Becker's Hospital Review

31 Executive Briefing Sponsored by: I t is often difficult to predict new trends, best practices and what will become an industry standard in healthcare. But one thing appears certain: the era of fee-for-service as the primary payment model is gradually coming to a close. Soon, most payment will be value-based. For as much as this change has been accepted in healthcare, it remains unclear what the value-based care world will ultimately look like. Looking toward future success As the shift in payment models continues, a clinician's need to better understand their patient population exponentially increases. This understanding, in turn, will help providers treat entire populations in a way that not only improves clinical outcomes, but also drives reimbursement. Additionally, having a population health strategy focused on improving both clinical and financial outcomes will, in part, determine your eligibility for participation with health plans. As plans move to narrow networks, they become more selective about who they include. If health systems and practices fail to show quality results, they will most certainly be excluded from those networks — limiting their access to patients. Health and disease management is key More than anything, metrics matter when it comes to succeeding in value-based care models. In 1987, 29 percent of women over the age of 40 had a mammogram within the prior two years and by 2015, that increased to 64 percent. 1 Certainly better, but a change that still leaves room for further improvement. Now, let's assume that percentage increases to 90 percent. With more patients receiving appropriate mammography, short-term costs will increase, but so should quality. Breast cancer may be detected sooner, leading to earlier, and often less expensive 2 treatment with — hopefully — better results. Without early detection, it is possible that the cancer advances prior to detection and the payer is responsible for covering much more of the patient's care. Increased costs with lesser outcomes help no one. The additional upfront cost for monitoring patients' health will pay off over time. If the value cycle starts now, the industry can improve both patient care while lowering healthcare spend. This is all to say that understanding and addressing a population's most common diseases invariably helps organizations improve patients' health status while controlling long-term costs. Preventing, managing and effectively controlling diabetes will reduce the risk of one day needing to treat the patient for a variety of known complications including both ophthalmologic and renal issues. This is one practical way to succeed within this payment model shift. Thriving in the change For organizations to successfully manage the health of their populations, they need a strategy. When devising a population health strategy, looking at how your organization addresses each of population health's four components — data aggregation and connectivity, analytics, care coordination and patient engagement — is a good place to start. Navigating your population health strategy 1 Table 70. Use of mammography among women aged 40 and over, by selected characteristics: United States, selected years 1987–2015: https://www. cdc.gov/nchs/hus/contents2017.htm#070 . 2 Blumen H, Fitch K, Polkus V. Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. Am Health Drug Benefits. 2016 Feb;9(1):23-32. PubMed PMID: 27066193; PubMed Central PMCID: PMC4822976. By Dr. Michael Blackman, Medical Director, Population Health and Analytics, Allscripts "One thing appears certain: the era of fee-for-service as the primary payment model is gradually coming to a close." — Dr. Michael Blackman, Medical Director, Population Health and Analytics, Allscripts

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