The latest report from Chilmark Research, Driving Speed to Value: Three Diverse Approaches to PHM, delves into three case studies to examine the clinical and technology models in force to enable a population health management strategy. We tackled this research project with a lens toward increasing PHM speed to value and helping to identify optimal health IT (HIT) enablement.
Healthcare organizations (HCOs) are taking a variety of approaches to deploy PHM models that produce positive results. Recognizing there will never be a one-size-fits-all model that generates positive outcomes across all metrics, there is much to be learned from early adopters that have been implementing PHM strategies for five or more years. By delving into these case studies and examining the clinical and technology models in force, we have identified specific lessons learned and recommendations applicable to other HCOs considering or already deploying PHM.
The following three approaches highlight a stark contrast in PHM strategies and technology models.
- Trenton Health Team: Community collaborative and health information exchange (HIE) that relies on a single-sourced HIT vendor.
- Partners HealthCare: Health system that has taken an extremely broad build-and-buy HIT portfolio approach.
- Marshfield Clinical Health System: Health system that has developed and deployed a proprietary, integrated EHR and PHM technology platform.
After reviewing the impetus within each organization for initially undertaking a PHM strategy, we then describe their clinical model and outcomes achieved. The report takes a close look into the enabling PHM technology solutions at each organization, reviewing both the timeline for, and the drivers of, technology and vendor decisions that each organization made along their journey. Each case study concludes with the critical lessons learned by each organization.
PHM Deployment Speedbumps Abound
Regarding the deployment of PHM models, it is often said, “there are many roads to get there.” But…even when there are multiple routes to travel, aren’t a few of the roads better than others? Shorter and less bumpy? Less expensive?
Speed toward meaningful PHM adoption, or lack thereof, has surprised most in the industry, even those well aware that this industry never moves at warp velocity. We all have the desire to maximize value for consumers, clinicians, and payers alike. We’re eager to move forward at a quicker pace with the expansion of PHM models as a highly probable means of delivering increased value.
That said, PHM models are difficult to develop due in large part to the specific market circumstances that vary for each HCO, complicating model development efforts.
The long march has already taken decades and seen many iterations of value-based care (VBC) models, including DRGs (1980s), “never events” (2008), and, of course, the Affordable Care Act (2010) demonstration models.
Year after year, survey after survey, approximately 95% of providers say they are “on the road to VBC,” yet roughly only 30% now actively participate in a formal VBC arrangement and those VBC contracts typically represent a very small percent of the population served. The year-to-year gain is surprisingly small.
Is this a factor of not enough “skin in the game,” with incentives too weak? Providers do not necessarily have to make any large investments or take any large risks, and even if they do, the upside and downside incentives are not large enough.
Is the sheer complexity of changing one-sixth of our national economy – via new business and clinical models as well as organizational culture transformation, coupled with procuring, funding, and implementing the enabling HIT – all justification enough for the deliberate pace of VBC adoption we’ve experienced to date?
Key Takeaways for HCOs Establishing PHM Strategies
While the report discusses in greater depth the different approaches for successfully implementing a PHM strategy, here are some high-level takeaways:
- Realize that many factors that affect PHM speed to value are within HCO control.
- Develop enterprise-level thinking to establish PHM framework.
- Establish business and clinical strategy prior to workflow modeling and IT adoption.
- Chose one key IT partner, but be prepared to recruit others, to fully enable strategy, as PHM solutions remain immature.
- Leverage existing PHM best practices, and look for them to rapidly evolve.
- Become a methodology-driven organization to effectively scale PHM.
We hope this research, and a growing cohort of other case studies in the public domain, can contribute to the communal knowledge base and move the needle in the right direction a little faster.
To purchase the report or watch the webinar sharing the story of the Marshfield Clinic Health System, click here.