A study published at the end of 2015 and updated earlier this year by HiMSS Analytics - the research and consulting arm of parent organization Healthcare Information and Management Systems Society - found the majority of healthcare executives surveyed are undertaking some population health initiatives, but most are not utilizing a consultant for their strategy or adopting a vendor-provided solution to manage programs at this point.
Brendan FitzGerald, director of Research for HiMSS Analytics, said the organization typically conducts nearly a dozen web-based studies a year on some of the industry's most talked about subjects. "Certainly, population health falls in that category," he noted.
While the term population health is broadly used, FitzGerald said for the purposes of this research, it was defined as 'improving the health outcomes for a defined population in a specific geographic area.' The study focused on hospital and health system initiatives and included responses from nearly 200 administrators, C-suite occupants, directors and vice presidents.
Overall 67 percent of respondents said they have some type of population health initiative in place. For organizations with more than 100 beds, 81 percent have programs or initiatives focused on population health, and 100 percent of academic medical centers interviewed said they are employing such initiatives.
"For those that did have population health initiatives in place, the majority had programs focused on chronic disease management and preventive health/wellness," said FitzGerald. He added these areas are the easiest places to start when launching a population health program and noted such programs are often initially directed toward employees before rolling out to the larger community.
Interestingly, however, was how few consultants and IT solutions are being employed in conjunction with these initiatives. FitzGerald said the anticipation was that consultants would help determine the course for an organization to move down the path to population health programming and help institute best practices. However, less than 25 percent of those surveyed said they are currently using or considering using a consultant to help with population health initiatives.
"We asked how many used a consultant and very few did," FitzGerald said. "I think it will develop, but it hasn't developed as quickly as I thought it would."
There were similar low numbers for those currently using a vendor-provided solution despite the recognition by organizations that such solutions could be utilized in the areas of business intelligence, analytics, reporting, data warehousing, aggregation, case management, risk stratification, predictive analytics and patient engagement.
Over the last seven years, since HITECH, FitzGerald said providers and organizations have begun to figure out how to use the data derived from individual EHRs. Now, he continued, those lessons will be scaled up. "It's the same with population health - figuring out how to harness the necessary data to improve outcomes."
While interest in population health continues to grow, FitzGerald said the lack of wide adoption for vendor-provided solutions could potentially be tied to a number of factors. "There are a lot of non IT-based applications that really do help with the population health approach," he pointed out. "Because it's so new ... and population health, itself, is such a blanket term ... it can be approached in several ways." FitzGerald added call centers, case management and nurse navigators are all ways of deploying initiatives without using vendor solutions.
In addition, some respondents indicated they were relying on systems already in place or creating such systems internally. "When you look at IT solutions, there is certainly some overlap with those dedicated, best-of-breed population health solutions and larger analytic platforms," he said.
FitzGerald continued, "For clinical business analytics, the industry-wide adoption rate is about 42 percent so it's not surprising to see a much lower number in the population health aspect for vendor-provided solutions since its newer."
However, he said, there is a slow-but-growing shift from volume to value-based health. As CMS continues to push hospitals and health systems towards a risk-based structure, more organizations are beginning to assume risk for at least some portion of patient populations. Nearly 20 percent of the respondents indicated that 1-10 percent of their patients were under risk contracts, and another 7 percent have 11-25 percent of patients under that type of model.
Still, he pointed out, the discrepancy in how many facilities have some population health programming in place compared to those with patients under risk contracts highlights the gap that exists. "While people are beginning to implement these programs (population health initiatives), the at-risk cost structure isn't necessarily occurring at the same time," he said. "That's going to take some time, but in essence, that is population health."
For the more than 30 percent of organizations without current population health programming in place, more than half indicated the intention to launch initiatives in the future, primarily geared toward chronic disease management and wellness and prevention. Another 25 percent were unsure of future plans and the balance didn't plan to undertake such efforts.
Of those surveyed, 53 percent represented small or specialized facilities with less than 50 beds. Hospitals and health systems ranged in size with 54.2 percent of the respondents serve fewer than 50,000 patients annually, a little more than a third caring for between 50,000 and 500,000 patients annually, another 8.5 percent serving 500,000 or more each year.
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