Selecting a Population Health Management Vendor: Taming the Wave A White Paper February 2015 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com
Introduction As more and 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? There are number of population health management software solutions available, but picking the right one(s) can be a big challenge. There are currently over 100 population health management vendors. Some have decades of experience in managing populations. Others are very recent market entrants, riding the tidal wave of interest. The current market is immature and rapidly evolving and, as of yet, no clear vendor/product market leader has emerged. 1 This is due partly because 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 strengths either on the analytics side or on the care management side. Few do both well, and even fewer have a multitude of satisfied clients. The Vendor Selection Process The following steps can help you select a vendor that is the right fit for your organization. 1. Identify key stakeholders and assemble a vendor evaluation team. Who are the key people in your organization that need to inform the decision? Do your executives know what is needed, or should you reach down to the next layers of your organization to access those who know what happens on the front lines? 2. Develop an understanding of key population health requirements. Now that you ve selected your team, educate them on the tools necessary for success in population health management. These include: EHR While you should not expect your population health management software to also serve as your EHR, it is worth taking the time during this educational phase to discuss some of the key capabilities of the EHR that are foundational to population health management. These might include having a common or interoperable EHR across the continuum of care, e-prescribe and formulary support. If your organization has already implemented an enterprise EHR solution, it is a good idea to explore whether your EHR vendor offers population health management solutions of which you can also take advantage. Data Management/Exchange The ability to aggregate data, including both claims data and various forms of clinical data, is critical to being able to manage populations. Registries Registries will be the key tools you will use to identify patients at risk, based on disease processes or other criteria, and identify care gaps. Ideally, care managers should be able to place orders and communicate with patients directly from the registry. 1 Analytics for Population Health Management. Chilmark Research, August 2014. Selecting a Population Health Management Vendor 1
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, prescription refill requests, patient education and health maintenance reminders. The ability to integrate virtual visits, tele-monitoring and mobile health applications is emerging as a requirement. Another key functionality for your organization will be 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 with those practices at the point of care. Functionality like health maintenance reminders, care pathways, best practice alerts, drug/drug and drug/allergy checks all help to support clinical best practices. Analytics Sometimes known as Business Intelligence, analytics is critical to your population health management program. Analytics software gives you the ability to analyze and segment populations, understand sub-populations and design target services for those sub-populations. Using predictive modeling, your organization can identify those patients who are more at risk of readmission, sepsis, or high resource use. Reporting Along with analytics, you will require considerable reporting, (e.g., to report longitudinal utilization, total cost of care and quality performance measures). 3. Develop an organization-specific population health management definition. Nationally the definition of population health management is widely variable, and there is no generally accepted definition. Every organization has different needs based on the specifics of their patient population and payor arrangements. Developing your own definition of population health management is the first step in establishing an organizational vision for population health. Impact Advisors uses the following: Population Health Management Information enabled, proactive application of strategies and interventions to defined groups of individuals across the continuum of care in an effort to improve the health of the individuals within the group at the lowest necessary cost. Central to the practice of population health management are: Clinical Decision Support at the Point of Care Supporting Evidence-Based Care Risk-Stratified Care Management Across the Continuum Patient Engagement Analytics, Reporting and Performance Tracking Selecting a Population Health Management Vendor 2
4. Develop a strategic vision for 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? Where? What functionality do we need to accomplish 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 (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 identified and prioritize or weigh 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 like KLAS and Chilmark publish research on population health vendors regularly and offer a good starting place. From this research, narrow the field to four to six vendors and request information and demonstrations from them. Give the vendors a script of what you desire to be demonstrated so that the stakeholders attending vendor demonstrations can score the vendors and be able to appropriately compare them. Don t forget to assess not only their functionality but also how they are doing in the market. Who are their key clients and who have they sold to recently? How many clients do they have? What has their growth rate been over the past few years? Check references! By the end of the vendor selection process, your organization will likely have narrowed the contenders to just one or two that are most likely to meet the needs of the organization. The final decision can then be made based on other factors such as cost and time to value (implementation time and time required to affect positive change in outcomes). The Bottom Line Choosing a population health management vendor from the large number out there can be a daunting task. By taking time to educate yourself about population health tools, define the needs of your organization and utilize independent research, you can narrow the field considerably. Using an organized and objective approach to evaluating a short list of vendors can then help you avoid potential pitfalls and choose the vendor that will best meet your organization s needs. Selecting a Population Health Management Vendor 3
About Impact Advisors Impact Advisors provides high-value strategy and implementation services to help healthcare clients drive clinical and operational performance excellence through the use of technology. We partner with industry-leading organizations to identify and implement improvements in quality, safety and value. Our Associates are experienced professionals with deep domain expertise and a commitment to delivering results. Impact Advisors has helped many clients address their Population Health Management needs by drawing upon years of technical and operational experience. Our Population Health Services include: Population Health Strategic Planning Strategic Visioning and Planning Readiness Assessment and Gap Analysis Change Management Data Governance Population Health IT Planning Infrastructure Development Planning HIE, empi, Data Warehouse Population Health Vendor Selection Population Health IT Roadmap Business Intelligence / Analytics Planning Care Management / Registry Planning Patient Engagement Planning Population Health Clinical Support and Implementation Clinical Workflow Optimization Clinical Decision Support Optimization Physician Portals Performance Dashboards and Quality Reporting Care Management / Registry Implementation Clinician Engagement / Adoption To learn more about Impact Advisors' approach to Population Health Management contact Tonya Edwards, MD: tonya.edwards@impact-advisors.com or (864) 430-6227. For more information visit: www.impact-advisors.com Follow us on Facebook and LinkedIn. Copyright 2015 Impact Advisors, LLC. All rights reserved. These materials are provided to you by Impact Advisors as a professional courtesy for personal use only and may not be sold. Please appropriately credit/cite your source as Impact Advisors, LLC. All copying for commercial use requires written prior permission secured from impact-advisors.com. Selecting a Population Health Management Vendor 4