High performing healthcare entities integrate a combination of analytics, clinical care coordination, and patient/member engagement to define their internal population health management solution. Common attributes associated with successful population health management strategies include:
- Early identification and stratification of at-risk (potentially liable for increased severity of illness) populations
- Early interventions using a hybrid Machine Learning (ML) and human capital expertise
- Cohesive partnership with patient and provider to manage overall health
Early adopters of population health management endured a significant learning curve since PPACA with regard to investing in ML/AI tech against an expected ROI. Vee Technologies has observed consistent improvement across payers and providers to leverage digital population health management tools to meet fiscal and value-based targets.
The New New
Claims data remains the backbone for most digitally connected population health suppliers and users, which also makes users vulnerable to time/accuracy issues with any claims-based solution. For the time being, disease identification, stratification, and clinical intervention will remain a hybrid use of tech for clinical data integration augmented with professional services.
At Vee Technologies, our clients strongly support pursuing “technology-enabled” services where our critical differentiator is the ability to avoid being fully contingent on data or human capital.
The fluid revenue stream associated with value-based care will keep population health management in the “maturing technology” category. The purpose and principles of PHM intersect with broader industry dynamics, particularly digital evolution. Eventually, the value-based sector will separate, leaving those who adopted a digitally connected population health strategy well positioned to navigate the increase in M&A activity versus niche entities that may be non-scalable in the new new.
In 2020, healthcare entities were scattered across all levels of population health maturity, strategy, adoption, and digital integration to support an integrated care model. In the payer sector, several regionalized markets of the Big 5 (UHC - 70 million, Anthem - 40 million, Aetna - 22.1 million, Cigna - 20.4 million, Humana - 16.6 million2) saw the fruits of their PHM strategy align with the incentive and revenue models.
Our recommendation for 2021 is to define the transformation roadmap for integrating a PHM strategy, which includes digital adoption, disease identification, clinical intervention, and patient engagement.