Population Health is Here, But More Needed in 2017

With 2017 right around the corner, MedeAnalytics is looking ahead to see what’s on the healthcare horizon. From now into the New Year, we will be focusing on the evolution of the industry – from value-based care to data. 

Population health management is not a new concept for any healthcare provider. In fact, a Deloitte study predicted that having advanced analytics capabilities to improve population health initiatives was a top priority for providers in 2016. To succeed, more providers will need to adopt this initiative in a value-based care world.

We connected with Christian Wieland, vice president of product management at MedeAnalytics, to get his take on the key aspects to watch in 2017 as they relate to population health and the transition to value-based care. 

1.)    How important have population health initiatives been within healthcare organizations in 2016?

The simple answer: very important. In 2016, we saw population health initiatives become increasingly important and mainstream. Accountable Care Organizations, Bundled Payments, Pay-For Performance and Value Based purchasing are just a few of the many initiatives providers are now participating in within the population health domain that is increasingly its fiscal implications. With the shift towards both delivery reform and payment reform, population health has spread to providers as well, but initially only through the more progressive institutions.  

2.)    Across your customer base, how many are succeeding with population health?

While it’s still too early to say, many providers and payers are seeing tangible results – such as, avoidable ER visits, network leakage, and chronic condition management (just to name a few).

3.)    What is the evolution of population health initiatives?

Population health has nowhere to go but up. Fee For-Service will be around for some time, but it’s widely losing market share. As performance based financial incentives continue to grow, population health will see a larger impact on organizations. To avoid costly inpatient stays, programs like preventative health will become more common place and will be a good starting point. Identifying and implementing care pathways that have both the greatest clinical result as well as a positive financial result is where this continues to evolve.

Providers will continue to seek out ways to organize their care to optimize their finances; those that don’t may not survive in the long term. This will offer continued opportunity in the vendor space to innovate technology for payers, providers and especially consumers. At the end of the day, each individual is the most important advocate of their own healthcare and any product that finds its way to mass adoption of the community-at-large has a chance to make a major difference in the long term impact of our population’s health.

4.)    If you were to make a statement on what will happen to population health in 2017– what would it be?

2017 will be a big year for population health if for no other reason than the Medicare Access and CHIP Reauthorization Act (MACRA). CMS’s new Quality Payment Program officially begins next year for anyone providing Medicare part B services (e.g., outpatient care, preventive services, ambulance services and durable medical equipment). The first performance period opens January 1.  

Providers that submit at least 90 days of data in 2017 have the potential to break even; if they submit a full year of data they may earn a modest positive payment adjustment of up to 5% through 2019. That’s the carrot. The stick is that if providers don’t send in any 2017 data, then they will receive a negative 4% payment adjustment. With financial incentives that material, it’s fair to assume material changes to behavior as well starting next year.

Interested in learning more about the role of population health and how MedeAnalytics helps payers and providers tackle these issues? Check out our population health management solutions for providers here and for payers here.