Last week, I had the opportunity to host a Q&A with the Advisory Board’s leading experts on population health management—Dennis Weaver, MD, MBA, and Lisa Bielamowicz, MD. Here are the top three questions asked, and their answers.
1. How far along are most health systems on this journey?
To set some context, we tend to see that organizations fall within five population health profiles—with the most successful health systems setting a solid foundation before advancing to the next stage.
That said, there are only a handful of what we call “committed” organizations with over half of their business into risk-based contracting. There are also still a fair number of organizations that are skeptical of the transition and are still reimbursed predominately through fee-for-services.
The majority of the organizations that have started down the path are in “intender” and “builder” categories—they’re testing the waters with plans to grow.
2. How should I evaluate my progress?
There are five key areas to evaluate the milestones of the transition path:
- Network: Is there a clear value proposition for staying within the system or clinically integrated network? And how do you communicate that to patients and employers?
- Care model: Is there unnecessary variation in clinical practices across providers, and therefore little control of costs or outcomes?
- Technology: Do you have the tools to identify which initiatives are working, which are not, and prioritize upcoming strategies based on that data?
- Strategic operations: What do you do centrally and what do you do locally?
- Financial performance: How much risk are you going to take on and how quickly?
3. How are organizations measuring ROI?
While it’s critical to measure the impact of shared savings and value-based care contracts, there are three other things every organization should look at to measure ROI in the transition: access, clinical standardization, and network integrity.
Let’s talk about patient access first. One physician network in the Northeast made a commitment to offer appointments within 24 hours, and phone visits within two hours—and they increased their panel by 20%. Expanding access by making sure patients can get in the door quickly, mapping your services with the geography of patients, and positioning yourself favorably for large employers—is good no matter what your risk portfolio looks like.
The same is true for clinical variation. Many struggle with clinical variability not just across the health system but in the ACO and clinically integrated network, and that impacts quality and efficiency in a major way. Although we’d all love to get to the 90th percentile when it comes to reducing variation, we’ve seen tremendous returns at the 50th percentile as well.
And we can’t stress how important “keepage” is and building pathways for patients to stay in the network. Even for small systems, this can have a big impact on cost, quality, and productivity.