By Tonya Edwards, MD
As more organizations embrace population health management as a strategy to succeed in the emerging new paradigm of value-based payment, many are facing the next big question: “What tools do I need to support population health?” They are turning to population health management software solutions to fill these needs, but picking the right one can be a big challenge.
There are currently more than 100 population health management vendors. Some have had decades of experience in managing populations. Others are very recent entries, hoping to ride the tidal wave of interest. The current market is immature and highly evolving and as of yet no clear vendor/product market leader is emerging. Part of the reason for that is that the market is still trying to define population health management. What it takes to manage an accountable care organization (ACO) is still unclear. Most population health management vendors have entered and continue to have strengths primarily either on the analytics side or on the care management side. Few do both well. Few vendors have a multitude of existing clients.
Here are some steps you can take to select the vendor that is the right fit for your organization.
1. Identify key stakeholders. Who are the key people in your organization who need to inform the decision? Do your executives know what is needed or do you really need to reach down to the next layers of your organization to those who know what happens on the front lines? Put together a vendor evaluation team.
2. Develop an understanding of key population health requirements. Now that you’ve selected your team, educate the team regarding the tools necessary for success in population health management. These include the following:
• EHR: While you should not expect your population health management software to also be your EHR, it is worth taking the time during this educational phase to discuss key capabilities that are foundational to population health management, such as interoperability, ePrescribing, and formulary support. If your organization has already implemented an enterprise EHR solution, it is a good idea to explore whether the vendor offers population health management solutions.
• Data Management/Exchange: The ability to aggregate data, including both claims and clinical information, is critical to being able to manage populations.
• Registries: Registries are key tools to identify patients at risk based on disease processes or other criteria, and identify care gaps. Ideally, care managers would place orders and communicate with patients directly from the registry.
• Care Management Tools: Care management tools, such as longitudinal care plans, documentation and communication tools, work queues, and discharge planning applications, are essential.
• Patient Engagement Tools: No attempt at population health management can be successful without the ability to engage patients. Key tools for patient engagement include patient portals for secure messaging, patient scheduling, refill requests, patient education, and health maintenance reminders. The ability to integrate virtual visits and telemonitoring as well as mobile health applications is emerging as a requirement as well. Another key functionality is the ability to manage referrals and track system leakage.
• Clinical Decision Support: Identifying patients at high or moderate risk won’t mean much unless you can identify best practices for treating those patients to improve outcomes and drive compliance at the point of care. Functionality such as health maintenance reminders, care pathways, best practice alerts, drug/drug checks, and drug/allergy checks all help support clinical best practices.
• Analytics: Also known as business intelligence, analytics is critical to a population health management program. Analytics software can analyze and segment populations, understand subpopulations, and design target services for those subpopulations. Predictive modeling can help organizations anticipate which patients may be more at risk of readmission, sepsis, or high resource use.
• Reporting: Categories include longitudinal utilization, total cost of care, and quality performance measures.
3. Develop an organizational specific population health management definition. Nationally, the definition of population health management is widely variable. Every organization has different needs based on the specifics of patient population and payer arrangements. Developing a definition of population health management is the first step in establishing an organizational vision.
4. Develop a strategic vision of population health management in your organization. Begin by asking the following questions:
• What do we want to do?
• For what population(s)?
• In what time frame?
• What functionality do we need to do this?
• Do we need partners? If so, who? To do what?
• Do we need new roles? If so, what are they?
• What percentage of value-based payment do you anticipate in three to five years (eg, ACO, bundled payments, risk-based contracts)?
5. Evaluate the current state of your organization. Do an inventory to determine what functionality you already have in place.
6. Perform a gap analysis. Identify your gaps. These are the functionalities you need to focus on when evaluating population health management vendors.
7. Develop a vendor “scorecard.” Base the scorecard on the vendor’s ability to perform each functional area, and prioritize or weight the scoring based on organizational needs.
8. Evaluate four to six vendors. Do your research to find vendors that have the functionality likely to meet your organization’s needs. Independent research organizations such KLAS and Chilmark that publish research on population health vendors regularly are a good starting place. Request information and demonstrations from four to six vendors. Supply each candidate with a script of what to demonstrate so stakeholders can score and compare the vendors appropriately. Don’t forget to assess not only their functionality but also how they are performing in the market. Who are their key clients and who have they sold to recently? How many clients do they have? What has been their growth rate over the past few years?
By the end of the vendor demonstration process, the field will likely have been narrowed to the one or two that are most likely to meet the organization’s needs. The final decision can then be made based on other factors such as cost, time, and value (implementation time and time required to effect positive change in outcomes).
The population health vendor selection process can be daunting, but with a well-thought-out approach organizations can “hang ten” to ride the population health wave.
— Tonya Edwards, MD, is the principal-physician advisor at Impact Advisors.