Chapter 1: Introduction
Excerpted from original article published by Population Health Management, copyright Mary Ann Liebert, Inc.
Guide for Developing an Information Technology Investment Road Map for Population Health Management
Jacquelyn Hunt, PharmD, MS, Richard Gibson, MD, PhD, John Whittington, MD, Kitty Powell, Brad Wozney, MD, Susan Knudson, MA
Many health systems recovering from a massive investment in electronic health records are now faced with the prospect of maturing into accountable care organizations. This maturation includes the need to cooperate with new partners, involve substantially new data sources, require investment in additional information technology (IT) solutions, and become proficient in managing care from a new perspective. This seven-part series, with excerpts drawn from the article originally composed by leading authorities on population health management and enabling IT, will help organizations chart their position on the population health readiness spectrum and enhance their chances for a successful transition from volume-based to value-based care.
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POPULATION HEALTH MANAGEMENT (PHM) is a term that has entered the health care industry vocabulary with increasing fervor in the past several years. The trend began with provocation from the Institute for Healthcare Improvement’s Triple Aim framework, in which Berwick and colleagues surfaced ‘‘health’’ as a necessary aim to be pursued in balance with the other 2 aims of improving the individual experience of care and reducing the per capita cost of care.1
Since that seminal 2008 publication, there have been significant advancements in thinking, innovation, and methods for further defining, measuring, and pursuing the Triple Aim,2 including supporting legislation and demonstration projects.3–7 Specifically, the 2011 Patient Protection and Affordable Care Act promoted a transformation in the underlying business model of health care delivery systems, as well as third-party payers.8 The Act encourages a transition from the current fragmented system focused on volume-based services toward one that financially rewards patient-centered, coordinated, accountable care through value-based payment models.
The response of health care delivery organizations has been wide ranging. A few bold companies have revised their organizational vision statements in keeping with the Triple Aim, taking board-level accountability for the health and health care affordability in the communities they serve.9–11 Organizations like these have taken dramatic and innovative steps to seek out Triple Aim responsibility for a population, regardless of the patient attribution to their delivery system. Other organizations are providing customer guarantees based on cost and quality performance.12,13
Most health care delivery organizations are at least thinking about where they are on the PHM readiness continuum. Whether driven by vision, leadership, market competition, payer signals, employer demands, or the rising cost of their own employee health benefit, health care delivery and accountable care leaders are facing increasing pressure to define their organizations’ PHM strategy in preparation for a shift to value-based reimbursement.14–16 There is also burgeoning awareness that traditional health care represents a minor determinant of overall health relative to other determinants (eg, socioeconomic factors, physical environment, genetics).2
Encompassed in any PHM strategy is the requirement for supporting information technology (IT) and analytics.17,18 Organizations pursuing PHM transformation have found that their investment in certified electronic health records (EHRs) provides a necessary foundation. However, the investment in their EHR and requisite IT infrastructure is insufficient to support the technology and analytic requirements of new accountable business models. Many of the early organizations aggressively pursuing population health risk-based contracts report that their initial exploration into PHM IT was marked by confusion, unclear vision and IT capability requirements, lack of internal expertise, and build-versus-buy debates without frameworks for decision making overlaid by a succession of overwhelming vendor product demonstrations.
In this paper we acknowledge the challenges facing leaders accountable for PHM IT investment and offer tactics for health care delivery systems and payers to develop and gain support for a PHM IT investment road map. The content of the paper was informed by published literature17–20 and case studies,4–6,15,21–27 engagement with organizations with early experience in Medicare, Medicaid, commercial, and employer value-based programs, and interaction with technology vendors.
1. Berwick DM, Nolan TW, Wittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008;27:759–69.
2. Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012.
3. Berwick DM. Making good on ACO’s promise—the final rule for the Medicare Shared Savings Program. NEJM. 2011;365:1753–1756.
4. Larson BK, VanCitters AD, Kreindler SA, et al. Insights from transformations under way at four Brookings-Dartmouth Accountable Care Organization pilot sites. Health Aff (Millwood). 2012;31:2395–2406.
5. Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). 2012;31:1156–1166.
6. Coughlin TA, Long SK, Sheen E, Tolbert J. How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform. Health Aff (Millwood). 2012;31:1690–1697.
7. Epstein AM, Jha AK, Orav J, et al. The care span. Analysis of early accountable care organizations defines patient structural, cost, and quality-of-care characteristics. Health Aff (Millwood). 2014;33:95–102.
8. US Department of Health and Human Services. Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule. November 2, 2011. http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf. Accessed July 7, 2014.
9. Bellin Health. Mission, vision, strategic objectives. https://www.bellin.org/images/uploads/Mission_Vision_Values_2013_Adopted_0402131.pdf. Accessed July 7, 2014.
10. ThedaCare. Mission, vision, values. http://www.thedacare.org/About%20Us/Mission%20Vision%20Values.aspx. Accessed July 7, 2014.
11. HealthPartners. Mission, vision & values. https://www.healthpartners.com/public/about/mission/. Accessed July 7, 2014.
12. Connolly C. Health system program that guarantees doing things right the first time, for flat fee, pays off. March 31, 2009. http://www.washingtonpost.com/wp-dyn/content/article/2009/03/30/AR2009033003008.html. Accessed July 7, 2014.
13. Bisognano M, Kenney C. Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health and Lower Costs. San Fransico, CA: John Wiley & Sons, Inc.; 2012.
14. Lewis VA, Colla CH, Carluzzo KL, Kler SE, Fisher ES. Accountable care organizations in the United States: market and demographic factors associated with formation. Health Serv Res. 2013;48:1840–1858.
15. Forster AJ, Childs BG, Damore JF, DeVore SD, Kroch EA, Lloyd DA. Accountable care strategies: lessons from the Premier Health Care Alliance Accountable Care Collaborative. August 2012. http://www.commonwealthfund.org/Publications/Fund-Reports/2012/Aug/Accountable-Care-Strategies.aspx. Accessed July 7, 2014.
16. American Hospital Association. A Call to Action: Creating a Culture of Health. January 2011. http://www.aha.org/research/cor/content/creating-a-culture-of-health.pdf. Accessed July 7, 2014.
17. Fisher ES, McCellan MB, Safran DG. Building the path to accountable care. NEJM. 2011;365:2445–2447.
18. Buntin MB, Jain SH, Blumenthal D. Health information technology: laying the infrastructure for national health reform. Health Aff (Millwood). 2010;29:1214– 1219.
19. Certification Commission for Health Information Technology (CCHIT). A health IT framework for accountable care. June 6, 2013. https://www.cchit.org/aco-hit-framework. Accessed July 7, 2014.
20. Ostrovsky A, Deen N, Simon A, Mate K. A framework for selecting digital health technology. June 2014. http://www.ihi.org/resources/Pages/Publications/AFrameworkforSelectingDigitalHealthTechnology.aspx. Accessed July 7, 2014.
21. Gbemudu JN, Larson BK, Van Citters AD, et al. Norton Healthcare: a strong payer–provider partnership for the journey to accountable care. January 2012. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2012/Jan/1574_Gbemudu_Norton_case%20study_01_12_2012.pdf. Accessed July 7, 2014.
22. Carluzzo KL, Larson BK, Van Citters AD, et al. Monarch HealthCare: Leveraging expertise in population health management. January 2012. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2012/Jan/1573_Carluzzo_Monarch_case%20study_01_17_2012.pdf. Accessed July 7, 2014.
23. Carluzzo KL, Larson BK, VanCitters AD, et al. Tucson Medical Center: a community hospital aligning stakeholders for accountable care. January 2012. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2012/Jan/1575_Carluzzo_Tucson_case%20study_01_12_2012.pdf. Accessed July 7, 2014.
24. Gbemudu JN, Larson BK, Van Citters AD, et al. HealthCare Partners: building on a foundation of global risk management to achieve accountable care. January 2012. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2012/Jan/1572_Gbemudu_HealthCare_Partners_case%20study_01_17_2012.pdf. Accessed July 7, 2014.
25. Hester J, Lewis J, McKethan A. The Vermont Accountable Care Organization pilot: a community health system to control total medical costs and improve population health. May 2010. http://www.commonwealthfund.org/Publications/Fund-Reports/2010/May/The-Vermont-Accountable-Care-Organization-Pilot-A-Community-Health-System-to-Control.aspx. Accessed July 7, 2014.
26. James BC, Savitz LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood). 2011;30:1185–1191.
27. Silow-Carroll S, Edwards JN. Early adopters of the accountable care model: a field report on improvements in health care delivery. March 2013. http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Mar/Early-Adopters-Accountable-Care-Model.aspx. Accessed July 7, 2014.