Collab Docs

A recent study from the New England Journal of Medicine stated healthcare executives and administrators see population health as the future of healthcare. However, that message is not being effectively communicated to the doctors and clinicians who interact with patients.

According to the study, CEOs and managers saw population health as “the path to creating better health, with revenue more tightly linked to outcomes, panel management, and improved community health markers.”

Whereas frontline clinicians were apprehensive about the future of reimbursement, their main concern was losing focus “on the complexities and benefits of highly personalized, individualized care.”

“These attitudes seem to reflect a fundamental misunderstanding of population health,” said Jay Reddy, CEO of VitreosHealth, a population health analytics company.

“A truly predictive population health program cannot succeed without focusing on individual patients. True, these programs begin by broadly analyzing the state of the population health to identify high risk cohorts leveraging both clinical and non-clinical drivers to design care management programs, but at an execution level, all of that information funnels down to pinpoint and focus on the individual patient in order to deliver a customized care plan to close all the relevant gaps-in-care.”

If the effectiveness of overall clinical and non-clinical risk assessment programs is not being relayed to clinicians on the frontline, it’s likely due to a communications gap between administrators and providers. Interestingly, a well-designed population health program can help bridge this gap, too.

A good example is the relationship that exists between payer and provider.

Payers who employ a focused outreach approach backed by a predictive and prescriptive Big Data analytics program can support providers in three key areas:

  • Closing gaps in care
  • Putting providers at the center of patient care
  • Strengthening a provider’s existing outreach program

Click here to discover how predictive analytics can help forge a stronger bond between payer and provider.

Traditionally, in the fee-for-service world, the relationship between provider and payer has been at arms length, especially when it came to population health programs. Payers delivered these care management programs to their membership with minimal input and involvement from the providers.

However, this is changing as healthcare shifts to a value-based care model where providers are being compensated by pay-for-performance incentives. The most effective plans are developing incentive plans for the providers and also providing the tools to help them succeed.

“Our payer clients leverage population health Insights as a Service using VitreosHealth’s Big Data predictive analytics platform to provide patient specific gaps-in-care reports to the physicians in their network to help them close the gaps at the point of care,” said Reddy. “And by closing the gaps-in-care in partnership with the larger ecosystem, providers are able to succeed and get paid for better outcomes, creating a win-win situation for both payer and provider.”

“We’ve been able to share data with our providers that they’re not getting from any other health plans,” said Scott Vaughn, President and CEO of GlobalHealth. “This data provides our physicians with actionable insights on their patients that will help them practice medicine in a more focused manner. This collaborative approach ultimately helps improve health outcomes for our members.”

“We work closely with VitreosHealth to develop workable/manageable reports to share with our physicians,” said Sheila Ware, chief operating officer of Patient Physician Network. “For example, we can say these patients have access-to-care issues that need to be contacted about having a mammography and these diabetic patients haven’t had their A1C and these are the reasons why they are non-compliant to best evidence care. With such patient-centric insights, it helps put the primary care physician at the center of care.”

Members will always have a better relationship with their physicians than they do with their health plan. A successful outreach program makes the most of this opportunity to improve outcomes and lower costs at the intersection of the member-physician relationship. Payers are realizing that by sharing this information with providers they can strengthen existing relationships and improve the health and wellness of members.

“What we’re working on right now is integrating our data with a provider’s existing outreach program so that they can make informed decisions, and call the patients who need the most attention,” said Kyle Hager, director of process improvement and business optimization of GlobalHealth. “For example, our analytics can point providers toward the top 50 patients most in need of outreach by factoring in the clinical, socio-economic, access-to-care, and well-being needs. We’re finding that our providers are eager for this kind of prioritized information.”

Click here to discover how predictive analytics can help forge a stronger bond between payer and provider.

Three Surprising Ways Big Data Strengthens the Payer/Provider Relationship

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