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HIEs Fail to Meet Needs of Population Health Management

A Black Book survey reported 83% of providers find their health information exchanges to be lacking when trying to meet the needs of population health management.

Population Health Management

Source: Thinkstock.

By Kate Monica

- Population health management (PHM) is one of the most rapidly expanding areas in healthcare IT according to a recent Black Book report.

Despite the growing relevance of this fast-growing aspect of the healthcare industry, a majority of hospitals (83%) and physicians (86%) participating in the Black Book survey reported their community health information exchanges (HIEs) are insufficient or not functioning at a level sufficient to meeting the needs of population health modeling for reliable clinical data.

As of 2016, PHM spending reached a record $8 billion, with most of that money being funneled toward population health and patient experience tools.

In the first quarter of 2017, 81 percent of providers undertook population health projects without a strategic technology purchase to meet all their needs. To mediate issues caused by insufficient technology, nearly a third of those providers are using value-added tools from their EHR vendors instead.

Over the past year, mergers and acquisitions in the healthcare IT realm forged end-to-end PHM and value-based care solutions.

 “In order to maximize the value and benefits of a PHM solutions, it is imperative that providers and payers master the art of data capture,” said Brown. “Collecting continuous data on whole populations, from the sick to the healthy, will help fuel the immense data appetite for next-generation PHM solutions.”

According to a published Black Book survey supplement, patient access to health information online- through EHR technology offering online patient portals is one of the most useful tools for promoting patient engagement.

Interoperable data cross networks are then necessary for providers to manage population health.

Since clinical data has mostly been restricted to EHR technology, six of the top twenty PHM vendors are EHRs. While EHR data to this point consisted primarily of information gathered during patient visits, PHM solutions will likely expand the ways of gathering clinical data at the point of care as time goes on, according to Doug Brown, Managing Partner of Black Book Research.

Solutions utilizing claims and clinical data to indicate at-risk patients, locate missing or inconsistent clinical documentation, and encourage collaboration between providers, patients, and payers are gaining traction in the healthcare industry.

 “Next generation PHM will not be achieved via old-school directives to cut staff, slash expenses, and pushing PHM work with the lowest-cost tech vendor,” said Brown. “The new era of how providers get paid is going to impact the entire organization, and most hospitals aren’t remotely prepared for it.”

More than 6,000 respondents from physician practices, hospitals, health systems and chains, and ACOs (among others) reported on vendor performance in 18 Black Book key performance, satisfaction, and usability criteria for population health and value-based care solutions to find the top PHM and value-based care technology solutions.

The top three core EHR and PHM vendors based on user experience are Allscripts, Cerner, and Epic, according to Black Book respondents.

The survey also found 98 percent of respondents believe information-powered clinical decision making is a top priority in PHM, followed by 96 percent choosing primary care-led clinical workforce as an integral element in PHM. Finally, 93 percent stated patient engagement and communication as a necessary element.

Ninety percent of respondents agreed they prefer an external consulting advisor with Population Health Management and Revenue Cycle Management experience in 2017. Additionally, one-half of participating PHM head-hunting firms claim to be experiencing challenges in finding qualified PHM process experts.

Hospital leaders credit increased demand for PHM advisory services to factors beyond their range of experience. Specifically, 77 percent do not have a strategic plan for transforming PHM or value-based care solutions end-to-end to meet deadlines because of a lack of internal experts.

Further, of the 84 percent of respondents claiming they are acquiring or replacing PHM solutions, vendors, service delivery processes or outsources within the next 12-18 months, less than 20 percent have begun vendor selection activities and 79 percent would ask external consultants for assistance in this process.

Eighty percent of responding CIOs say they do not have the healthcare IT or in-house staff necessary to transform PHM end-to-end in the way their executive team hopes.

In order to optimize PHM, providers will need to integrate PHM experts into their staff and technology. Otherwise, what providers aim to accomplish with population health projects and what they are equipped to accomplish will continue to exist on separate planes. 

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