As providers try to streamline and improve healthcare services, plenty of challenges remain

While technology is offering the opportunity to provide better care for patients, transitioning to a world of shared population health data and more coordinated care is easier said than done.

This post was originally published on MedCity News.

“Population Health Management means many things to many people,” says Amber Thompson, Vice President of Coordinated Care at PatientSafe Solutions. But overall, she says, PHM is about improving the health of the population, removing waste from the care delivery cycle, and improving the patient experience.

As large hospital systems move to PHM systems, plenty of obstacles remain:

Getting quality metrics under control before contracting with private payers

 Before you can have a PHM system that provides cost efficiencies rather than draining the bottom line, you must first identify and understand the causality of your high consumers of services, patients who often translate to the most costly, explains Thompson.

“Providers usually have an intuitive idea of their most difficult population segments, but presenting iron-clad data to support segmentation is more difficult,” she says. “Having a solid understanding of population health data is crucial for systems entering into risk-based contracting with payers”.

Having enough data from patients outside hospital doors

“Everybody struggles with sharing and trading data,” Thompson points out. Given that only large hospital systems are moving to PHM today, they will often struggle with having enough data from patients’ outpatient providers. Marrying inpatient and outpatient data is critical to building longitudinal surveillance models that can predict risk and outcomes over time. And then even among providers who engage in PHM, they are frequently using non-standard systems. That means caseworkers often have to obtain patient data by all kinds of means—phone, fax, email—to provide care coordination.

“In a year,” Thompson notes, “the average patient can see up to seven different physicians.” This puts a big burden on case workers and makes “time economy” a big issue for PHM.

Controlling expenses

So long as healthcare systems must contend with non-standard data systems, the burden on caseworkers can reduce the ability to increase efficiency and control costs. “Are hospital discharge instructions being given to other care providers?” Brant Castellow, VP Sales, Coordinated Care of PatientSafe Solutions asks. “Do patients get to PCPs within seven days of discharge?”

Implementation of both of these things improves patient outcomes and reduces ER visits and readmissions, both of which can be a drain on hospital budgets. In a pay-for-performance healthcare world (which is the direction in which patient care is moving), having patients come back to hospitals reduces profitability.

Gaining patient participation

“Electronic medical records aren’t designed for patients,” Thompson notes. “They are not designed to encourage patient participation in healthcare.”

She would like to see EMRs made with the patient in mind. “When patients and their families actively participate in their own care, they often experience fewer complications and readmissions, and often experience a better quality of life even when living with chronic illness,” she adds.

Lack of participation by small providers

Small practices generally can’t afford to participate in the cost of data sharing, which means new population health technology and more time (hence, additional employees or employee hours).

“You have to get them to buy into the benefit to patients and their practices,” Thompson says. “The cost and technical challenge can be daunting compared to the value provided.”

Does all this mean population health management has a long row to hoe? Probably. But getting PHM to work for the benefit of all patients and providers isn’t unrealistic.

“The industry as a whole is in a transformative phase, one that is very exciting for all of us working in healthcare. But the most important change is that patients finally have a voice that cannot be ignored. That is true patient-centered care.”