Population Health Management is one of the disruptive forces shaping the future of healthcare delivery and the traditional payment models associated with quality of care. While this concept involves intervention strategies to improve patient outcomes, the basis of the concept is the transfer of financial risk from payers to providers and ultimately consumers.
The movement from fee for service to fee for value is a monumental shift for all participants in the healthcare industry. According to Dr. Paul Kaplan, Senior Medical Director with Lumeris, a leader in Population Health solutions, “The transition of risk from payers to providers—and shift of costs from providers to consumers—requires redesign, rethinking and retooling to achieve the level of transformation that will deliver on the promise of better outcomes.”
To manage population health, healthcare delivery organizations need to align business models, including value-based contracts, and design the underlying support structures (physician engagement, care team enablement, technology, etc.) to support those value-based arrangements.
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Dr. Kaplan identifies three specific segments, within healthcare, which are undergoing business model shifts:
- Health delivery organizations in risk-bearing arrangements need differentiated health plan operations and functions focused on economic benefits and behavior change that produce improved health outcomes.
- Payers and their health plan operations must support improved business and care delivery outcomes. Payer’s existing platforms are not built for outcomes and management of clinical risk, but are directed to the management of the financial functions of healthcare.
- Health systems with value-based contracts—as well as those wanting to become their own payer— need to align the business model and support structures to manage operations as well as the health of their populations. The missing piece today is the merger of clinical and financial information over the population and down to the individual patient to allow clinicians to make decisions based on actionable data.
“A key strategy to meet the promise of better health outcomes requires solutions that engage providers and care teams, yet keeps the patient at the center of care,” continues Dr. Kaplan. “Doing this requires the seamless integration of new, interactive data sources that enable workflow integration at the provider office.” To ensure care plan compliance, communications channels are evolving that allow care teams and patients to work together without unnecessary and costly office visits.
Dr. Paul Kaplan will specifically address population health strategies and the shifts in payment models for value-based care at Disrupted. The Business of Healthcare.
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Disrupted. The Business of Healthcare. is an executive conference bringing together change leaders who will share lessons and suggest responses to the rapidly changing business of healthcare. Friday, September 18, at the Global Center for Health Innovation, Cleveland. Be a part of this event…make plans to participate and Register Today.
