What’s Population Health Management anyways?


We are back with some of the latest stories around digital health that is impacting our lives. Today we are going to explore some of the trends in population health and how the population health landscape is going to evolve and will go more virtual. 


As per Wikipedia – 

“Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” 

“The global population health management market is estimated to be USD 21.5 Bn in 2020 and is expected to reach USD 49.2 Bn by 2025, growing at a CAGR of 18%

·       As published by Researchandmarkets.com 

Some History

Population health initiatives have initially gained popularity, precisely the tide started on March 23, 2010 when President Obama signed the Affordable Care Act and because of the intent to manage and control the surge in cost, population health management was considered as one of the key strategies that will bring changes in healthcare delivery. Just after 1 year with the Patient Protection and Affordable Care Act (PPACA), US Department of Health and Human Services (HHS) proposed the guidelines for ACOs under Managed Shared Saving Program.

Transition to Value Based Care (VBC) from Fee for Service (FFS) and the impact:

The idea was to change the Fee For Service (FFS) model towards a Value Based Care (VBC) model, which meant transition into the payment models of risk adjustment and quality performance.

However, what it meant for the ecosystem of providers and payers, were bigger impact on following areas of the healthcare landscape:

Provider’s Impact:

·       End to end patient engagement to create a continuum of care experience over a period of time to identify gaps in quality care, current state of the disease and risks for any adverse events or hospitalization  

·       Population monitoring and classification of patient not just by conditions but by their risk of getting sick 

·       Interoperable technology that focuses to acquire data from multiple systems and present better insights to health plans. Providers has to leverage Health Information Exchange to facilitate this aggregation of data   

·       Centralize the system / data warehouse that hosts the aggregated data from multiple systems. These data are usually then collected in registries or processed via supplemental applications. Registries are population wide databases and shouldn't be only for similar classification of patients 

·       Care Coordination that focuses on improved outcomes and streamlined operational efficiency

·       Analytics that focus on Accurate and Actionable Data

·       Comprehensive patient education around managing the patient conditions

Payer’s Impact: 

Health insurers shall be leveraging predictive modeling algorithms, that can help forecast which patients are likely to have significant health costs. 

Some health plans are already bringing up tools that shall help in identifying patients who may be hospitalized or suffer complications in coming months. From a payer standpoint these are valuable information as they can literally come up with plans focused on these groups of population. 

Such patients are then proactively reached out for preventive care alerts  and timely interventions will ensure droppage in patient visits. In case of patients requiring follow ups, all such patients alerts can be reported to the provider for their attention.

Where are we today?

With a continuous shift to Value based programs, CMS has come up with a number of initiatives like Hospital Value Based Purchasing under Hospital Quality Initiatives. This is an effort to reward high performing providers for the quality of care they provide. There are number of programs that CMS has introduced like – 

·       Hospital Inpatient Quality Reporting Program

·       Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program

·       Hospital Outpatient Quality Reporting Program

These programs finally adjust payments to hospitals based on the quality of care they deliver. CMS also makes the data available to consumers with the goal of driving quality improvement through measurement and transparency by publicly displaying data. This approach finally enables consumers to make more informed decisions about their health care.

Additionally during the post covid era, these programs will potentially also interface with virtual care strategies i.e. tele health programs integrated with remote patient monitoring capabilities to deliver larger care services to both urban and rural communities across the country. 

Latest  Healthtech investment news:

Health data analytics startup Komodo Health's $220M Series E propels it to $3.3B valuation

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100Plus Raises $25 Million for Remote Patient Monitoring Platform

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Cerner, Philips invest in Carevive Systems’ oversubscribed $18M equity round

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 Some more impact news on population health management and how companies are leveraging technologies are covered below: 

Strong Patient Engagement and Outcomes Achieved Virtually through Remote Patient Monitoring: 

Carium a leader in telehealth technology announced the success of Health Logx's virtual care program 

Read more 

SelectHealth Uses Decision Point to Deploy Whole Person Population Health Management

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How to Rethink Population Health Management for Rare Disease Care 

In order to improve population health management for patients with rare diseases, payers may need to rethink member identification and modify traditional member engagement strategies.

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Community Care Plan Builds the Future of Payer Provider Collaboration on the Innovaccer Health Cloud

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If you have some of the interesting initiatives going around handling population health management and want to share your stories please share with us at heathviva@taliun.com


Team HealthViva