44 percent of health plans, providers find their platforms efficient, effective
According to a KPMG survey, population health programs, which are aimed at improving quality and access to care while reducing costs for a designated group of patients, are taking hold at health plans and providers.
Healthcare provider and health plans see this happening despite challenges associated with moving away from fee-for-service payment models, which have been in effect for decades, and toward alternate payment methods that are tied to quality, bundled contracts or other means.
“The move to population health is very encouraging given that nearly half of providers and payers are seeing the benefits,” said Michael Beaty, a principal at KPMG’s Healthcare & Life Sciences practice. “Providers are taking on more financial risk from these programs, but they have a greater opportunity to share from savings. Payers gain from administrative efficiencies and letting providers take on that risk.”
In the survey, 44 percent of respondents at payer and providers found that they have a population health platform in place that is being “utilized efficiently and effectively.” Another 24 percent are in the process of implementing a population health program within the next three years. Only 10 percent said they have no plans to implement a population health platform and another 21 percent of respondents said their organization doesn’t require a population health platform.
The biggest individual barrier to implementing a population health program is aggregating and standardizing information from multiple sources, 30 percent of respondents said. Stakeholder adoption (10 percent) and integrating with clinical work flows (10 percent) were cited as additional barriers. Another 34 percent cited “all of the above” which includes those barriers, as well as enabling patient engagement, funding investments, and selecting appropriate vendors as additional challenges.
“The complaints about incorporating technology into clinical workflows are fairly common and have many doctors and others involved with care delivery dissatisfied with electronic health records and other tools,” said Todd Ellis, principal at KPMG who co-hosted a Webcast titled Lessons from the Front Lines: Building your population health program – it’s not as easy as it sounds (click link for replay), with Beaty and KPMG Partner Joe Kuehn. “This can be remedied by better training and incorporating clinicians into the process of selecting technology.”
When asked about where they stand with value-based payments, 36 percent said “some of our revenue is generated by value-based payments and 14 percent said the majority of revenue is generated by value based payments. A quarter of respondents (26 percent) said they are planning to enter value-based payment arrangements in the next one-to-three years and only 7 percent of the organizations said they are not. The remaining 17 percent of healthcare organizations said they don’t require value-based payments.
“It is not necessarily a surprise that nearly a quarter of providers are not acknowledging the need for value-based payments,” Kuehn said. “Various parts of the country are transitioning at a slower pace. The vast majority of health plans and providers, however are moving this way, particularly after CMS had set some aggressive targets in January 2015, followed by some of the national health plans, to shift their reimbursement in this direction.”
Survey results were gathered from 86 respondents who identified themselves as working for a payer or healthcare provider during KPMG’s webcast on Dec. 2. The webcast featured Kash Patel, Vice President Population Health & Analytics, Information Technology, at Mount Sinai Health System. The webcast outlined how to develop population health management programs, developing measurable goals and addressing clinical, operational and technical considerations.
KPMG LLP, the audit, tax and advisory firm (www.kpmg.com/us), is the independent U.S. member firm of KPMG International Cooperative (“KPMG International”). KPMG International’s independent member firms have 189,000 professionals, including more than 9,000 partners, in 152 countries.