The Essentials of Population Health: Ten Things You Need to Know – #8

What are some key factors for a successful population health project? Before any technology project is initiated, it is worth a moment to consider what’s required to make it successful. For a PHM platform deployment, here are some of the key factors for success: Practice Leadership; an active population health project directly impacts your providers across a spectrum that ranges from organizational focus on closing gaps in care, to potentially…

The Essentials of Population Health: Ten Things You Need to Know – #7

What is involved in implementation and support of a population health management system? For staff experienced in the labor, process, and technology intensive implementation of EHR systems, the implementation of population health system is refreshingly easy—with the majority of the tasks and set up completed by the PHM platform vendor. While implementations of different PHMs will vary, for EagleDream Health (EDH), an implementation team lead by an EDH physician will…

The Essentials of Population Health: Ten Things You Need to Know – #6

Is claims data part of a PHM platform? Robust PHM platforms can be implemented without incorporating adjudicated health insurance claims. Nonetheless, when available, paid claims offer rich and important insights not possible with clinical data alone. Paid Claims data helps administrators manage complex value-based contracts in which some level of accountability (and thus risk) for cost and quality is assumed by the practice. Both risk and gain sharing arrangements require…

The Essentials of Population Health: Ten Things You Need to Know – #5

Can population health be integrated into daily workflow, or will it slow down a busy staff? Effective PHM platforms actually enhance care team workflows by increasing team effciency, shifting tasks away from the point of care to the pre-visit period by supporting streamlined pre-visit planning. For those tasks or gaps in care that the care team is unable to close prior to the patient’s visit, the PHM platform’s point of…

The Essentials of Population Health: Ten Things You Need to Know – #4

How do we get the data? How do you insure data integrity? How is data updated? The first task of a PHM platform vendor is to extract the relevant clinical and financial data that will populate the PHM platform’s data warehouse. For clinical data, the main source will be the practice’s own EHR, other EHRs within the same delivery system, data feeds from regional HIEs (as needed) and lab interfaces.…

The Essentials of Population Health: Ten Things You Need to Know – #3

Doesn’t my EHR provide this sort of information? Why do I need another system? While an essential tool in helping practices manage the daily process of seeing patients and documenting visits, EHR systems were designed to support the care of individual patients rather than populations of patients who share common denominators. Additionally, EHRs have not evolved the necessary capabilities to integrate disparate sources of information such as adjudicated payer claims,…

The Essentials of Population Health: Ten Things You Need to Know – #2

What exactly does a PHM platform do? Employing descriptive, predictive, and prescriptive analytics, population health management platforms are able to identify high-risk patients who require care management interventions in order to improve outcomes at reduced costs. Advanced systems further identify specific risk characteristics, which helps practices assign specific interventions to mitigate these risks. PHM platforms support measurement of quality against national standard metrics, identifying gaps in care for evidence-based preventive…

The Essentials of Population Health: Ten Things You Need to Know – #1

Population health seems complex and difficult. Why implement a PHM platform now? The current urgency for population health systems is due primarily to the transition from fee-for-service to a value-based reimbursement. Although there are various iterations of value-based programs, virtually all of them impose a new level of accountability that goes far beyond the expectations of the traditional fee-for-service programs. Providers are being asked to offer better care while reducing…

Evidence: The Foundation of Payment Reform

By Howard Beckman, MD, FACP, FAACH, Chief Medical Officer –  In the February 28, 2017 issue of JAMA, Shrank, Saunders and McClellan confront the notion that insurance decisions about reforming the payment system require evidence from randomized controlled trials to be scaled by payers1.  To focus the discussion, they choose to direct discussion to reducing co-pays for high value care. As an example of data being available, they cite a study…

Benefit Design that Makes Sense

By Howard Beckman, MD, FACP, FAACH, Chief Medical Officer – Chernew and Fredrick1 in a viewpoint piece in the Oct. 25, 2016 JAMA, entitled Improving Benefit Design to Promote Effective, Efficient and Affordable Care, make some valuable points at a time when thoughtful redesign is sorely needed. The authors describe High Deductible plans as blunt instruments because their first dollar costs, even tied to a health savings account, discourage BOTH…