How Population Health Analytics Drives Value-Based Care Success

Population health analysis is closely intertwined with value-based care. Not only can population health analytics help identify patient care gaps, but strategies can identify patient-wide interventions and programming that enable better patient outcomes, and ultimately, more success in value-based care contracts.

In other words, value-based care needs population health to identify patient risk, target interventions, and monitor progress. But rolling out population health strategies requires more than a robust analytics team.

"When you think about population health, you have to think about the components like clinical engagement, data, and operations,” Shaun Garcia, MD, MHCDS, director of quality at Brevard Health Alliance told Insights during a conversation about the division’s latest research.

At his organization, his team is building out clinical operations to account for population health measures rather than retrospectively trying to fill in gaps for data collection. They avoid back-end paper shuffles with payers by having the information gathered on the front-end.

“It starts with operations. Build it from the front-end, that is the difference-maker,” Garcia explained. “When strategies are retrospective, you are always chart chasing and that wastes time. You don’t have to do that.”

This method might require an upfront change in workflow and tough conversations with payers, Garcia acknowledged. But the growing pains make for smoother processes down the line.

Data that is captured appropriately at the point of care can be clearly communicated with providers, payers, and revenue cycle teams. Providers will see immediate insights into gaps in care and refer patients to the appropriate providers or treat them as needed while the patient is still in the exam room. Meanwhile, payers can see these gap closure metrics in near real time for quicker payment and quality reporting.

Population health metrics tied to billing also ease the burden on the revenue cycle team. The data they need is communicated clearly upfront, avoiding the need to rebill patients and health plans for services buried in unclear and disorganized data.

“I always bring in someone from the billing side because I want to make sure as we influence the front-end, we’re capturing the data appropriately so that when the bill is sent out, it’s clean,” Garcia advised.   

A front-end strategy also captures incentive dollars tied to value-based reimbursement more efficiently. In turn, this allowed Brevard Health Alliance to hire more staff to help grow its capabilities.  

“If you were to change a workflow from a back-end to a front-end, you can capture incentive dollars that will begin to provide that foundation for you to be able to then hire,” furthered Garcia.

A more robust population health team increases an organization’s capabilities, allowing the opportunity for greater, more risk-based contracts, better patient insights, and improved patient outcomes.

A driving force behind the change at Brevard Health Alliance was a new administration who shifted focus from economies of scale to value-based care. The culture shift helped Garcia rollout provider engagement initiatives as he and his team began developing the front-end analytics they needed for value-based care success.

“Historically here, we did not have clinical engagement. It really started when we overhauled the peer review process,” he explained. The process began with a survey of all providers to see what they wanted to learn more about when it came to value-based care.

“We developed a volunteer peer review committee who would take evidence-based guidelines and create a standard of care. Then they would use that standard of care to measure themselves,” Garcia continued.

The information gathered through the peer review process revealed a need to focus more on population health measures that were used regularly by many providers. Garcia’s team could then work on building out the front-end capabilities for routine reporting and documentation to ease provider burden.

“They’re frankly really thrilled to be engaged in it,” Garcia explained.

Now, he says, providers still feel comfortable coming to him when there is too much administrative burden or chart diving associated with a quality measure. He and his team can work on making the process simpler and more efficient.

Ultimately, Garcia wants to grow the program so his organization is equipped to bring data to payers and advocate for more risk-based models.

“If we push through population health and start to make better strides with preventative care, I will absolutely go to the payers and propose a higher cap rate to take on greater responsibility,” he emphasized. “All the health plans are driving that conversation right now.”

Having the bargaining power to go to health plans and vouch for value-based care begins with efforts like Garcia’s. He started by talking with his providers and revenue cycle team to build out front-end analytics that would align with what each team needed.

Providers felt comfortable pointing out when a quality measure was too cumbersome and revenue cycle team could highlight when measures were not captured appropriately for billing.

 “You can really build something wonderful this way versus having to consistently chase your tail,” Garcia highlighted.

The process began where data collection begins—at the point of care. Building out analytic workflows that captured population health insights as needed had trickle-down effects and ultimately helped Garcia and Brevard Health Alliance succeed in value-based care efforts.

This interview was conducted as a part of Insights by Xtelligent Healthcare Media’s research work. Findings from this interview and others are compiled in Choosing the Right Alternative Payment Model report. For a deeper dive into alternative payment models and value-based care success, check out the full report here.