Population health prevails despite ACA uncertainties, other barriers

The vast majority of hospitals are continuing population health management strategies, despite uncertainties concerning healthcare reform.

That’s according to a survey of 199 CEOs, chief information officers, chief financial officers, and chief medical or nursing officers from integrated delivery systems to national health insurers and independent physician practices.

Though efforts to repeal and replace the Affordable Care Act continue to be hashed out, the survey, by Health Catalyst, found that 82% of respondents are not changing population health strategies. Four percent of respondents say that they are accelerating their population health management, while another 4% have paused strategies due to impending law changes.

One survey respondent, a physician leader at a large multidisciplinary group, said that “accelerating your population health management strategy has never been more important given uncertainty and expanding hurdles to achieving quality care and outcomes.”

Why health execs continue to move forward

The reason that health executives are moving forward with population health: They believe MACRA is here to stay, says Amy Flaster, MD, MBA, primary care physician at Brigham and Women’s Hospital, assistant medical director at Partners Center for Population Health, and vice president of population health management and care management at Health Catalyst.

“[MACRA] has received bipartisan support in both the House and the Senate, and folks have not campaigned around overturning it,” Flaster says. “This leads healthcare leaders to trust the move to value-based care is here to stay. The details of what these value-based care arrangements look like may shift-but the spirit of value-based care is to stay.”

Though healthcare organizations are pursuing and increasing interest in population health, many are still hesitant about risk-based contracts. Only 13% of survey respondents say that a third of the patient population is covered by risk-based contracts. Nearly 40% say it will take three to five years to achieve that level of risk. Fourteen percent say it will take six years to a decade.

Flaster says that health executives are wise to take slow steps in implementing risk-based contracts.

“To be successful in risk-based contacts, systems have to manage new forms of contracting and have to access and analyze data in new ways in order to understand the care being delivered both within and outside the walls of their system,” Flaster says, adding that they have to develop and implement new and innovative approaches to care delivery, including a site of care strategy, an approach to gaps of care, and a strategy for utilization management. “They have to be creative about engaging their patients in their health and wellness. It all has to come together and it can be complicated.”

Next: Top pop health barriers

Top barriers when implementing pop health

One of the top barriers that healthcare organizations report facing when implementing population health strategies is money. Almost 40% say that “financial issues,” “getting paid for our efforts,” and “balancing competing contract incentives,” are hurdles to balancing new revenue models with existing fee-for-service payment.

“It is a crucial and interesting time of transition,” Flaster says. “To add to this, it’s tricky to be in predominantly fee-for-service arrangements, while simultaneously beginning to take on some risk-bearing contracts.”

Accessing quality data and analytics is a barrier for 17% of survey respondents. Sixteen percent of healthcare leaders say that care model issues, including getting buy-in to make changes was a factor that hindered population health development. A lack of cohesive leadership and governance stalled population health strategies, according to 12% of survey respondents.

Risk evaluation issues, including “access to the right data useful to evaluate at-risk contracts” is a barrier to 9% of survey respondents.