HealthEC Blog Posts

Value-Based Care: Increasing Physician Awareness of High-Risk, High-Cost Patients Using Population Health Management Solutions

Ask anyone who’s switched to a healthy lifestyle after years of inactivity, and they’ll likely say the hardest part was starting an exercise program and learning how to eat right. They’re also likely to state how the quality of their life has improved dramatically over time by changing behaviors and incorporating wellness into their daily routines.

Similarly, ask any provider about transitioning to a value-based care model after years of operating within a fee-for-service paradigm, and they’re likely to have an experience comparable to the converted fitness buff.

That is, as they procrastinate the implementation of this new reimbursement model in to their practice, they only recognize the benefits of their efforts later – only this time, patient outcomes have shown demonstrable improvement with reduced costs through greater patient and provider interactions.

This is achieved in part by increasing physician awareness of high-risk, high-cost patients, and ensuring beneficiaries consuming the highest proportion of resources receive optimized care in the most effective environment and with a preventative approach.

As doctors better recognize high-risk, high-cost patients and identify the greatest opportunities to improve outcomes and reduce costs, they may become eligible for additional revenue from the performance incentives established by Medicare and commercial payers.

Physicians switching to value-based care require a population health management (PHM) solution that transforms data into information, and provides guidance for developing patient-care strategies. These innovative applications not only help identify high-risk patients and analyze information about them, but they also highlight opportunities to improve outcomes for patient panels as a whole.

Further, for a physician group or organization, PHM solutions aggregate clinical data from disparate sources on common patients across the care continuum, allowing the entire organization to succeed.

We have seen good PHM solutions enable the engagement of doctors by deploying centralized, easy-to-use platforms with easy-to-read, benchmarked data on dashboards – giving providers key insights and the opportunity to look at longitudinal records in a way that was unimaginable five years ago.

Over time, physicians are likely to stay focused on patient care being delivered for the right reasons, at the right place, and for the right costs, as they gradually recognize the positive outcomes derived from monitoring their own performance on quality metrics, cost-of-care comparisons to local and national benchmarks, and trends in the use of resources.

So, whether it’s a diet and exercise plan or the implementation of a value-based care model, starting is the hardest part. And by increasing physician awareness about high-risk patient populations, value-based care plans thrive.

Dr. Sanjay Seth

Blogger Name: Sanjay Seth

Date of Publishing : April 4, 2018

About the Author : Sanjay Seth, MD, is executive vice president at HealthEC. With over 30 years of clinical, administrative and consulting experience, Dr. Seth is uniquely positioned to develop population health management strategies that support health care providers and organizations.

Interested in learning more about the HealthEC Population Health Management platform that is helping ACOs and CINs participate in value-based contracts and meet their goals for patient outcomes and quality?

Request A Demo