Population Health Management: Are Existing Tools Fit for Purpose?

Abstract

Background : As part of the global move towards value-based care, many health systems are experimenting with new forms of population health management. Population health management assumes an organization taking over responsibility to assess the needs of a population in, while identifying groups of patients at risk that might benefit from an intervention to alter the natural cause of their disease. Population health management also often provides aggregate or provider specific performance data to track performance and identify opportunities to improve clinical and financial outcomes Groene, Pimperl & Hildebrandt 2017. Historically, data utilised for population health management has been dispersed at a range of institutions, such as GP practices, hospitals, municipalities, registries or statistical offices. Furthermore, data has mostly been limited to administrative data data collected for billing purposes. The linkage of health care data to other data sources, such as demographic or census data has been an exception Chadwick, Varagunam & Groene 2015. With health systems increasingly focusing on population health management, commercial providers have developed a suite of tools that aim to extract data from a range of sources, link them in a data warehouse, apply tools for patient segmentation and construct performance dashboards to guide population health management. Aim : We will a describe reporting requirements for population health management such as CMS indicators for Accountable Care Organizations, b compare the data sources, functionality and indicators included in existing population health management tools and c map these on established frameworks of population health and health system performance. After an input presentation covering these aims, we will d engage a panel of three experts to discuss the implication of the work. Initial findings : Our initial findings suggest that existing tools for population health management are underutilized in many health systems. USA based Accountable Care Systems have to report on a minimum set of performance indicators, thus driving IT providers to produce appropriate tools. Elsewhere, in absence of similar standardized requirements, a more heterogeneous approach to assessing and managing population health can be observed. Second, population health management suites represent a rather wide range of services, from simple reporting tools, over business intelligence including patient segmentation tools and predictive modelling, to tools that provide nudges to improve individual patients´ care management. Third, and more importantly, the mapping of existing population health management tools on OECD and WHO frameworks suggests that they are insufficient to address to wider determinants of population health. Rather, existing tools are naturally build around formal reporting requirements and limited to well-established disease-focused care programmes. Implications : With the increasing focus on rewarding the value of service delivery health systems need to apply population health management tools much more coherently than in the past. Various IT providers have prepared tools with compelling functionality, however, existing tools still map poorly on the conceptual frameworks of population health as proposed by OECD and WHO. The presentation will outline which steps are required to ensure that future upgrades address the determinants of population health in a more consistent manner.