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PHM Cornerstone Summit 2019 White Paper
Clearing the Way to Value-Based Care Success

author - Bradley Hunter
Bradley Hunter
April 1, 2019 | Read Time: 25  minutes

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.)

questions addressed at the 2018 klas cornerstone summit on population health management

What Is a KLAS Summit?

Most of the work KLAS does is focused on the core mission of differentiating vendors, usually through the research published on our website and in specialty reports. KLAS also organizes several summits each year to address select industry challenges and move the industry forward. These meetings bring together leading provider and vendor executives along with other industry experts to define problems, propose solutions, and establish measurements to track progress. At these events, KLAS acts as a facilitator rather than the expert.

Temporary Detours on the Road to Value-Based Care

In its early days, value-based reimbursement (VBR) appeared promising as a solution to reduce costs and improve care, with organizations predicting rapid adoption of VBR payment models. More recently, early excitement has dimmed; studies show increased hesitancy among providers to shift from traditional fee-for-service contracts to ones that involve meaningful risk.

Ironically, when summit attendees were asked in a pre-summit survey about their level of VBR optimism, most (84%) said that the industry transition to VBR was likely or very likely to be successful in the end. In one respect, this might be expected since many attendees were invited based on their own organizations’ successful experiences supporting VBR programs, and attendees may also have a clearer vision of industry potential.

how likely is the transition from fee for service to vbr to be successful

Even so, attendees were circumspect about the immediate future. On average, fee-for-service reimbursements represent the majority of revenue for attendees. When attendees were asked when VBR will outpace fee-for-service in their organizations, their responses showed a continuing trend KLAS has seen with past projections: each time, fewer respondents say they have reached or are about to reach that point, and more respondents push their projection to 3–5 or 6–8 years.

when will vbr outpace fee for service revenue
average percent of revenue from vbr programs

However, conservative projections seem to be the result of realism rather than negativity. When asked about satisfaction with their current level of VBR success, 64% of attendees were less than happy (rated 6 or lower on 1–9 scale). Yet when asked to rate their expected satisfaction two years from now, 79% said they expect to be somewhat or very content (7 or higher on 1–9 scale).

how satisfied are you with your organization s progress towards achieving your vbr goals
how satisfied do you expect to be with your progress towards your vbr goals two years from now

Drawing on in-summit poll results and summaries of table conversations, the following pages reflect real-life observations and recommendations to help clear the path to VBR success.

VBR Strategy: Why Are Providers Hesitant to Take On Meaningful Risk?

During the first summit session, attendees discussed common obstacles to provider organizations taking on risk as well as solutions that can help move the industry forward. Each discussion group consisted of, where possible, a mix of providers, payers, and vendors. Guiding principles included the following:

  • Obstacles and solutions should be realistic, preferably based on personal experience.
  • Discussion of obstacles should not be a finger-pointing exercise.
  • Remedies should be practical and actionable rather than theoretical.

Key discussion points were captured by scribes. Attendees then ranked both obstacles and solutions through an electronic poll.

obstacles that impede vbr adoption missing motivation

1. ROI is not apparent or guaranteed

Health system leaders often feel like the financial risk of VBR contracts is not compelling. Today’s focus is on the bottom line, and provider organizations are making money in the current fee-for-service model. VBR reduces utilization of clinicians and puts revenue streams at risk.

2. Insufficient infrastructure in place

Organizations often lack fundamental tools, staff, and expertise needed to run basic VBR components like care management and risk analytics. Some feel they are already holding systems together with duct tape and wire and have no room in their budgets to invest in new infrastructure.

3. General fear of change

Having little VBR experience, organizations don’t know what they don’t know and may lack the money, talent, or data to move forward with confidence.

4. Needed data is not accessible

Health system leaders often lack confidence that the data they need to be successful is available or timely. Without the information they need, organizations are less likely to take on downside risk. And without actionable information, it can be difficult to change processes, behavior, and culture.

5. Existing tight margins

The transition to VBR takes money, time, and talent. Some organizations lack cash reserves. Even if they have had record revenues, organizations can be cash poor due to other recent spending, such as a major EMR rollout. And even if organizations are successful in their VBR contracts, it takes significant time for the money to actually show up.

6. Lack of actuarial or contracting expertise

Not all organizations have the actuarial, analytical, and contract management expertise needed to take on deeper levels of risk with confidence. This can put these organizations at a disadvantage in negotiating payer contracts and achieving predicted outcomes regardless of clinical competence.

7. Payers unwilling to change/collaborate

Regardless of their own ability to manage VBR contracts, some provider organizations say payers’ appetite for change is low. Value-based care has been shifting historically antagonistic relationships between payers and providers toward partnerships. Still, some feel that at the end of the day, there is a lingering disconnect when both payers and providers feel the other is benefiting more from shared risk. When payers and providers are not on the same page, trust issues often persist.

8. Inertia in local markets

Even without payers, providers are hesitant to move on their own. There is no urgency in most markets because fee-for-service is so profitable. The worst place to be in is stuck in the middle: some organizations see clearly that fee-for-service is still extremely profitable but are also dipping their toe in risk-based contracts and losing money. In more competitive markets, it is more difficult to transition to value-based care.

9. Lack of data interoperability

While some interoperability standards exist, they don’t cover the full breadth of needed data types and/or are not fully adopted across all stakeholders.

10. Consumers/patients are not ready

Providers are hesitant to take on risk when they ultimately cannot control a major part of that risk: patient behavior. Despite providers’ best efforts, patients can continue to make poor health decisions, which will cost provider organizations money.

solutions that enable vbr adoption knowledge empowers

1. Design incentives to influence provider behaviors/outcomes

Provider organizations’ ROI concerns are more easily overcome when contracts contain easy-to-understand requirements that translate directly to outcomes. When outcomes are linked to specific, doable behaviors, incentives will be seen as achievable and risk as more manageable.

2. Create better transparency into provider organization performance

Provider organizations need the confidence of knowing that they will be able to track and manage performance over time. Contract provisions should include timely access to performance data at reasonable intervals. Where possible, outcomes and other performance measures should be simplified and align with known, relatable, and measurable industry-standard metrics.

3. Establish relationships across the care continuum

Before signing any contract, stakeholders should be fully aligned in terms of internal goals, infrastructure, process, and culture. The roles of each participating group (e.g., providers, payers, employers, community services, etc.) should be mutually identified and documented.

4. Learn how to better understand/assess risk

Provider organizations are more confident in taking on risk if they attain a clear understanding of that risk up front. This includes working with payers to achieve a deep understanding of the patient population’s makeup and needs as well as providers’ capacity to meet those needs.

5. Design benefits to influence patient behaviors and outcomes

Organizations should maximize collaboration with patients as well as providers and payers. A good start is patients being informed about what is going on, what their individual roles are, and what benefits and risks are involved. Benefits can include financial incentives that reward specific behaviors and outcomes.

6. Supply infrastructure up front to providers

When providers are confident that they have the tools needed, they are more willing to accept risk. Payers can support health systems by giving them seed money up front (embedded in contract negotiations) to help build up their infrastructure. Alternatively, payers can provide data and tools directly or minimize risk during the first two to three years so provider organizations can more easily absorb infrastructure costs.

7. Build in physician governance

Organizations involved in VBR should include physicians in planning and governance from the beginning in order to not lose focus on the relationship between physician and patient. This focus can help reinvigorate physicians and let them do their jobs during the transition. VBR programs don’t work well if physicians feel like they can’t do their jobs.

8. Be realistic about time frames

VBR contracts are often for just a year, but organizations can only move so fast, and it takes time to adjust and produce results. Organizations should be patient, realize that needed up-front efforts will take time, and base expectations on a strong understanding of available capacity and reasonable throughput.

9. Obtain/make better use of strong predictive modeling

Provider organizations can gain a better understanding of risk by using predictive models that go beyond basic risk-scoring of patients to account for costs and upstream activities (e.g., preventive care, education, nutrition, diet, exercise, genetics, etc.).

10. Engineer/resolve data governance access up front

Health systems should work with payers and other stakeholders to iron out the details of data access and governance before the contract instead of trusting that they will get usable data afterward. Providers should prepare infrastructure to not only warehouse data but work to understand its meaning and value. When stakeholders understand how data will be used, they are often more willing to share it.

11. Advocate for government-enforced interoperability standards

Aside from aggregating data from payers, provider organizations also need to share data with other provider organizations (not affiliated or in the CIN). Unfortunately, this has been a persistent problem in the industry. Some progress has been made with record sharing at the point of care, but not enough (mainly single-record exchange, and data is not aggregated very well). Some provider organizations feel there is a need to get the government to enforce compliance with providing an API for exchanging standardized and normalized data. This could help address the need for a universal unique patient identifier for outside-data sharing and access.

12. Educate consumers for the VBR shift

While providers cannot control patients, they can put in place an effective plan to influence patients as a precursor to taking on risk. Influence can be achieved through education via provider-organization marketing, individualized patient outreach, and employer efforts.

13. Pursue legislation

At a macro level, providers can support legislative and regulatory changes that take down VBR barriers. These changes might be related to privacy and interoperability, but they may also involve acceleration of CMS programs that effectively reward accountable care.

VBR Success: Why Are Outcomes So Elusive?

Once providers and payers move forward with VBR contracts, success in achieving financial and patient outcome goals is frequently still elusive over the long term. Organizations often underestimate the time, effort, and investment required to build appropriate infrastructure, effect cultural change among providers, and activate patients. For many organizations, the result of VBR efforts is moderate movement on quality measures but little financial reward. Attendees explored common obstacles to achieving both financial and patient outcomes, then discussed real-life solutions that can help move the industry forward.

obstacles to achieving vbr outcomes collaboration and trust

1. Incentives are not aligned, don’t encourage collaboration

Without aligned incentives, there can be conflicts of interest not only between providers and payers but also within providers’ clinically integrated networks. This can dampen active, ongoing collaboration between stakeholders that need to work in lockstep to achieve mutually beneficial outcomes.

2. Data-reliability problems

Even when governance is decided ahead of time, data-quality issues can persist due to lack of integration, variations in standards, and slow data delivery. If physicians and care managers do not have the trustworthy data they need, their level of engagement and their ability to make the best patient-care decisions are limited.

3. Mistrust between stakeholders

Even with a contract in place, decades of adversarial relationships between providers and payers do not vanish overnight. Even within health networks, independent providers may feel they are being shamed into compliance rather than being seen as partners. In either case, continued skepticism can inhibit the cooperative behavior needed to produce results.

4. Risk is not shared fairly among stakeholders

When provider organizations consistently fail to achieve contracted benchmarks and targets despite significant investment and efforts, they may feel the model is unfair and become disinterested in pursuing outcomes when downside risk is limited.

5. Difficulty influencing individual behavior within care teams

Achieving outcomes depends on success in changing the culture and behavior of clinicians. Lack of awareness, weak incentives, and burnout drain clinicians’ motivation to make needed changes.

6. Inability to measure the cost of care

In some high-risk reimbursement models, such as capitation and bundled payments, provider organizations’ inability to measure the true cost of care makes assessing financial outcomes a guessing game and can obscure low returns in the long run.

7. Unsure of how to pay providers, measure value

Without activity-based costing, provider organizations have difficulty allocating costs for specific services. And preventive services are often the hardest to allocate costs for, making population health management (PHM) work particularly challenging in this aspect.

8. Lack of clinical leadership to drive change

If physicians are left out when VBR teams are built, trust can quickly erode among providers. Without physician leadership, organizations lack perspective on what is needed in terms of care redesign, workflow adjustment, and cultural change.

9. Measured outcomes are poorly defined

Providers often find that metrics are too broad or too numerous. Too many metrics make it difficult to know where to focus and determine the financial impacts of those metrics. Poorly defined metrics make collaboration more difficult.

10. Players outside of the health system not being engaged

When health systems concentrate solely on their own capabilities, they can miss out on insights from other players in their communities such as food banks, transportation services, elderly centers, and so forth that can help health systems achieve their population health goals. Often, provider organizations do not know how to engage these groups.

11. Juggling too many treatment models

Provider organizations that dip their toes into too many contracts can find it distracting and difficult to treat different patients with the same health conditions differently depending on the contract they fit under.

12. Lack of patient engagement after discharge

In some situations, there is little accountability to follow up with patients after treatment to ensure they are adhering to care instructions. Lack of engagement is not limited to patients themselves, but also includes engagement with other caregivers and members of a patient’s social circle who should be assisting in the patient’s recovery.

13. Lack of contracting expertise

Due to a lack of contracting expertise, provider organizations can end up with contracts that favor payers’ health plans rather than the health system. This can leave providers with the short end of the stick in negotiations, which causes them to enter contracts that are difficult to execute.

14. HIT change is too costly, time consuming

Health systems are still coping with the costs of recent EMR replacements driven by regulatory requirements as well as the cost of interoperability tools to connect multiple data sources that are needed. Some organizations have difficulty transitioning from a focus on the EMR, which prioritizes data gathering, to a focus on analytics tools to make sense of the data.

15. HIT vendors are not nimble

Regulatory demands have often driven the development priorities of many vendors. Some provider organizations feel that EMR vendors have become less nimble as they have grown. As vendors catch up in meeting population health needs, system changes and new solutions can be costly for provider organizations and take time to be delivered.

solutions for achieving vbr outcomes managing change

1. Align contract incentives for payers and providers

When drawing up contracts, provider organizations and payers should spend time aligning strategic goals and setting up balanced incentives that reward collaborative behaviors from all parties. For example, on the payer side, incentives might ensure timely sharing of data. On the provider side, incentives might support a greater focus on primary care and overall cooperation between care teams. In some cases, it might be helpful to employ an objective third party for oversight during the process.

2. Ensure cultural change at all levels in the health system

An organization’s shift from fee-for-service to value-based care requires cultural change from top-level leadership to frontline clinicians. At the core of this culture change, there should be a shift from a transactional mindset to a business-service mindset where primary care and patient relationships drive utilization. Incentives are one part of supporting change but must be backed up by training along with new workflows in the EMR and other tools that support PHM and patient outreach. Third-party readiness assessments can help all parties understand their gaps.

3. Focus on fewer, more meaningful metrics

Efforts to adjust culture, employ incentives, and reform care are easier when supported by meaningful measurement. Stakeholders should work together to condense the number of metrics tracked to include only those that are most directly related to success in key areas. This includes aligning contracts to eliminate metrics that are largely redundant in their purpose but require unique data or formulas. Instead of beginning with an expansive program, it can be helpful for providers to focus on measurements that directly relate to certain behaviors in order to help clinicians better understand what they need to do and reduce feelings of being overwhelmed (e.g., instead of focusing on readmissions, start with missed appointments).

4. Involve physicians in governance up front

As physicians are on the front lines of achieving outcomes, they should have an influential voice in the implementation and operation of VBR programs. Input from experienced physician leadership helps ensure that incentives correctly motivate clinicians, training provides meaningful education, and technology delivers effective automation.

5. Increase financial and outcomes transparency for providers

The nature of VBC requires health systems to expand the depth and breadth of responsibility given to providers, who must enact change in working with patients. When providers can clearly see the connection between their behaviors and the resultant financial and clinical outcomes, they are better equipped to make decisions about care processes and workflows that can improve their practices. This clear vision is only possible when providers have convenient and timely access to accurate performance data.

6. Build trust by communicating with providers more extensively and more often

Taking on real risk requires ongoing change management. Organizations who think sending out a report and then hoping people downstream will take action are often disappointed. Instead, organizations must formalize communication with stakeholders and communicate on a regular basis. A joint operating committee that includes administrators, providers, and payers facilitates transparency, coordination, and strategy refinement.

7. Engage in care-model redesign

Most organizations delving into VBR inevitably need to engage in care-model transformation in order to produce desired outcomes. New care models should emphasize core principles such as putting primary care providers in the driver’s seat, establishing cross-functional care teams, leveraging care managers, and increasing patient outreach. Physicians can help prioritize redesign efforts and plan for the automation of new workflows within clinical software solutions.

8. Better explain the business case of VBC

Once incentives are properly aligned, provider organizations can sell their vision to prospective physician participants. This involves clearly explaining the business case behind the VBC program with a focus on the long-term clinical benefits. When physicians see exactly what the financial result is from closing care gaps, what was just data becomes something more tangible and meaningful. Clearly seeing how their activities impact what they are paid encourages behavior change. To support the business case of VBC, health systems can focus on driving some measurable value in the first year of a program.

9. Obtain contracting/actuarial expertise and guidance at provider organization level

Healthcare executives often don’t understand the specifics of payer processes and VBR contracts, so having an actuary on staff or otherwise available can be helpful. Internal and third-party experts in contract negotiation can help create consistency across contracts, making VBR programs easier to manage and outcomes easier to achieve.

10. Monitor specific patient behaviors that create health problems

Understanding what patients need and why they do what they do is critical to the long-term success of VBR efforts. When patient behavior is understood, providers can more easily establish behavior-changing incentives and communicate them to patients. Providers can better understand patients by paying increased attention to social determinants of health.

11. Put cost accounting in place

For some organizations, taking on deeper levels of risk (e.g., bundled payments and capitation) is their ultimate goal. Without the ability to measure the total cost of care, understanding the outcomes and value of these high-risk programs is almost impossible. Those planning for long-term success with such programs should develop and/or buy cost-accounting capabilities.

Measuring VBR Progress

There is no shortage of studies, reports, and opinions that declare progress (or lack of progress) in US healthcare organizations’ move away from fee-for-service and toward value-based reimbursement. However, there is little established consensus on how that progress should be consistently measured. Summit attendees weighed in on national progress metrics as well as ways to measure the preparation and performance of each of the key stakeholders at the summit: providers, payers, and vendors.

national measurement benchmarking progress

1. Percentage of revenue from risk-based contracts

A broad metric like the percentage of revenue from risk-based contracts not only tracks the average financial commitment to VBR over time but also allows for the setting of threshold percentages indicating when an organization is meaningfully invested in risk-based contracts rather than just dabbling. Based on a defined threshold, the number of organizations that have meaningfully invested in VBR can also be calculated.

2. Cost savings (per member, overall, etc.)

A metric based on cost savings can indicate how well value-based care programs are performing; notably, this type of metric should be based on gross savings, not just shared savings from a subset of contracts. Cost savings can also be used to compare health systems with each other or even nationally. When tracked as real dollars, cost savings can be compared to spending to measure ROI.

3. Percentage of members under value-based contracts

Like VBR revenue, the number of individuals under value-based contracts represents the ongoing level of commitment to risk sharing. This metric could also include specific thresholds to measure progress.

4. Number or percentage of members being managed under risk-based contracts

Measuring the number of members/patients that are being actively managed goes beyond simply quantifying those for whom accountability has been assumed via a VBR contract. Counting those who are actively managed (i.e., those who interact with providers on a regular basis, such as those working with a care manager) would also assess the level of effort from the healthcare organization.

5. Amount of risk-based revenue earned or lost

Tracking the amount of risk-based revenue that organizations earn or lose can help assess health systems’ ability to meet VBR contract requirements and thus achieve financial outcomes over time. Rather than assessing the level of commitment to VBR, this measurement highlights strengths and weaknesses in contracting and care processes.

6. Depth of risk-based contract portfolio (types of risk)

Tracking a provider organization’s distribution of risk-based contract types (e.g., fee-for-service, pay for performance, shared savings, capitation, etc.) shows the current depth of downside risk being assumed. It can also act as a proxy for a provider organization’s level of confidence and/or capabilities to manage population health.

7. Overall health system profitability

When correlated with other metrics, a health system’s profitability can help organizations assess the success of VBR efforts. This metric can also be used to show how many organizations have the financial stability—and thus the needed margins—to fund a value-based care transformation.

8. Percentage of care processes re-engineered/newly adopted

Setting aside financial measures, the percentage of care processes that have been reengineered or newly adopted can be used to represent effort expended and progress made toward transforming a fee-for-service organization to one centered on VBR. In order to serve as a national measure, this would require that all provider organizations use a standardized maturity model. While a number of such models exist, none have received broad enough adoption to serve as a de facto standard today.

provider measurement the health of relationships

1. Access options for patients (e.g., urgent care, telehealth, etc.)

One way to control cost of care is to offer patients multiple access options that meet care needs at a lower cost. Measuring the number and type of options available (e.g., telemedicine, urgent care, behavioral health, etc.) can help provider organizations assess their current readiness and set goals for the future.

2. Patient-reported outcomes

Tracking outcomes based on direct patient feedback can help organizations understand the effectiveness of their VBR efforts better than many existing, process-based quality measures that track activity rather than end results.

3. Patient satisfaction

Satisfied patients are more likely to trust providers and follow through on treatment plans. They are also less likely to contribute to leakage by seeking care outside of the official health network to which they are assigned.

4. Patient loyalty

Patient loyalty (e.g., how often patients return to a specific health system for ongoing care) can serve as an indirect measurement of patient satisfaction (or even a measure of the perception of members who have not recently interacted with the health system).

5. Engagement with community organizations

Organizations outside the four walls of a health system can play a valuable role in managing patient health and wellness. Provider organizations that develop strategies for engaging with community services (e.g., police departments, food banks, transportation services, homeless shelters, etc.) can track progress in meeting milestones.

5. Provider retention and satisfaction

Appropriate support and engagement with network providers can build trust and motivation while reducing burnout that might lead some to opt out of participation in VBR programs. Tracking satisfaction and retention can help organizations assess the success of provider support and plan strategies for improvement going forward.

7. Number of patients getting health assessments

VBR and ACO contracts often include targets for foundational health assessments performed for covered members/patients. Tracking the percentage who have received needed assessments can drive strategies for improvement.

8. Amount of patient leakage

Managing patient care is made more difficult when patients seek care outside of the care network accountable for their care. Tracking patient leakage can help organizations understand the extent of the problem and define strategies to compensate at both individual and health system levels.

9. Recruitment of primary care providers

As value-based care places greater weight and responsibility on primary care, many organizations need to increase their PCP ranks to handle the increasing workload. Tracking changes in recruitment progress and the proportion of PCPs can help organizations sustain their drive toward long-term goals.

10. Number of care managers hired

In most cases, implementation of VBR requires a care-model change that involves using care managers to engage patients and help them navigate the care continuum. Tracking care-manager recruitment can help organizations meet ongoing hiring needs.

payer measurement financial commitment

1. Percentage of payments based on value-based care

Tracking the percent of payments related to risk-based contracts can help payers assess commitment to VBR over time. It also allows for setting threshold percentages to indicate which payers are meaningfully invested rather than just experimenting.

2. Decrease in spending for VBC population vs. fee-for-service consumers

If VBR programs are effective, payers should see an overall drop in spending for VBR populations compared to fee-for-service patients. Tracking progress can help payers understand which strategies are most effective and which strategies need adjustment.

3. Percentage of insurance products that are risk based at various levels

Tracking the distribution of risk-based contract types (e.g., fee-for-service, pay for performance, shared savings, capitation, etc.) shows the depth of risk being shared with provider organizations. This can suggest whether payers are willing to invest in value-based care and incentivize providers to take on greater levels of risk. Investigating slow progress in risk-based offerings could highlight areas where payers might support provider organizations to better care for patients through care management and other strategies.

4. Percentage of claims data being shared with providers

Claims data is a critical resource for effective provider-based VBR programs. The amount of claims data being shared can represent the level of transparency and partnership that payers have with contracted provider organizations.

5. Percentage of increase in premiums for employers

Ultimately, effective VBR programs should reduce the cost premiums paid by employers. Tracking trends in premiums over time could help payers understand the effectiveness of combined payer-provider efforts and adjust strategies where appropriate.

6. Frequency of provider-performance reporting

In addition to offering data transparency, payers can better support the contracted provider organizations’ improvement efforts by transparently sharing timely and detailed performance results.

7. Medical loss ratio (e.g., member absenteeism in the workplace)

Assessing changes in member employee absentee rates due to medical issues can shed light on the effectiveness of combined payer-provider efforts and how to adjust strategies where appropriate.

vendor measurement partnership with customers

1. Customer ROI from population health tools

Provider organizations want to know the level of return they are achieving from their investment in PHM solutions and would like tools measuring ROI to be built into the solutions themselves. Although such assessments can be difficult, vendors would benefit from the ability to assess ROI successes and failures in order to adjust development and implementation strategies. Proven ROI could also potentially boost interest from potential customers.

2. Level of success in achieving customer-defined outcomes

Not all customer goals are the same or are measured in dollars. At a customer-by-customer level, vendors can help define and measure specific outcome goals; these goals might represent provider capabilities (e.g., patient stratification) in addition to financial returns, including other provider measures mentioned above.

3. Data liquidity/interoperability

With the help of customers, vendors could define measures that represent how well their solutions can support data liquidity and interoperability when it comes to sharing data with payers, external health systems, and other parties. This type of measurement would require definitions of what must be exchanged and agreement on terminology.

4. Change in cost of care for customers

As part of calculating the ROI of their VBR efforts, customers would like vendors to track changes in cost of care. By assessing cost changes while considering unique customer characteristics and approaches to VBR, vendors could drive product improvements and develop guidance for their wider customer bases.

5. Willingness to share risk with customers

Across vendors, provider organization customers would like their vendor to report when and where they have shared risk or are willing to share risk in the future as part of their business model.

6. Level and amount of customer guidance

Going beyond technology, vendor guidance has proven to be an important factor in provider organization success. Vendors can develop metrics to track the breadth and depth of the assistance they give customers and the circumstances under which they provide guidance (e.g., implementation guidance, added-fee consulting, types of customer, level of clinical focus, etc.). Not only could this help address gaps for individual customers, but it could also help vendors evolve a guidance strategy tuned to the needs of specific customer groups with low incremental costs.

7. Price transparency in vendor-customer contracts

Across vendors, provider organizations would like their vendor to provide accurate price transparency up front. Vendors can track how often and to what degree price predictions fail and adjust selling strategies to minimize perceptions of nickel-and-diming.

8. Allocation of money and technology driving innovation

Across vendors, providers would like their vendor to report the amount of money they are investing in driving innovation in their solutions. Investments should be tied to real improvements in achieving customer goals and outcomes.

Summit Attendees


Chuck Newton

Senior Vice President
Risk Strategies

Howard Underwood

VP & Actuary

Kevin Larsen

Enterprise Lean and Performance Improvement Lead
Centers for Medicare & Medicaid Services

Krishna Ramachandran

VP Health Data Strategy & ENS
BlueCross BlueShield Illinois

Shawn Stinson, MD FACP

SVP, Managed Care and Population Health
BlueCross BlueShield of South Carolina


Betsy McVay

Vice President & Chief Analytics Officer
UnityPoint Health

Cliff Frank

Interim Executive Director
Shore Quality Partners

David Coe

VP of Data Management Analytics and Population Health
Banner Health

David Tilstra

CentraCare Health System

Debra Simmons

Executive Director, COSEHC
Wake Forest University Baptist Medical Center

Deirdre Marek

VP, Population Health Advisors
Baylor Scott & White Health

George Reynolds

Retired CIO & CMIO
Reynolds Healthcare Advisors

James Doulgeris

Osler Health

Jim Przybilla

PrimeWest Health

Jimmie Glorioso

Director, Population Health & Analytics Systems
UT Southwestern Medical Center

Jorge Petit

Coordinated Behavioral Care

Lee Milligan

Asante Health System

Luke Harris

Director of Operations & Population Health Management
Children's Mercy Kansas City

Mansour Al-Swaidan

Deputy CIO
King Faisal Specialist Hospital & Research Centre - Riyadh

Mark Wendling

Executive Director of PHO
Lehigh Valley Health Network

Nick Bassett

Executive Director, Population Health
Intermountain Healthcare

Susan Hawkins

VP, Population Health
Henry Ford Health System

Travis Turner

Senior VP, Chief Population Health Officer
Mary Washington Healthcare


Abdullah Al-Rabiah

Director of Customer Touch Points Solutions

Abhinav Shashank


Alana Tucker

Sr. Product Marketing Manager

Andrew Croshaw

Leavitt Partners

Ann O'Brien

National Coordination Center

Bharat Sutariya

VP & Chief Medical Officer

Bo Nemelka

Director of Business Development
Leavitt Partners

Brad Carey

Vice President, Population Health Advisory Service

Daniel Malloy


David Lee

Leavitt Partners

Don Woodlock

VP of HealthShare

Helen Waters

Executive Vice President

Hoda Sayed-Friel

Executive Vice President

Jean Balgrosky

MD Revolution

Jennifer Sprague

Director, Product Management

Jerry Shultz

Lightbeam Health Solutions

Jessica Sweeney-Platt

Executive Director, National Health Systems and Provider Networks

Joe DaMore

VP, Population Health

John Vivoda

AVP, Strategy and Product Management

Josh Rubel

SVP Sales

Kathleen Aller

Director of Market Strategy

Kathy VanEnkevort

Director, Provider Client Solutions
IBM Watson Health

LeRoy Jones

GSI Health

Luis Machuca


Mark Pingel 

Director of Population Health R&D

Megan North

President, Value-Based Care
Conifer Health Solutions

Michael Barbouche

Founder, CEO
Forward Health Group

Michael Gleeson

Chief Analytics Officer

Murugan Subramanian

VP, Connected Communities Solution Management

Natalie Burton

Leavitt Partners

Parker Hinshaw

MD Revolution

Patrick Schenk

Implementation Executive

Rachel Connolly

Sr Project Manager
IBM Watson Health

Shawn Griffin

VP Clinical Performance Improvement & Applied Analytics

Sita Kapoor


Tim Zoph

VP of Strategy
Impact Advisors

Todd Christiansen

Forward Health Group

Tonya Mallory

Strategic Advisor
Creo Wellness

Tushar Mehrotra 

Sr Vice President, Analytics

author - Robert Ellis
Project Manager
Robert Ellis
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.