A KPMG study revealed that population health programs, designed to improve quality and access to care while reducing costs for designated patient groups, are taking hold at health plans and providers.
For the survey, 86 respondents, who were identified as working for a payer or healthcare provider, gave feedback during a KPMG webcast in December. The webcast outlined how to develop “population health management programs, measurable goals and address clinical, operation, and technical considerations.”
The KPMG survey reported 44 percent of respondents have a population health platform in place being “utilized efficiently and effectively.” Meanwhile, 24 percent of respondents said they are in the process of implementing a population health program within the next three years. Twenty-one percent of respondents said their organization doesn’t require a population health platform. And 10 percent said they have “no plans to implement a population health platform.”
Tom Mayo, associate professor at Southern Methodist University’s Dedman School of Law and adjunct associate professor for internal medicine at UT Southwestern Medical School, says despite KPMG’s survey using a smaller sample size and being limited to registered attendees at a single webinar, it raises “pretty typical concerns of those expressed by health care providers over the years.”
“Starting with Kaiser’s creation of HMOs in the 1930s and 1940s, many different models of managed care have been rolled out,” Mayo said. “The new label of ‘population health’ is more than old wine in new models, but there are common features and common challenges that are present in all attempts to manage health care.”
Mayo says coordinating patient care, incentivizing providers to evaluate the cost-effectiveness of treatments, and making patients partners in their own decisions about nutrition, exercise, and chronic disease management is a difficult task.
However, he believes one key to the success of any plan that offers financial rewards to providers (through performance-based reimbursements), patients (through lowered insurance premiums), employers (lowered healthcare costs), and insurers (through reduced claims), is the creation of quality measures helping to avoid the abuses that marked many managed-care models in the 1980s and 1990s.
“The Affordable Care Act tried to encourage the creation of Accountable Care Organizations to accomplish all of this, but many providers thought the financial risks were not justified by the potential financial rewards,” Mayo said. “The concept of a team approach to health care, though, makes all the sense in the world, and it is working in lots of locations around the country, including here in Texas.”
This team approach seems to be receiving positive feedback so far.
Michael Beaty, principal at KPMG’s healthcare and life sciences practice, says the statistics showing nearly half of providers and payers see benefits to population health plans is “very encouraging.”
“Providers are taking on more financial risk from these programs, but they have a greater opportunity to share from savings,” Beaty said in a statement. “Payers gain from administrative efficiencies and letting providers take on that risk.”
According to the KPMG survey respondents, the biggest barriers to successfully implementing a population health program would be aggregating and standardizing information from multiple sources, stakeholder adoption, and integrating clinical work flows.
Other notable barriers include enabling patient engagement, funding investments, and selecting appropriate vendors.
Todd Ellis, principal at KPMG who co-hosted the webcast with Beaty and KPMG partner Joe Kuehn, says complaints about incorporating technology into clinical workflows are fairly common and have many doctors and others involved with care delivery dissatisfied with electronic health records and other tools.
“This can be remedied by better training and incorporating clinicians into the process of selecting technology,” Ellis said in a statement.
Mayo believes the advantages of integrating technology into clinical workflows overshadow the resistance, and can play a role in reforming future approaches to resolving healthcare issues.
“The biggest single change from previous eras is probably the electronic health record, which has the potential to create massive amounts of data and to inform and reform approaches to illness prevention and treatment,” Mayo said. “The advantages for coordinated patient care and evidence-based medicine are too great to allow paper medical records for much longer.”