Population Health Cornerstone Summit 2017
Pop Health Definition, Outcomes Measurement, and Best Practices

Population Health Definition, Outcomes Measurement, and Best Practices

Population Health Technology and Services Framework

Provider organizations managing risk have access to a broad array of services and technology that can help assist the organizations in their efforts.

The functionalities and services that risk-bearing organizations need in order to manage risk are broad and interconnected. While the list below does not exhaust the functionalities and services that risk-bearing organizations may need, the items listed are needed by many of the organizations. Six key layers of functionality/service stand out as somewhat independent.

Functional capabilities and services that many providers require are grouped into three broad categories:

VERTICAL 1

Data Aggregation

Definition: Compilation of disparate clinical/administrative data sources to support population health

Advisory Services

• Data-gap analysis—assess the sources, structure and quality of the data
• Development of a data-governance strategy
• Development and implementation of data-governance training
• Structural setup and training to ensure data integrity (i.e. data accuracy, completeness, timeliness)
• Creation and implementation of data-use agreements and standards

Managed Services

• Outsourced data aggregation services
• Outsourced-data steward
• Data-hosting services
• Attribution services

VERTICAL 2

Attribution services

Definition: Segmentation of aggregated data to present actionable insights

Advisory Services

• Quality-measurement advisory services
• Benchmarking
• Prioritization planning and analysis of clinical and financial opporunities—identify priority list
• Change readiness assessment

Managed Services

• Data science as a service
• Reporting as a service
• Analytics as a service

VERTICAL 3

Care Management

Definition: Scalable care management support for standardized interventions

Advisory Services

• Care-plan redesign
• Development of integrated population health campaign
• Care management workflow design (i.e. how care managers use the care management tools)
• Risk-adjustment consulting services
• Analysis of care-settings gaps, strategic planning

Managed Services

• Care management—outsourced care managers and care coordinators
• Management and execution of integrated population health campaign
• Behavoral health coordination
• Risk-adjustment services (i.e. improve HEDIS, STAR, etc performance)
• Transitional care management services
• Disease management services
• Quality management services

VERTICAL 4

Administrative/Financial Reporting

Definition: Analysis of internal and external strategic programs

Advisory Services

• Understanding total cost of care
• Governance-model assessment
• Network-strategy development
• Assessment of clinician alignment and readiness
• Network design and build
• Development of contracting strategy
• Insurance-product development
• Employer-engagement strategy
• Payer-contract negotiation

Managed Services

• Provider-performance management
• Quality reporting
• Provider reimbursement from value-based care contracts
• Network management—outsourced clinical and administrative leadership
• Contract-management support
• Certification services
• Provider-sponsored health-plan administration
• TPA services
• Member-benefit coordination
• Cost-management services
• Actuarial and financial reporting
• Utilization management
• Pharmacy-benefit management

VERTICAL 5

Patient Engagement

Definition: Patient-centric communication and alignment with health goals and improvement

Advisory Services

• Develop patient engagement strategy
• Benefit design
• Wellness-program design

Managed Services

• Consumer engagement and outreach services
• Education and support for providers on end-of-life services
• Health plan services (i.e. billing, member services, denials and appeals management)
• Employer engagement—screening and wellness program with employer
• Coordination of patient education programs
• Member enrollment services
• Call center
• Patient-satisfaction measurement

VERTICAL 6

Clinician Engagement

Definition: Actionable workflow integration for clinicians

Advisory Services

• Design of clinician incentives and compensation
• Facility-layout design in order to improve clinician efficiency
• Development of strategic staffing plan
• Physician-capacity planning (i.e. reduce workflow overload), optimization of MA workflow, identification of care gaps before physician intervention
• Optimization of physician workflow to value-based care measures
• Integration of analytics into clinician workflow

Managed Services

• Co-physician leadership, building relationship (i.e. identifying who performs physician training and showing benchmarks for clinical leadership)
• Clinician recruitment
• Clinician education programs

Provider-Success Best Practices

In the 2016 Keystone Summit, vendors identified several common provider failures that hamper the success of healthcare provider organizations in adopting population health technology and advancing in risk-bearing activities.

The 2017 Summit explored these common failures further by identifying best practices for overcoming these challenges.

CIO, CMIO, and CEO Relationships: How can CIOs, CMIOs, and CEOs best work together to make population health efforts successful?

• CEOs Must Lead Out on Strategy: Summit participants agreed that when the CEO does not lead out with a clear organization strategy, the organization’s leadership will almost always be misaligned.
• The Board Can Help: If a leadership team is poorly aligned and lacking a clear strategy, the board can help cultivate discussions so that a clear strategy can be created.
• First Step—Identify: No organization is perfect, but organizations can identify where they are and where they want to be. Leaders can agree that, for instance, clinical leadership is not being brought in early enough. Just identifying organization misalignments is a critical step.

Prioritizing Strategy Over Technology: How can provider organizations better align their strategies for population health?

• Planning: Provider organizations need to decide now that they will not purchase technology until a clear strategy and proper alignment have been achieved. This disciplined planning helps provider organizations start with the end in mind. Participants indicated that a provider organization should identify the outcomes and the measures they want to uncover and then build a plan backward from there.
• Key Stakeholder Involvement: Summit participants debated over who should be involved in the building of a population health strategy: executives or physicians? The consensus was that both of them, as well as everybody in between, should be involved. All key stakeholders need to be involved early in the planning stages of a value-based care strategy. While this process can be taxing, it can help speed the organization’s progress in the implementation of technology and services.
• Governance: Summit participants suggested that stronger governance be established by providers. A provider organization should assign an executive leader, establish roles, and even align incentives in the form of compensation to ensure that the plan is implemented effectively.

Committing to the Future of Value-Based Care: How can provider organizations elevate risktaking activities from a side business to a core organizational focus?

• Commitment: "Just do it" was a sentiment widely repeated by summit participants. They recommended that provider organizations start small and practice with initiatives that benefit both value-based care and fee-for-service efforts. Organizations should also take advantage of small at-risk contracts, such as MSSP, bundled payments, and contracts with employers/employees before moving to larger patient populations.
• Incentives and Education: Organizations must create aligned incentives that drive physician-behavior changes and educate physicians on the importance of value-based care. Providers should align incentives to drive outcomes, which may include bringing in additional revenue from value-based care and improving gaps in care
• Share the Risk: Provider organizations cannot accomplish value-based care alone. Several questions were posed about having vendors and providers share the risk for driving successful outcomes.

Vendor-Success Best Practices

In the 2016 Keystone Summit, providers identified several common vendor failures that hamper the successful deployment of population health technology solutions.

The 2017 Summit explored these common failures further by identifying best practices for overcoming these challenges.

Anticipating Complexity: How can vendors better understand and appreciate the complexity of these areas?

• Discovery Phase: Before a vendor contracts with a provider, there must be a discovery phase during which vendor and providers honestly communicate about both what needs to be done as well as why an organization has specific goals. Vendors and providers must both insist on this phase. Vendors must give providers feedback when providers' eyes are larger than their wallets.
• Tight Engagement Facilitating Communication: Vendor and provider leaders need to be tightly engaged and very honest with each other. This tight alignment allows each group to communicate candidly and often so as to identify where disconnections are occurring.
• Overinvest in Implementation and Be Willing to Walk Away: Several vendors reported that their customer-success teams are larger than their engineering teams because they understand that every customer is very different. When a vendor realizes that a provider is unwilling to invest similar resources, they need to be willing to walk away. Specific examples might be when a provider organization has no resources dedicated to data governance or when a provider organization does not agree upon their own core workflows.

Getting the Right People into the Room: How can vendors better engage all key stakeholders and avoid limited engagement?

• Vendor Empowerment: It is critical for vendors to have decided on situations in which they will call an all-out stop or pause when the right people are not in the room. These predetermined situations should include checkpoints to ensure that stakeholders are aligned and engaged.
• The Right Stakeholder: Many participants said there needs to be a methodology from the vendor side to identify the right stakeholders. Other participants provided a list of questions to ask to get there. One provider suggested that vendors should ask whose lives the project will impact and then get those people at the table right from the beginning, even before the executive team, so that those stakeholders will not get blindsided.
• Accountability: Once the right people are defined on each side, participants said both groups need to have a structured method to hold each other accountable on a consistent basis. This format should be periodic and cultivate deep discussions and feedback.

Avoiding Overpromising: How can vendors better align sales teams with delivery realities and still remain competitive?

• Tie Incentives For Sales to Customer Success. The best situations exist when the salesperson is tied to all steps of the implementation and his/her compensation is tied directly to the go-live, customer satisfaction, retention rates, and success of the clients. Other incentive opportunities could include shared-risk agreements between vendors and providers.
• Honesty (Candor) Is the Best Policy. Providers should be careful not to make an RFP so strict that it could prematurely eliminate a vendor without opportunities for explanation and understanding. One provider stated, “It’s a breath of fresh air when a vendor tells me a project will be really difficult or take double the time that a competitor claimed, and they stand out to me as an honest vendor. I want my vendor to be brutally honest with me.”
• Clarity in Terms. Vendors should set clear contract terms and not rush the sales process. Providers are interested in knowing today’s reality as well as the road map for the future.