Population Health Solutions
Population Health
Population health businesses, built around primary care, have been experiencing rapid growth due to their promise of better quality and reduced costs. However, while the concept of empowering PCPs to drive patient care with the right protocols seems straightforward, the success of these models heavily depends on the economic, operational, and execution strategies employed. Unfortunately, most of these businesses have yet to deliver on their promises, struggling to meet both quality and cost metrics.
Our analysis of various primary care companies indicates that while many share a primary care-driven and technology-enabled approach, their performance varies significantly, likely due to differences in underlying delivery models. We believe that without changing their delivery models, these businesses are likely to fail, particularly as the cost of capital increases.
PCP driven Population health has grown, but results lag behind.
Population Health Trends
Over the last 15 years, investments in primary care has greatly increased. A vast majority of primary care practices have been acquired by hospital, health systems and built for purpose MSOs. The prevailing view being that by acquiring Medicare Advantage patients there is a great potential to generate profits by reducing cost of care.
The basic premise of the model is that by moving care to outpatient settings, we can reduce ED/hospital admissions and savings on those admissions will bend the cost curve. In order to support this model, there has been a great investment in patient access technologies as startups and acquisition of a huge care ordination staff for whom there is traditional reimbursement. Although several of these businesses have shown reductions in admission rates, it remains to be seen if this trend is related the pandemic or is a sustainable outcome of their business models.
While for integrated delivery systems like United Healthcare, the model has generated earning growth, a vast majority of these business have continued to lose money despite rapid revenue growth.
Driven by PCP and digital health, results are limited, so what is the solution?
Population Health Challenges
Population health management (PHM) is a complex and evolving field that involves coordinating care across different providers and settings to improve the health of a specific population while also reducing cost. Some of the key challenges of population health management include:
- Reimbursement and financing: PHM requires a shift from traditional fee-for-service reimbursement models to value-based payment models that reward providers for achieving improved outcomes and lower costs. However, these payment models can be complex and require significant investment in infrastructure and technology to support effective PHM.
- Alignment of incentives: Ensuring alignment of incentives among payers, providers, and patients remains a challenge in population health management. To achieve better health outcomes and reduce costs, it is critical to establish payment models that incentivize providers to deliver high-quality care and encourage patients to engage in their own care.
- Sustained primary care engagement: Sustaining patient engagement with primary care providers is essential to improving health outcomes and reducing healthcare costs. However, this can be challenging and expensive, particularly for populations with complex medical needs or social determinants of health.
- Variance in network efficiency: Network efficiency varies significantly across different geographies and providers, which can impact the effectiveness of population health management initiatives. Addressing this requires a comprehensive understanding of the local healthcare market and targeted strategies to improve provider engagement and care coordination.
- Lack of integration between analytics and patient journey: While advanced analytics are available for population health management, there is often a lack of integration between the analytics and the patient journey. This can make it difficult to effectively identify high-risk patients and develop targeted interventions that address their specific needs. Integrating analytics with the patient journey is critical to achieving better health outcomes and reducing costs.
- Data management: PHM requires collecting and analyzing data from multiple sources, including electronic health records, claims data, and patient-generated data. Effective data management is critical to identifying high-risk patients and developing targeted interventions, but it can be challenging to integrate data from different sources and ensure its accuracy and completeness.
Population heath has a lot of moving parts, it is easy to get lost. Let analytics/AI guide you.
Our Population Health Solution
As a pioneer of population health, we have a comprehensive understanding of models that drive results both in-terms of quality and cost. We work with collaboratively to assess and develop end-to-end capability for population health. Our approach involves refinement of delivery models through the utilization of Analytics, Workflow, and a focused approach to organizing care for cohorts with higher need for healthcare services.
1. Model Review and Development:
- Economic Model
- Operating Model
- Technology Model
2. Data Analytics: Using our proprietary BI and AI/ML based platform:
- Population Analytics and Risk Assessment
- Attribution and Stratification
- Identify Key cohorts of patients for proactive intervention.
- Study and define a model for reactive interventions.
- Analyze provider and protocol efficiencies.
- Population health quality and cost dashboards and analytics
- Performance driven bonus programs
2. Facilitation and development of Outpatient Care-coordination Model:
- Unified patient access to primary care (tele, in-person, specialist)
- Cohort specific micro-delivery networks
- Cohort specific outpatient care protocols/ program
- Care-coordination roles and responsibilities
- Medication adherence monitoring model
3. Facilitation and Developemnt of Acute Care Coordination Model
- Authorization and Utilization management
- In-patient coordination and Monitoring
- Pre-Admi and Post discharge protocols by cohorts