From program to business model: Using population health management to drive value-based care

Tamara Cull Tamara Cull
Senior Vice President, Aveus

What does “population health management” really mean?

Many healthcare organizations think of population health management in terms of condition-specific programs designed to improve care and reduce costs for at-risk patients. Medicare’s bundled payment initiatives for joint replacements and cardiac care may come to mind, for instance.

Very often organizations launch programs like these in response to some sort of reimbursement mandate. Yet think of how powerful they could be if they were instead driven by an overarching strategy aimed at moving the organization toward value-based care. It’s never too late to leverage population health “program” investments to build an effective value-based business model.

Managing risk successfully

For many healthcare organizations, population health decisions have been made to meet specific short-term needs — for example, investing in software that solves a particular problem. Creating a business model that fully supports risk management and value-based care, however, requires a long-term strategic view.

The good news is that some of the pieces of a more comprehensive value-based business model are likely already in place. Perhaps, for example, an organization is already using real-time integrated clinical and financial data to drive point-of-care interventions for certain high-risk patient populations.

The key now is to take a few steps to zero in on an integrated strategy that can help turn isolated “programs” into an effective business model:

• Get objective support from expert population health management partners
• Conduct a product agnostic assessment of key strategic elements including organizational readiness, infrastructure needs, care delivery and reimbursement models.
• Develop an implementation plan that closes gaps between where the organization is, and where it would like to be on the path to value-based care.

“Population health management” may have a limited, program-specific definition within most healthcare organizations today. But when linked with the right strategy, those investments in population health can set the foundation for successfully bearing risk within a value-based business model.

Learn more about how Medecision’s strategic and advisory consulting services help healthcare organizations avoid potential roadblocks and find the most efficient use of people, processes and technologies to meet their distinct population health strategy goals.

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