Staying Ahead of the Puck: Six Trends to Follow in Population Health and Payment

Yes, this blog post is about population health, accountable care and the changing economics of healthcare payment. But first, a little bit about ice hockey from Walter Gretzky, father of Wayne “The Great One” Gretzky.

When Wayne was a young boy, Walter encouraged his son’s interest in hockey. In the family’s back yard he built an ice rink, the Wally Coliseum, where he taught Wayne and the neighbor kids to skate. Wayne was obsessed with hockey. Walter recalls seven-year-old Wayne’s fascination during a televised hockey match. On a pad of paper, the boy traced the path of the puck as it careened across the ice. To Walter, the lines on the notepad were scribbles. But to Wayne the pattern showed the places on the ice where the puck was most likely to be at any given time. The intersections, as he called them.

That was part of the Great One’s strategy, to know where the puck was most of the time.

In a way, the same strategy applies to accountable care and population health management. As payment systems evolve, the marketplace is changing like the shifting configuration of hockey players on the ice. Success with accountable care, bundled payment, and population health management means finding the intersections between patients, providers, and payers where the best possible outcomes can be achieved with limited resources. Based on a review of recent media reports, here are six key trends or intersections for population health.

Risk-sharing payment agreements: Currently an estimated 25% of hospitals are part of an accountable care organization (ACO) or have at least one at-risk contract. By the end of the year, that number could pass 50 percent. Health systems feel the market pressure. Chances are very good their competitors are analyzing patient populations and modeling risk-based payment right now, if not managing accountable care.

Physician alignment: About a third of physicians are employed by a hospital or a practice that is owned by a health system. This number is growing. Within the next three years, as much as 70 percent of physicians will be “owned” by hospitals, either as employees or through partnership agreements. This new hospital-physician arrangement provides an organizational foundation for health networks to standardize and coordinate care, share patient data, communicate more effectively among providers, and align payment incentives to reduce waste and improve patient outcomes.

Data sophistication: Right now health systems are grappling with ICD-10, EMR implementations, and compliance with meaningful use requirements. This could be called the digitize phase of health data management. Over the next three years, health systems will invest more in health information exchanges (HIEs), patient registries, enterprise data warehouses, and care management systems, moving successively to connect, analyze, and act on health data.

Shifting volume of care: In recent months, inpatient admissions have been down 4 – 5 percent over the previous year. That trend is expected to continue as increasing treatment is shifted to outpatient and ambulatory settings, with significant impact on capital planning, budgets, contract negotiations, and staffing. Health systems need to understand how both patient and healthy populations are receiving care within a broad network in order to plan capital investments, negotiate contracts, set budgets, train leadership, and hire clinical staff.

Staffing: Population health management is a new thing for many hospitals. The demands are broader than the usual job descriptions for CMOs and managed care directors, spawning new and broader healthcare roles to manage financial risk, coordinate across care settings, and collaborate with community health partners.

Strategic partnerships: ACOs aren’t the only partnerships emerging. In order to consolidate coverage within a market, hospitals are entering into strategic agreements for clinical integration, data analytics, contracting and/or operations. (For example, see the alliances announced last month between Benefis Health and Sanford Health or The University of Florida and Shands with Orlando Health.)

There you have it, six of the intersections where the pop-health puck is going to be most of the time in the coming year. Now here is another strategy attributed to Wayne Gretzky: Skate where the puck is going, not where is has been. That will be the test for health systems in the coming year, whether they can move quickly enough to place themselves where they need to be, not where they should have been.

Best of luck, players. Get out there and light the lamp.

Kristine Daynes is a marketing manager at 3M Health Information Systems.

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