Population health management software and support services have been hot topics in healthcare and healthcare IT for several years now, and are among the top three expenditures of health systems, according to a poll reported in Healthcare Finance in October of 2015. One would hope it is because of an increased awareness of the needs of our patient populations and an overwhelming desire to provide better care and outcomes for them.
Unfortunately, I suspect much of the vendor and industry excitement is really about the increasing money being spent on population health management. According to PRNewswire, the global population health management solutions market was estimated to be $8.92 billion in 2016 and is expected to grow over $50.35 billion by 2025, with Grandview Research sizing the worldwide market at $20.7 billion in 2015 and $89.5 billion by 2025. In a Becker’s Hospital Review article profiling “70-plus population health management companies to know,” the rapid growth and increasingly crowded field depicted by the author suggests to me a gold rush mentality. What I have heard and read from vendors further supports the gold rush analogy, with conflation of experience and outcomes luring new prospects.
KLAS has included population health management vendors in their ratings for the last several years and it was Adam Gale’s thoughtful comments in a recent piece that got me thinking about what I have heard and what I would like to hear from vendors about their population health management services.
What I have heard:
- “We have deep experience in population health.” This statement came from a company that had grown in one year from 20 to 225 employees and then to more than 600 over the subsequent year. There may be several principle players with experience, but that gets diluted quickly with this kind of growth, and the growth in the sector in general.
- “With our software you will have real-time insight into your patient population.” The software receives feeds from our systems and claims-based data, which is often three to six months old at the time of ingestion. Yes, calculation speeds are near-instantaneous, but you are crunching old numbers. Our high utilizing and vulnerable populations can use a lot of services and experience a lot of complications in six months.
- “We will be your partners in this effort.” Whenever I have entered into partnerships, my partners bore equal risk with me for negative outcomes and shared equally in positive outcomes. I have yet to meet a vendor who is willing to be at equal risk with the purchaser of services; risking a non-majority percentage of your fees is not partnering.
- “Our population stratification methodology is more precise, with proven superior patient outcomes and financial performance.” Despite population health being a topic of interest and discussion for a number of years and an effort for some systems for several years, there has not been enough time to rigorously evaluate performance and prove statistically significantly better outcomes. My experience has been that everyone falls back on nearly identical strata and all focus on the same population — those who result in the most expenditure and least reimbursement in the fee-for-service world. This is not preparing us to manage in a true value-based reimbursement environment.
- “Our solution fits seamlessly into your clinicians’ workflow.” To date, there is no information technology solution that fits seamlessly into a physician’s or other clinical provider’s workflow. It is always a new workflow, and therefore, a change. Change management and a real, and acted on understanding of change capacity is critical.
- “You will see a return on investment in the first 18 months after implementation.” Return on investment is thrown around a lot and rarely works out. Most healthcare systems tell this lie to themselves internally on a frequent basis, but when a vendor tells this lie, there is likely a contractual breach to be pursued. Objective evaluations have cited percentages of patient populations that must be in risk based contracts to recoup population health infrastructure investments above 50 percent. Except for Kaiser Permanente, I don’t think any of us are there yet. That doesn’t mean we should not invest (risk based/value based/outcomes based reimbursement is a near future reality), but we should not be given false hopes of recouping the investment.
- “We can have you up and running in 90 days.” This is the classic lie (“miscommunication” per Adam Gale, who is kinder and gentler than me) of IT technology vendors. I have personally never seen the 90-day promise fulfilled and vendors are expert at assigning responsibility for the miss back on the purchaser of services.
Of course, it would be unfair to point out the miscommunications and misrepresentations that I have heard without suggesting some alternate communications and presentations.
What I would like to hear:
- “Population health is a rapidly evolving field. We feel that we have the best product currently on the market for these reasons: 1, 2, 3, etc. We will work with you to evolve both our product and services and your utilization of them to give you the best chance of managing the changing environment and succeeding.”
- “Our software will be a key part of your solution, but you will need other pieces and you will need to work with us to ensure that your infrastructure and securities are capable of supporting the data acquisition, aggregation, analysis, and transmission. This is a complex undertaking and there is no one-size fits all solution.”
- “We will work diligently with you and will enter into a contractual arrangement that memorializes that commitment. We recognize that you are at financial risk and we are at reputational risk in this relationship, so working together is in both of our best interest. We also know that you cannot afford to have us and contracted support in place indefinitely and commit to work ourselves out of your shop by providing training to your team and working with you to create a vision and plan for future evolution. We will then stand ready to return at any time that need to correct course or implement new capabilities.”
- “We are very proud of the software solution that we have created and the algorithms that we have implemented to assist with stratifying and gaining insights into your population. However, we recognize that there are a number of possible solutions to your needs and that the most beneficial thing we can do is help ensure a smooth, functional implementation, excellent training and preparation of your teams, and support to allow you to stay the course to experience the benefit that will come with time.”
- “Return on your investment is dependent on many things. We will do all in our power to provide an efficient implementation and support excellent use of our software and services so that our variable in the equation is not an impediment to your value realization. We know that population health capabilities are a very significant investment and that real returns won’t be realized until a majority of your reimbursement is value-based. Our commitment is to have you as prepared to experience that value realization as we possibly can.”
- “Our software and support services will result in workflow changes at every level, from the front office to the bedside and to the back office. Change management will be critical and you will have to help us determine timing of implementation and go live, based on your knowledge and understanding of the change capacity of your system, particularly your physicians and other clinical care team members.”
- “We will work with you to create a build and implementation schedule that makes the most sense for your system, taking into account budget, competing projects, infrastructure alignment needs, and staffing. Our goal, in concert with you, is the timeliest and most efficient implementation possible. We know that this will require open communication and mutual accountability within a non-blame, solutions-oriented environment at all levels.”
I know that as a physician, former CIO, and former CMIO, this kind of presentation would make me a lot more open to a relationship than what I have previously heard. I would strongly encourage vendors to take the risk of transparency. Don’t keep coming with the same misrepresentations, reshuffling the slide deck and hoping I won’t notice. I would further challenge the C-Suite to hold ourselves accountable and cease our self-destructive and costly behavior of allowing vendors to keep telling us lies until we hear the lie we want to believe.
Finally, I would remind myself and each of us that there are no easy, fast, or cheap answers to the complex issue of population health management, and will leave you with one of my favorite Nietzsche quotes:
“The essential thing ‘in heaven and earth’ is that there should be a long obedience in the same direction; there thereby results, and has always resulted in the long run, something which has made life worth living.”
Currently working as a freelance consultant, David Bensema, MD, was previously both CIO and CMIO at Baptist Health Kentucky, where he led the implementation of an enterprise-wide EHR system. Bensema has served in various physician leadership roles and has a strong passion for advancing healthcare IT to improve patient care.