As we approach the holiday season, the health and wellness of our loved ones, friends and communities is certainly top of mind for us all. To say that 2021 has been a challenging year is an enormous understatement. As I reflect on the impact of the COVID-19 pandemic on our physical and mental health, the focus on population health management becomes even more important.
Population health management is most commonly defined as the process of improving clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models. The perception may be that population health management is a relatively new trend, but it has been a fundamental component of the U.S. healthcare industry for years.
In my 25+ years at AssureCare, I have seen population health management evolve as a significant part of many different initiatives. The following drivers have influenced this evolution:
- Integration of the Commercial and Public Sectors. In the United States and U.S. Territories two prominent groups are responsible for the payment of healthcare services. The commercial sector includes insurance companies such as Aetna, Cigna, the Blue Cross Blue Shield companies, and many others. The second is the public sector, which offers and funds government-sponsored healthcare programs. These two sectors were historically divided operationally until the signing of the 2010 Affordable Care Act (ACA). ACA catalyzed the breaking down of the walls between the public and private sectors, leading to an increase in healthcare coverage and access to care—both essential to achieving the goals of the Institute of Healthcare Improvement (IHI) Triple Aim.
- Impact of HCBS and LTSS Programs. Home & Community Based Services (HCBS) and Long-Term Services and Supports (LTSS) programs are critical to population health management initiatives, to help keep patients independent and in their home. These programs are designed to improve people’s lives by offering a range of services that are crucial to managing chronic diseases — medication management, healthy eating habits, basic needs and more.
- Transition from Fee-for-Service to Value-Based Care. The traditional fee-for-service reimbursement model focused on quantity of services, whereas the newer approach of value-based care focuses on quality of services and patient care. This patient-centric, outcomes-driven model is a key driver in population health management and ensuring that your platform enables patient engagement solutions is critical.
- Staying Ahead of the Curve. Healthcare and supporting healthcare information technology (HIT) are constantly advancing. Telehealth, wellness initiatives and access to mobile devices are just a few of the drivers that are improving population health management today. The healthcare industry, including payors, providers, and pharmacists, must be committed to a proactive approach. As mentioned earlier, the COVID-19 pandemic placed a tremendous burden on the healthcare system. It is more important than ever to keep our communities healthy through targeted and effective population health management initiatives.
AssureCare’s core mission is to provide solutions that transform population health management, specifically to greatly enhance the programs I mentioned above. From our company’s legacy care management solutions to the evolution of our latest comprehensive population health management platform, we are unifying payers, providers, government sponsored healthcare programs and pharmacies to work efficiently and effectively together to deliver patient-centric care. I am humbled by our company and customers’ commitment to improve patient care, and I am proud of the innovations we are collectively bringing to the market today and in the future.
Interested in learning more? Check out some of our recent Population Health Resources here.