8 issues affecting population health management in 2012

Recently, the Care Continuum Alliance, an advocate for population health management, surveyed industry leaders to assess the market and predict key issues for 2012. According to the alliance’s white paper, two predominant themes were brought to light as a result of the survey.

“First, significant market movement will occur toward accountability and value creation in healthcare, driven partly by new physician-guided and collaborative models,” according to the report. “And second, population health management is well-positioned to add value to and support these emerging models, but must continue to build the case for wellness and prevention.”

Here are eight additional key issues, identified in the report, that could affect population health management in 2012. 

1. Accountable care and the Medicare Shared Savings program. Many comments from survey respondents centered on accountable care and collaborative models, as well as federal support for both. According to the report, population health has a lot to offer collaborative care, such as health risk assessment and predictive modeling, HIT infrastructure, data analytics, care coordination and other core competencies. “But tempering optimism around accountable care models were caveats,” the report noted. One respondent summed it up: “If ACOs become a reality and are structured in a way that provides a real incentive for managing health, they could be a major market opportunity. If they just become HMOs redux, not much will change."

2. Consumer use of mobile and eHealth technologies. According to the report, population health management has been both a driver and benefactor of the rise in eHealth and mHealth technologies. The demand for these technologies, said one respondent, will drive healthcare “to adopt … a patient-centered, consumer-empowered, pull-rather-than-push model, which has already been realized in the music, travel, book and news industries.” The importance of social media was also noted by those surveyed, and when coupled with mobile technology, will be used as a tool and patient engagement and shared decision-making. 

[See also: ACOs offer new risks and rewards.]

3. Reducing avoidable hospital readmissions in Medicare. The Hospital Readmissions Reduction Program (HRRP) could be a “big opportunity for companies who have developed proven strategies for reducing hospital readmissions,” wrote one survey respondent. The program includes Medicare tracking readmissions for three conditions – heart failure, acute myocardial infarction and pneumonia – within 30 days on or after Oct. 1, 2012. Medicare will then reduce payments to hospitals to account for excess readmissions. “The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary projects that the HRRP, when fully implemented, will reduce Medicare costs by $8.2 billion through 2019," the report read. “Further, the law gives CMS the authority to consider additional conditions in 2015.”

4. Quality improvement in Medicare advantage. The Medicare Advantage’s (MA) “stars” rating system was another topic of discussion. The program will award bonus payments to plans under the stars system to assess performance on a myriad of measures. “The developing stars system appears [to be] headed toward a structure consistent with industry-advocated changes, including additional wellness and prevention measures and retirement of process-related measures,” the report read. It added that, combined with continued growth in the Medicare Advantage population, the need for plans to demonstrate improvement in wellness and chronic care measures will drive “expanded opportunities” in the Medicare managed care market, according to industry experts. 

Continued on the next page.

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