Population health management (PHM) technology empowers healthcare providers to be successful in achieving quality goals that are the driving force behind the shift from volume-based to value-based care.
The Quality Payment Program (QPP) of the 2015 Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) opened the floodgates to a host of new performance metrics that physicians are required to report. MACRA’s QPP is just the tip of the iceberg as both government and commercial payers are continually pursuing new programs that compensate physicians on the quality of care they deliver. MACRA’s Merit-Based Incentive Payment System (MIPS), for example, bases 60 percent of its score on care quality performance.
Physician practices spend 785 hours per physician and more than $15.4 billion each year on factors associated with reporting quality measures, according to a 2016 study published in Health Affairs. That number is only expected to increase, placing additional burden on office staff who struggle to perform time-consuming data searching, analysis and outreach for at-risk patients. Currently, care managers can spend approximately 40 percent of their time just searching for patient data, with an industry average of 130 minutes per patient for care management.
PHM has emerged as the solution for streamlining data, conducting outreach, elevating outcomes, and improving MIPS performance. A sophisticated PHM platform can help providers stay ahead of the curve by monitoring patient populations more efficiently and automating patient interventions based on timely, reliable data integrated from multiple sources.
Integrating information systems
Organizations need to first align their population health management and value-based care quality goals. A new enterprise-wide EHR system is not a requirement for effective PHM, but data from the EHR, as well as from patient registries or HL7 feeds, needs to be comprehensive and timely for meaningful analysis and reporting. That’s why organizations need to seek out a platform that is truly vendor agnostic and easy to integrate. Expensive customizations or a flat-out refusal to link systems with other vendors should immediately disqualify any platform.
Once systems are integrated with a PHM platform, organizations can establish intervention campaigns to support their otherwise manual care management workflows. Care managers can more proficiently manage their time by prioritizing caseloads and focusing manual efforts and workflows to higher-risk, higher-cost patient populations.
Data drives targeted, automated interventions
With a population health management platform in place, providers rely on data in their electronic health record (EHR) to conduct the analysis that can help them predict patient behaviors and outcomes. Data sources such as claims and clinical data are the foundation of these technologies.
From this baseline, providers can incorporate other crucial information into their PHM analysis that can aid in more accurate predictions and precise interventions. These include social determinants of health data points such as:
• Physical environment. Air and water quality; housing type, access to transportation and proximity to grocery stores.
• Behavioral. Diet, exercise, tobacco- and drug-use; stress, adherence history information, and even metrics on estimated likelihood to modify behavior.
• Social. Education level, literacy, employment, income, financial history, neighborhood, and highly granular data such as the distance away from the closest relatives.
Armed with diverse and deep datasets, care managers can stratify patients into risk categories, such as chronic-condition populations. Success in MIPS or any value-based care program rests on the providers’ ability to manage populations across all risk profiles. After all, today’s moderate-risk patient can be tomorrow’s high-risk patient.
For example, organizations tracking diabetic patients can establish rules to automatically contact patients through a myriad of methods such as phone, text, postal letter, or through a patient portal. The notifications send an alert when patients should take a certain medication, have not scheduled a maintenance appointment, or forget to fulfill self-management tasks such as recording home blood pressure readings or glucose monitoring.
Multiple campaigns can be combined for a more comprehensive automated analysis and outreach effort. Regardless, organizations must only create the campaigns one time and the platform will automatically search the updated patient populations for at-risk patients.
As a result of automated interventions, patients can be contacted using their preferred communication methods seven to 10 additional times in a month without giving more work to already overburdened care managers. A 2016 study of text message medication reminders found it doubled the likelihood of adherence to regimens, affirming the efficacy of technology-assisted interventions.
Peer performance affects MIPS payment
A discussion about MIPS would not be complete without looking at the payment adjustments that will be made by the Centers for Medicare and Medicaid Services (CMS) in 2019. Based on providers’ performance from last year, the payment difference between the maximum negative score and exceptional performance is 26 percent.
This payment difference is due to the peer-based performance incentives included in MIPS for providers who report the highest quality metrics. For 2017, the top performing quartile could receive as much as a 22 percent payment bonus, while the lowest performing would receive a 4 percent penalty. By 2022, the difference could reach 46 percent due to increased bonuses for top performers and penalties for poorer performance. Considering the large portion of revenue most healthcare organizations receive from Medicare, this payment swing could have a massive impact on sustainability. That alone is a compelling reason to implement a population health management solution that generates a positive return on investment.
With the insight and power of a reliable PHM platform, physicians and care managers can analyze and target patient populations, drive healthy outcomes with automated interventions, and successfully master MIPS or any other value-based care payment program.