The Essentials of Population Health: Ten Things You Need to Know – #10

How much do population health management systems cost, and what is their return on investment?
Price methodologies vary, but many vendors base their price on the number of billable providers as
measured by national provider identifiers (NPIs). Cloud-based systems typically price on a monthly
subscription basis with additional one-time fees for implementation. A vendor quote should provide
the meaningful details you need.

A system’s return on investment is directly correlated to its use cases. For example, if the use case is to
identify and correct gaps in care across specific or broadly defined cohorts, then the return is equal to
the incremental revenue generated by the outreach divided by the cost of the system. If closure in these
gaps (or avoidance of events like ED visit or hospital readmissions), qualifies the practice for certain bonus
payments, that should be part of the ROI.

There may be contractually related use cases. As a prominent example, consider Medicare. Starting in
January 2017, the requirement for collecting outcomes performance measures will increase as part of the
requirements for the Quality Payment Programs under the Medicare Access and CHIP Reauthorization Act
(MACRA) of 2015. Specifically, for MACRA, reimbursements will be adjusted 4% up or down in 2019 based
on data collected in 2017, with additional bonuses for the highest performers increasing to 9% positive or
negative adjustment by 2022. Population health systems will play a major role in helping providers achieve
maximum incentive payments and avoidance of potential penalties. Commercial payers are likely to craft
similar value-based reimbursement programs.

Data is becoming pivotal in healthcare. This is not only critical for external review (Medicare, commercial
payers), but also internal quality improvements. To assure the success of a practice as the shift from volume
to value-based reimbursement occurs, it is imperative that practices implement PHM platforms that
support their long-term success.

This blog comes from a white paper published by EHR Integration Services and EagleDream Health.
Click here to read the white paper in its entirety, or visit our blog regularly to read all Top Ten
Essentials of Population Health.

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