Healthcare providers that orient themselves toward a population health-based model are better prepared for shifts in reimbursement, according to Hospitals & Health Networks Daily.
As healthcare costs rise, they remain an obstacle to economic expansion, according to the article, and a recent report found that the United States is first in cost but last in outcomes among 17 industrialized Western nations. Several provisions of the Affordable Care Act (ACA) seek to make the healthcare system more cost-effective, and in addition, many private insurers develop accountable care organizations in advance of looming changes in reimbursement models.
As healthcare increasingly shifts from a volume-based to a value-based model, managing population health involves four key steps, according to the article:
Define the population: Providers must target a specific population; this initial focus allows the organization to identify its successes and apply them across multiple populations, according to the article. When selecting a population, organizations should consider both what types of care they wish to be known for and those for which the organization may be at risk.
Provide a continuum of care: It is essential, the article states, for providers to provide chronic and preventive treatment to their targeted population before, during and between healthcare experiences, rather than restricting intervention to an office setting, according to the article. "Physicians must lead the development and adoption of evidence-based approaches to care and be willing to work in a team-based model of care coordination," it states. "This model includes the extensive use of advanced practice nurses, care coordinators and physician assistants to deliver routine care in the office, and effective use of health technology for at-home monitoring and reporting of follow-up care."
Obtain performance-based contracts: Rewarding financial and quality outcomes is a major part of the shift to value-based care, the article states, as compared to the fee-for-service symptom, which provides incentives for using more and costlier services.
Use data: Access to health status and utilization data for patients is necessary for organizations to identify and group patients within a population according to risk and likelihood they will need an intervention. This step needs improvement within healthcare, according to the article: as of last year, only 18 percent of hospitals reported wide use of predictive analytic tools to coordinate care.
To learn more:
- read the article