate where quality measures have been met and identify care gaps
  2. Complete the PHM checklist – build core risk-management competencies by ensuring the health IT system has the right functionality. Click here to see the complete checklist in a white paper on this topic.
  3. Leverage intelligent outreach – automatically trigger outbound messages to patients with reminders about care plans, appointment scheduling, test reminders and other notices that are important to specific patients and subpopulations.
  4. Augment staff with technology – implement risk stratification software to reduce the need for staff to manually review charts to predict which patients would benefit from a care management program.
  5. Create population profiles – integrate a variety of factors about patients such as socioeconomic status, environmental factors and access to transportation to pinpoint the needs of specific subgroups that affect health outcomes.
  6. Benchmark performance – keep the management team and physicians up-to-date about their performance metrics for quality of care, costs and utilization of services.
  7. Monitor near-term costs – use the capabilities of the health IT system to extract utilization metrics from clinical data to understand and manage costs in advance of receiving claims data which can take several weeks to receive after services are provided.

 If you’d like to learn more about role population health management plays in controlling financial risk with payers, read “Taking financial risk: A primer on IT infrastructure, Part 4: Managing populations to manage risk?”.

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