There is much ongoing discussion regarding COVID-19’s impacts on the overall shift in the healthcare industry from volume to value and on population health management (PHM). In a recent CMS survey, more than half of healthcare organizations taking financial risk in a Medicare program have stated they are at least somewhat likely to drop out because of fiscal pressures being caused by the pandemic. Quality targets and reporting deadlines are likely to be missed as providers move many routine and preventative services to telehealth or suspend them entirely for the time being. Under some value-based arrangements, providers may be ineligible for savings due to their inability to meet “quality gates” (metric thresholds).
While it is clear that COVID-19 will affect some major CMS value-based programs such as the Medicare Shared Savings Program (MSSP), Oncology Care Model (OCM), etc., those predicting the demise of value-based care should think twice about that position. CMS has already begun to take sizeable steps in providing relief, granting exceptions from reporting requirements and deadline extensions with respect to upcoming measure reporting and data submission. Additionally, the agency has signaled a proration of any losses incurred by Medicare accountable care organizations (“ACOs”) in 2020. Certainly, there will be some slowdown in some of the more well-known value-based payment initiatives but this is necessitated by external constraints and not tied to specific value-based programs or PHM.
Population Health Management Has Been Here All Along
None of this will change the macro picture as medical costs will continue to rise, currently accounting for 19% of the country's GDP. Any pause in the shift to value-based care due to the coronavirus is likely to be a minor blip in the radar. However, the most compelling evidence for value-based care’s lasting impact is the very essence of what it represents. At its core, what drives success for value-based care is effective Population Health Management (PHM). And what is effective PHM at its barest roots?
Collecting and analyzing comprehensive datasets on large patient populations
Predicting and stratifying who is at-risk for certain diseases and acute care
Creating profiles and actionable care plans for those most needing intervention
Determining and referring patients to the most appropriate facilities and settings of care
Mobilizing assets and care team resources to deliver and coordinate medical care and community-based support
Carefully monitoring and stabilizing patients for transition back to home
Managing care transitions across settings of care delivery
Does any of this sound familiar and potentially helpful in managing this evolving pandemic? In fact, it’s likely that the COVID-19 worldwide pandemic makes a better case for Population Health Management’s importance than anything else. We must remember that population health is focused on the health of ordinary people, which is essentially good public health. Whichever label one may use, COVID-19 has proven that there are glaring gaps in our country’s health system, and that, going forward, we will need solutions and approaches that are scalable and data-driven, while being built around coordinated, patient-centered care management. PHM is all about serving the populations of patients hardest hit by disease, such as those with serious underlying medical conditions like chronic lung disease or severe obesity. If those vulnerable patient populations are being effectively identified and cared for, it’s likely that more COVID-19 cases can be caught earlier before they become life-threatening.
Providers who have been focusing on the care of the single patient in front of them are beginning to gain an appreciation for the importance of serving broader populations and using innovative approaches. Telehealth and remote monitoring are all about PHM principles put into practice. Treating the patient in the most convenient setting and lowering costs for the treating provider, all while leveraging technology assets most effectively are core tenets of effective PHM. COVID-19 has thrust telehealth into the spotlight, with its value being so evident and long-term potential undeniable. Now, healthcare leaders are starting to ask, “If I can achieve similar or better outcomes in a much lower cost and highly effective setting remotely for COVID-19, where else might this be possible?” This call to action will be pervasive across the healthcare industry, with a heightened focus on being best prepared for crises like the one we are now experiencing.
Population Health Management Is Not Going Anywhere
The physical and mental health toll of COVID-19 has been tragic and costly already, and we know that the pandemic is not over in any sense. Value-based arrangements of all types (be it shared savings, shared risk, or full risk) are likely to be disrupted as we live through what is, hopefully, a once-in-a-century worldwide pandemic. However, there will continue to be practical modifications and exemptions in order to align with our current reality. Population health management takes a community orientation to coordinating medical needs across the population and across the care continuum. The better we are at it, the more quality of care will increase, total costs of care will decrease, and patient experiences and outcomes will improve.
We should do our best to honor the memories of those who have passed and sacrifices of workers made by doing all that we can to prevent another pandemic while managing this current one. We should seek to fix the broken pieces of our healthcare system, now cast under a bright light. We should recognize the importance of aggregating patient data into actionable profiles that care providers can utilize to improve clinical interventions and financial outcomes for different patient risk segments. If we can live up to these objectives, we’ll have provider and community-based heroes who can stand tall and be proud of the lives they’ve saved. And ultimately, these saved lives will be a living testimonial to the hard work that needs to be done now.