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Challenges of PHM - Preparing for Changing Payment Paradigms

Making The Move To A Population-Based Reimbursement Model Requires

Transforming from the traditional "siloed" care model into a network care model, both for increased care coordination and the capability to scale effective interventions with the patient population. A network of Providers and hospitals.

The Active Wellness Drivers For PHM

Analytics the driving force: A significant increase in the need to acquire, aggregate, and analyze data on the population.

Patient - Provider Portal: An integrated PHS- EHR clinical platform that allows a single common view of the patient across care settings and over time.

Care Plans replace Treatment Plans: Provider needs to modify their clinical approach from event-based care to redesign that can help healthcare providers identify changes that could reduce operating cost and boost efficiency

Physician engagement: Aligned common goals and reimbursement incentives.

Patient Engagement: Instituting new clinical and operational processes that foster sustained behavior change

Evolving Patient Needs & Changing Expectations From Healthcare Providers And Institutions:

There is a changing pattern of diseases in the population. The shift is from infectious diseases to lifestyle-related Chronic disease conditions. The management of these is through the management and prevention of adverse events. The treatment protocols, unlike infections which get eliminated, is to maintain control on it through care plans. This is a new normal for healthcare delivery:

  • Increased access to care, which can lead to more patients and less network leakage
  • A higher number of chronic diseases that must be managed and treated over a longer period
  • An aging population and sicker patients with multiple chronic conditions
  • Patient engagement in his care. Patients want more insight into their care and want value for their dollar
  • Increasing market share when patients have more choice in where they receive care

As healthcare delivery where both the care model and the business model are increasingly intertwined. Change in the care pathway can have a significant impact on financial metrics. Organizations, therefore need tools that help them identify their revenue and cost drivers and provide insight into how cost, quality, and care decisions impact the network as a whole.

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