Many ACO and network leaders have made investments galore in population health management, yet struggle to articulate their progress. They wrestle with questions like how the mix of investments matches up to their risk profile, if their strategy is right for the market, what the ROI is across efforts, or how their overall approach compares to similar organizations.
But while there's no such thing as a linear path to value-based care success, there are iterative milestones that allow organizations to plot themselves along a spectrum.
The four stages of maturity
A few weeks ago, we surveyed leaders from over 30 health systems to help them with this exact challenge. The respondents ranged from those just getting started to those who are fully submerged in value-based care delivery; were primarily larger, integrated delivery systems; and represented markets in 29 states, both rural and urban.
We mapped the organizations across four broad stages of maturity, based on an Advisory Board segmentation model that was designed using industry research on population health management. (The model has five stages, but we left out The Skeptic for the purpose of this discussion).
I’ll start by sharing one of the most obvious hallmarks of maturity—the number and flavor of risk-based contracts. Here’s a snapshot of what we found to be common within each stage:
In looking at these averages, you might have the urge to drop yourself into one of the four stages based on your organization's portfolio of contracts. But to truly understand population health maturity, you have to dig a few levels deeper and also account for factors such as:
- Market positioning
- Care management infrastructure
- IT integration
- Financial management
- Network adequacy
Our survey analysis and segmentation exercise was informed by all of the above factors, with the goal of pinpointing the most striking areas of strength and weakness across the board.
The four key takeaways
Collectively, we found that organizations are pretty confident in the sufficiency of their physician networks and their ability to identify gaps in care and move the needle on quality.
However, most feel weaker on things like in-network utilization (a particular point of difficulty) and expanding care management capabilities to include behavioral health and non-clinical resources. And while organizations are mostly confident in their ability to measure traditional financial performance, many are unsure of how to build a pro forma for value-based care—which gives a full picture of the financial impact, including market share gains and efficiency improvements, for a cumulative economic projection.
We all know there’s a lot to get a handle on for success under value-based care. But overall, here’s what we found that separates the most advanced organizations from the rest:
- They make investments in capabilities and network assets to match their risk profile
- They have a highly engaged physician network with an aligned compensation model
- They have strong post-acute partnerships, and also offer non-clinical patient resources
- They leverage system-wide technology to analyze in-network utilization, and report on cost and quality
We recognize that organizations have different end states, with some driving towards population health leadership in their market and others preferring a more targeted strategy. Wherever you fall along the stages of maturity, the primary goal is to keep a healthy balance of risk to assets—so you’re not in a position where you’ve taken on value-based care contracts but don’t yet have the capabilities to make them successful, or you've invested significantly in the underlying assets but are still stuck in a fee-for-service world.