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    Effective population health management involves more than just data


    At a recent national conference of the Patient Centered Primary Care Collaborative (PCPCC), Patrick Conway, MD, said he anticipates 30% of Medicare payments will be value-based by the end of 2016. Conway, deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services (CMS) and chief medical officer at the U.S. Department of Health and Human Services (HHS),  added that population health management (PHM) will be an essential factor in reaching CMS' goal of 80% of payments being value based by 2018. Initiatives promoted through the Affordable Care Act are showing early positive results in this transition from fee for service, he said, noting that CMS has realized a 2% reduction in Medicare payments across all of its regions through population-based payments.

    Still, succeeding in a value-based payment model is not easy, and a common question facing healthcare executives is how to get started with population health management, Fred Goldstein, president and founder of Accountable Health, LLC, and a member of the board of directors for the Population Health Alliance.

    First steps

    GoldsteinGoldsteinWhen considering a PHM system investment, Goldstein says organizations should first do some background work to become familiar with their patient populations' needs. “Start by picking a disease or condition—the one that's the most costly—and develop a program to manage that," he says.  

    Marci Nielsen, executive director of the PCPCC, says the key to success is targeting the right interventions to the right patients before they get to the point of hospital admission. That often means identifying high-risk patients before they find their way into a physician's practice. “You don't have to do much for the healthy patients but those that present high cost [conditions or complexities] require a higher level of focus,” she says.

    Reaching these patients requires data. As Goldstein says, “You can't do population health without data.” PHM systems can supply this data. At the outset, they can provide a means of stratifying the populations under care, to pinpoint those patients whose conditions call for the most scrutiny and management.

    Next: Drilling down further



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