Does a PHM Strategy Give Leg-up During COVID19?

As the #COVID19 pandemic storms across the U.S., a thought I’ve been pondering is:

Will there be a measurable difference in ability to respond by those healthcare systems that have aggressively moved forward with adopting a population health management (PHM) strategy and supporting technology coupled with value-based care (VBC) models?

As mentioned in a previous post, in 2019 we did extensive research on how healthcare organizations (HCOs) were implementing a PHM strategy for VBC that culminated in a report released at year-end. Those HCOs implementing such a strategy for five years or more were, logically, far more sophisticated having migrated from a process-centric view of PHM/VBC to a strategic one including establishing a separate Population Health Service Organizations (PHSOs) to support their initiatives. These PHSOs most often have their own technology stack.

Technology Platform to Support PHM

As we outlined several years ago, PHM is not a technology solution, but a strategy. Our original definition still holds true today:

The proactive management of the health of a given population by a defined network of financially linked providers in partnership with community stakeholders (e.g., social workers, visiting nurses, hospice, patient, caregivers/family, etc.).

We have identified four core technologies required to support PHM:

1. Analytics platform, including enterprise data warehouse to ingest and normalize data from multiple sources (EHR, claims, labs, etc.) to provide insights (patient registries, gaps in care, high-risk patients) to frontline clinicians at the point of care.
2. Interoperability platform to facilitate data flows from multiple sources, providing alerts (ADTs, leakage) and analytical insights across a distributed clinically integrated network.
3. Care management platform to identify, prioritize and effectively manage high-risk and rising risk patients, especially those with high-cost, uncontrolled chronic conditions. Ideally, care management platform serves not only clinicians but also community resources for SDoH factors.
4. Engagement platform to proactively engage the population under management to utilize self-management tools to lower utilization costs. Such tools extend well-beyond the simplistic patient portal to remote patient monitoring, self-reporting, and use of virtual care modalities.

Each of these platforms can serve a potentially critical role in an HCO’s response to COVID19 for the communities they serve. However, the challenge will likely be speed of response and potentially extending the use of these solutions beyond the limited confines of only those patients and providers in a given VBC contract. This could prove quite difficult as the pandemic has no respect for time. It is moving so fast. In my conversations with those on the frontline, the focus is almost entirely on preparedness planning. For each of these core PHM enabling solution categories, the table below provides insight into how might we use them in the context of COVID19 across the care continuum.

Call to Action

HCO leadership needs to put every resource at their disposal to work to help stem the COVID19 outbreak. This goes far beyond just human and physical resources. By their very nature, IT resources and their impact can scale quickly. These resources are highly leverageable. Within the IT arsenal of your relatively newly formed PHSO they are a host of solutions that can assist in meeting that challenge. Think how your organization can creatively leverage the PHM-enabling solutions that are in use today to extend their reach beyond those patients/consumers in a VBC contract to educate the entire community you serve, providing proactive guidance to get in front of the coming COVID19 tsunami as best you can.

And vendors, many of you are rising to the challenge and I congratulate you. But think not what you can just do for a given client but more broadly what you can do for society as we will all be affected, there is no doubt. While like myself, I know you have a business to run, do think altruistically, we are all in this together and need you now more than ever.