Top Barriers to Population Health

While healthcare organizations understand the need for and inevitable adoption of value, significant progress on population health objectives has stalled, according to a new population health adoption study.

The study, from healthcare consulting firm Numerof & Associates, explores a national overview of population health progress on the transition from fee-for-service models to alternatives based on fixed payments linked to outcomes. The report distills survey responses from over 500 executives and key decision makers across U.S. healthcare delivery organizations.

This year’s survey results were similar to previous years, in that the majority of respondents agree population health will play an essential part in their future success, according to Rita Numerof, PhD, president of the firm.

“As a result, they still predict they’ll have revenue in upside gain/downside risk payment models in the next two years, but this year’s respondents’ moderated their expectations,” says Numerof.

Compared to 2016 and 2017 where respondents predicted they’d have 30% of revenue in risk-based contracts in two years, 2018 respondents predict that in two years, they’ll have less-only 25%, according to the fourth annual study.

“Nevertheless, providers have fallen short of these predictions by having 10% or less revenue in risk-based contracts in 2016, 2017, and 2018, leading us to believe that progress toward population health has stalled and that respondents expect its implementation to occur more slowly than they initially thought,” Numerof says.

These findings reinforce the fact that population health is critical for future success and also point out some of the challenges that organizations have to address in order to move toward these goals, according to Numerof.

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“These insights are pertinent to healthcare executives because there’s a conventional wisdom that you can either be in fee-for-service or in population health, but we believe you can do both simultaneously,” she says.

“Now-when they aren’t feeling significant pressure-is the time for providers to prepare by building the capabilities that will allow them to go at risk and create a differentiated value proposition for their organizations. Some providers are already making strides forward, and those that know how to thrive in an environment that rewards value early on will more quickly adapt when change becomes widespread.”

Not surprising

According to Numerof, it isn’t surprising that population health efforts have stalled given the absence of continued, external pressure.

“There are many barriers keeping providers from engaging in risk-based arrangements-financial risk is still their No. 1 concern, followed by difficulty in changing the organization’s culture, up three spots from last year-and many providers won’t change unless they are forced,” she says.

In addition, CMS eased up on the pressure providers were feeling by cancelling its mandatory bundled pricing programs and allowing them to be voluntary, but looking to the future, providers could face competitive threats from nontraditional players like Amazon, Google, and Apple, according to Numerof.

“These innovators know that consumers are frustrated with the current healthcare climate, and they are actively looking for solutions to patients’ problems-difficult-to-access care that is extremely expensive and not focused on outcomes. Providers must make population health efforts to get ahead before it’s too late.”

Healthcare executives should separate themselves from the deeply entrenched majority and begin seriously engaging with risk-based contracts now, Numerof says.

“As innovators continue to drive competition, pressure will eventually increase, and population health will no longer be voluntary,” she says. “The executives who start working toward these goals and investing more revenue in risk-based payment models today will find the greatest long-term success.”