Achieving ROI on population health

Growing your practice in the world of value-based payment means becoming skilled at using population health solutions—data analytics software for managing large numbers of patients. Consider that about 25% of the patient population has multiple chronic diseases, and the need for population health management becomes self-evident.

To achieve an ROI on population health—that is, to use population health tools to help your practice grow—you need to formulate a strategy appropriate to the specific needs of your practice. Understanding where your practice stands on the value-based continuum, which starts at minimal risk and extends to full risk, is the foundation of this strategy.

Fee-for-service

The continuum starts at the low end of risk: traditional fee-for-service. If your practice operates largely under the old-school model, population health solutions can still help you achieve greater success.

Close to 50% of covered preventive benefits available to patients go unused. This indicates an opportunity. Providing preventive services to close these gaps in care offers a way to build revenue. Your strategy: Use population health tools to identify—and then close—gaps in care in your patient population.

Pay-for-performance

Pay for performance represents the next stop along the risk continuum. Pay-for-performance contracts and other quality incentive programs offer financial incentives to encourage your practice to meet specific quality performance measures. By participating in one of these programs, your improved quality metrics can increase revenue.

In this scenario, expect to use population health solutions to help monitor performance on contracted quality metrics. In addition, you may also use these solutions to identify and close gaps in care, as described under fee-for-service.

Risk sharing

As the healthcare economy places more and more emphasis on value, providers must take on more risk. In risk-sharing contacts, achieving a bonus payment depends on meeting quality or efficiency performance measures.

Practices in an Accountable Care Organization (ACO), for example, must exceed a minimum savings rate threshold to participate in shared savings. Access to population health data and the ability to interpret and leverage this data becomes increasingly crucial to practice survival and growth.

Expect to use population health solutions to identify high-priority savings and efficiency opportunities. In addition, tools for monitoring quality metrics can help your practice identify opportunities for improving quality performance to maximize savings.

Full capitation

Here your practice accepts full risk because you are responsible for 100% of gains and losses. The good news—any savings you achieve go directly to increasing your bottom line. Bear in mind that up to 30% of medical expense dollars are avoidable, according to national estimates, which means there are almost always opportunities for savings.

In this scenario, expect to use resource utilization monitoring tools to help identify avoidable medical expenses and savings opportunities. Tools for monitoring quality metrics can also be important for maintaining and improving the quality of care as you monitor expenses.

The reality: A risk-based mix

Understanding where your practice stands on the curve from fee-for-service to full risk is the first step in taking full advantage of population health solutions. If your practice is like most, your risk profile will be mixed, with a segment of your population covered under value-based contracts or pilot programs.

In this case, use population health solutions to support the stage you’re at while you also look toward the future, which will most likely mean taking on more risk. Defining a narrow target for your first population health management efforts, for example reducing patient no-shows, may be a good place to begin.

The bottom line: Value-based reimbursement is here to stay. With the right population health strategy and solutions, you can make it work for your practice.