The Business Case for Population Health Management Software and Services

the-business-case-for-population-health-management-software-and-services

The convergence of the movement toward value-based payments in healthcare and large-scale infrastructure investments in health information technology (HIT), together with technology advancements in Big Data and growing consumerism in healthcare, are among the key drivers transforming the organization, delivery, and financing of healthcare worldwide. This transformation, now well underway in the United States, is driving investment in population health management (PHM) software and services. Vendors anticipate strong growth in other regional markets as health systems face similar pressures to transform healthcare systems to contain spending and improve outcomes.

Coupling the Business and Care Delivery Models for Efficiency and Financial Gain

PHM came to prominence in the United States with the advent of health reforms and the Institute for Healthcare Improvement’s Triple Aim framework for improving the population’s health, along with improving the individual experience of care and reducing the per capita cost of care. Use of the term PHM refers to data-driven approaches for targeting and delivering proactive interventions in the management of groups of individuals with defined sets of characteristics or conditions. As healthcare organizations find themselves increasingly at risk financially in a value-based system of care, both the business model and model of care delivery will need to be coupled to work effectively to realize targeted financial and clinical outcomes.

With PHM serving as the strategic framework by which healthcare organizations are increasingly paid for services on the basis of the quality of care they deliver, PHM software is the enabler for the organizational change required to successfully implement PHM in practice and drive performance improvement. It not only requires large-scale data collection and analysis for the identification and stratification of populations according to risk, but also the integration of actionable insights into the workflows of care teams for the coordination and management of care across the continuum, as well as the engagement of members to become active in the management of their care.

The core HIT elements associated with PHM software support applications in areas of data analytics, care management and coordination, and patient engagement are:

  1. Identify and stratify populations with data collection aggregation and analytics.
  2. Target and track populations that have been identified as at risk.
  3. Coordinate and deliver services for targeted groups across the care continuum.
  4. Engage patients in their care through multiple communication modalities.
  5. Monitor and report on clinical and financial performance.

Advice and Customization Are Needed to Change Organizational Mindsets

The PHM market is growing and still relatively new, and continues to evolve from the perspective of business models, organizational practices, and technology solutions. A challenge that healthcare organizations face with implementation is changing organizational culture. New strategic mindsets among organizational leadership and the development of new workforce competencies are required for large-scale transformation to occur. As a result, PHM also provides software vendors with a significant opportunity to provide advisory services to support organizations with planning and implementing technology-enabled strategies.

The business model challenge is being able to meet clients where they are in terms of their strategic priorities and functionality requirements for PHM. From an overall market perspective, integrated platforms that support data collection, aggregation, and analytics at the front-end and that are workflow-sensitive in meeting clinicians and patients’ needs are the optimal solution. The majority of PHM vendors currently offer specialized applications that can be used either as standalone solutions to meet a specific PHM functionality requirement or integrated within a suite of solutions to meet a broader set of customer needs. The competitive advantage for such vendors is that it provides them with flexibility in customizing solutions to meet each customer’s needs and priorities.

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