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Population Health Management
 

Pre-packaged IT solutions that provide analytics and care management functions for analyzing, understanding, and proactively managing patient populations.

Subject Expert
Bradley Hunter
Research Director
KLAS Research Director - Bradley Hunter
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PHM Downside Risk 2021: Guiding Principles from Successful Organizations) Report Cover Image
Performance
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PHM Downside Risk 2021: Guiding Principles from Successful Organizations
14 October 21
<p>In the United States, just 10% of the average healthcare organization’s revenue comes from downside risk contracts. However, several health systems are ahead of the curve, and their valuable insights on adopting downside risk can help peers figure out how to move the needle on value-based reimbursement (VBR). KLAS worked with population health management (PHM) vendors to identify which of their customers are most advanced in adoption of downside risk contracts and then conducted interviews with top executives at 15 of these organizations. We spoke with large, midsize, and small health systems as well as a handful of ACOs, highlighting the fact that with the right technology and organizational structure and buy-in, organizations of all types can make significant progress toward VBR.</p> <p>The Executive Insights portion of this report explores what outcomes the organizations have achieved as well as their aggregated insights regarding keys to success, lessons learned, and potential pitfalls. Case studies for each of the participating organizations provide additional detail and can be found in the Expanded Insights section of the report.</p>

Recent Insights

Key Findings:

  1. Outcomes Achieved with Downside Risk
  2. Principles Mastered by Deep Adopters of Downside Risk
  3. Top Advice for Peers: Contract Management Is Crucial with Downside Risk
  4. Biggest Pitfall to Be Aware Of: Despite Good Progress, Additional Functionality Still Needed for Data Aggregation and Advanced Analytics
  5. Strong Integration & Configurable Functionality Can Make or Break a Downside Risk Strategy
  6. Azara & HealthEC (for Smaller Organizations) and Innovaccer (for Large) Deliver Key Insights for VBR


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Performance Data

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Related Articles
Article
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What’s Happening in Value-Based Reimbursement
13 October 20    |   Bradley Hunter and Paul Warburton
COVID-19 has exposed many of the shortcomings of a fee-for-service model. On the other side of the pandemic, the transition to value-based reimbursement will be crucial.
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eTech Insight – Data Aggregation Solutions Drive Big Data Accessibility
17 June 20    |   Mike Davis
Healthcare providers need to allow their data to be used by cohort organizations but patient advocates are concerned that the data may not be deidentified to the extent necessary to protect patient id
Article
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The Next Step—Population Health Care Management
03 February 20    |   Bradley Hunter
The population health market is realizing that it needs more of the next step: the care management piece. There is some adoption, but there is not widespread adoption. A lot of the other players in th
Article
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The Calming Waters of the Digital Health Investment Market
05 December 19    |   Chris Chandler
As 2019 closes and 2020 opens, let’s take a moment to examine the past, present, and future of investing in digital health markets.
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Related ReportsView All Reports
Performance
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Population Health Vendor Overview 2021
22 June 21    |   Bradley Hunter and Cathy McCabe
Provider organizations looking to advance their value-based care strategies often look to population health management (PHM) technology to give them the confidence to move forward with value-based care. This report seeks to provide transparency into the major PHM technology offerings available today—the types of organizations that typically use the systems, what the customer experience is like, which solutions are seeing the most market energy, and the breadth of their PHM capabilities. PHM insights that go beyond this study’s general overview can be found here .
Performance
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SDOH Referral Networks 2021
30 March 21    |   Bradley Hunter and Paul Warburton
Adoption of technology to help provider organizations manage SDOH referrals is still early, but interest is growing as organizations seek to take on more value-based reimbursement risk. This report provides a first look at customer satisfaction with various SDOH referral network solutions and examines the parts of the SDOH referral process in which these solutions are being used. All measured vendors in this early market have overall scores above 90 (out of 100), indicating high overall satisfaction. Shifts in satisfaction are possible as the market matures and the number of KLAS ratings increases.
Best in KLAS
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2021 Best in KLAS Awards - Software and Professional Services
02 February 21    |   Mark Allphin and Sam Eaquinto
The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide. Read the report to see the top-rated medical software and services for 2021. Watch sessions from our first-ever virtual Best In KLAS Award Show to hear from the winning vendors in each segment. View Awards Show Recordings
First Look
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Relevant
29 January 21    |   Bradley Hunter and Sam Eaquinto
FQHCs have only had a couple of options to choose between in the last few years when it came to solutions that support taking on risk through value-based care. Relevant’s data analytics platform is intended to help community health centers make better decisions based on data. This report is KLAS’ first look at the experience of Relevant’s clients and seeks to provide early insights into satisfaction among these customers.
White Paper
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Value-Based Reimbursement 2020
01 October 20    |   Bradley Hunter and Paul Warburton
Insights from CHIME’s 2019 “HealthCare’s Most Wired” data, KLAS Population Health Management Cornerstone Summit, and KLAS Decision Insights In the nearly 10 years since accountable care organizations were first established, healthcare organizations have been slow to take on risk-based agreements, especially those with downside risk. While the industry agrees that the rising costs and stagnant outcomes of fee-for-service (FFS) are not sustainable, healthcare executives are becoming less optimistic about how quickly value-based reimbursement (VBR) will outpace FFS. This report examines data from a variety of sources to measure industry progress toward VBR and explore how technology is being used to support it.
White Paper
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PHM Cornerstone Summit 2019 White Paper
01 April 19    |   Bradley Hunter
When CMS rolled out the Medicare Shared Savings Program in 2011, it helped initiate a wave of optimism that value-based reimbursement (VBR) programs would go a long way toward resolving the persistent problem of rising healthcare costs. Eight years later, some say that VBR has not lived up to its promises, and enthusiasm seems to be shrinking as many provider organizations hesitate to take on meaningful risk. Those that press forward often find that expected financial outcomes are out of reach. What happened to dampen enthusiasm? Why is success so difficult to achieve? On November 14, 2018, leading executives from provider, payer, and vendor organizations convened in Salt Lake City, UT, to help answer these questions. Together, they identified strategic and operational barriers that have dampened VBR headway as well as potential solutions to clear the way. They also discussed ways to measure VBR progress in the future at both national and organizational levels. This document is being publicly shared to help all those that may benefit from the combined experience and expertise of summit attendees. (See page 15 for a list of attendees.)



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This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

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