Population Health Management Tool Improves Primary Care Outcomes in VBC Model

A new study conducted by health information exchange (HIE) HEALTHeLINK and the Milbank Memorial Fund has found that a population health management and analytics tool contributed to better patient outcomes in primary care practices enrolled in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care Plus (CPC+) program.

CPC+ is a now-defunct value-based payment (VBP) model designed to strengthen primary care via improved quality, access, and efficiency, according to CMS.

The study sought to evaluate whether population health management and analytics would help improve patient outcomes when combined with a VBP model such as the CPC+ program. According to the press release, stakeholders hypothesized that the combination would yield better outcomes because CPC+ creates the incentive, while population health analytics and management tools provide the means to achieve such outcomes.

In the study, researchers assessed data collected from four primary care practice groups in the Western New York region. Each had similar patient populations, but three were enrolled in CPC+, and two utilized HEALTHeOUTCOMES, HEALTHeLINK’s population health management tool. Outcomes from each group were measured from Jan. 1 to Dec. 31, 2020.

Overall, the study found that practices tend to have significantly better outcomes when a population health management tool and a VBP model are in place at the same time. Practices with both in place achieved a 24.1 percent reduction in admission rates and a 21 percent reduction in outpatient surgery. These practices also experienced decreases in length of hospital stay and readmission rates by 32.7 percent and 30.4 percent, respectively, compared with practices that didn’t participate in CPC+ or utilize HEALTHeOUTCOMES.

These findings indicate that medical practices that participated in the CPC+ program or are engaged in other multi-payer advanced primary care opportunities should also be encouraged to use population health management information technologies, the researchers posited.

“Although the study is small, it raises several important issues,” said Lisa Dulsky Watkins, MD, a program officer at the Milbank Memorial Fund, in the press release. “The federal evaluation of the CPC+ model looked exclusively at Medicare fee-for-service beneficiaries, not at anybody covered by commercial insurance or Medicaid. This study examines that broader population and adds the impact of a high-functioning health information exchange, facilitating the population health tracking and improvement that CPC+ was designed for. By demonstrating a combined positive impact, it will add to the ongoing conversation about how best to support primary care moving forward.”

This study is the latest in a larger conversation around the role of analytics in population health management and value-based care.

In August, Baptist Health South Florida shared that it would implement Innovaccer’s Health Cloud platform to enhance population health analytics, provider engagement, and care management across its health system in an effort to provide value-based care.

Earlier this year, Hawaii Health Network and COPE Health Solutions collaborated on a population health analytics partnership focused on providing value-based payment insights to enhance performance under a new Medicare risk arrangement for the clinically integrated network.