Paula H. Infeld, MSN, RN, CPHIMS, vice president, managing director of health IT with Sage Growth Partners, provided an overview of the key milestones needed to operationalize population health management during her convention presentation on Monday.
The use of value-based programs will result in the most significant paradigm shift in healthcare delivery since the introduction of DRGs, Infeld said. By the end of 2016, the Medicare Access and CHIP Reauthorization Act (MACRA) will drive the creation of new alternative payment models that will establish a fixed target price for each care episode—and entities that deliver higher-quality care will be reimbursed at a higher target amount. A new Merit-based Incentive Payment System will serve to link fee-for-service payments to quality and value. Focused on value and not volume, value-based care will reward healthcare providers with incentive payments for the quality of care they give to patients. These programs are part of a larger quality strategy to reform how healthcare is delivered and paid for—focusing payment on quality and not quantity. “It is important to remember that the new bottom line is outcomes,” Infeld said.
Value-based programs also support the Centers for Medicare and Medicaid Services’ Triple Aim: Better care for individuals, better health for populations, and lower cost.
With healthcare providers facing the new and significant challenges of transitioning to value-based reimbursement and the requirement to provide population health measurements and reporting, Infeld advised providers to immediately begin ramping up their population health programs. With numerous regulations and payer requirements, a healthcare organization’s staff learning curve becomes more pronounced the longer population health management implementation is delayed.
Educating one’s organization regarding the people, processes, and technologies required will create a strong foundation for a population health management program.
To ensure a successful transition, the organization will need to redefine their practice model around medical conditions of patients across the complete care episode.
An investment in new technology will be required to collect and report improvement data based on standard quality measurements, Infeld said. Resources will also need to be committed to staff education and training to develop the skills necessary to conduct patient surveys, locate community services, and develop policies and procedures. The organization’s staff will be expected to become experts in data cleansing, storage, and validation in order to properly utilize population health data for improved outcomes. These professionals will be responsible for ensuring the accuracy of all data reported, Infeld said. Beyond the initial education and training, staff will need ongoing continuing education regarding the goals and management of a population healthcare model. Additionally, consideration must be given to the resources necessary for implementing, managing, and maintaining required software applications, Infeld said.