Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses.
The 15 most expensive health conditions account for 44% of total healthcare expenses, according to the Agency for Healthcare Research and Quality. To bend the healthcare cost curve, providers will need to redesign care processes so that the focus is on keeping chronic-care patients healthy and out of ERs and hospitals.
One key element in the process is identifying your chronic care patients. Proactive identification of a patient population requires a new approach to decision support. A PHM aggregates data from electronic health records and physician practice management systems to help manage patient outreach, identify gaps in care, stratify risk, provide care management, and evaluate performance.
A PHM analyzes the aggregated data, applies built-in, rules-driven alerts, and presents it to the care team for more effective preventive care and chronic disease management.
A PHM works within and around your EHR and is integrated into your work flow. Some PHM systems present their findings and analysis to the care team via embedded templates and checklists. Others appear to sit on top of the EHR, as if your actionable items are pushed or pop up at you.
A comprehensive, fully interfaced PHM-EHR solution enables providers to execute on all aspects of care management: identification of the appropriate care for the specific patient, outbound reach for patient scheduling, monitoring treatment compliance with evidence-based guidelines and protocols.
Your practice becomes more proactive and more efficient, resulting in a better financial performance. A 10-physician internal medicine group in the Southeast recently earned more than $80,000 per physician in quality and incentive bonuses in one year using a PHM.
Which PHM and how much will it cost is best addressed by starting with your EHR. Look at the gaps and select a PHM that fills those gaps. Here’s what you should have:
- Rules-based alerts (already built and defined in the PHM) on specific population levels for preventive care and chronic disease management
- Automated outreach to patients identified in those alerts, including an interactive patient portal
- Patient queues for care coordinators on your team to drive one-on-one patient communication for compliance to care plans
- Established reporting (existing reports so you do not have to create your own) to mine population-based data and to report on patient outcomes
Ask your EHR vendor if they support a population health management module or if they partner with a PHM solution. It is likely that you’ll find the partner PHM to be more readily interfaced to your EHR. That means an established implementation for you with less set-up and a quicker go-live time line for your clinical care team.
If your ERH vendor doesn’t support a PHM module just yet, ask your hospital or physician organization if they have a PHM. As reimbursement methods continue to evolve and as accountable care organizations develop, shared population health management will drive larger organizations to aggregate data across the entire delivery system. Participating with a community-based PHM implementation may also provide an affordable entry point for a small-to-mid-sized practice.
PHM solutions are priced on a per-physician, per-month subscription (approximately $100 to $120) or a per-patient, per-month (approximately $.20 to $.40), often with a base minimum.
Is the outlay for a PHM worth it? Quality incentives and bonuses can offset the annual cost in 1 to 3 months.
And, when used in conjunction with an EHR, a PHM solution can help improve patient outcomes as well as your organization’s financial health.
Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group and blogs at Practice Pointers.
