Note: This is an authorized excerpt from 2016 Healthcare Benchmarks: Population Health Management. To download the entire report, go to

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1 Note: This is an authorized excerpt from 2016 Healthcare Benchmarks: Population Health Management. To download the entire report, go to or call

2 2016 Healthcare Benchmarks: Population Health Management In this inaugural survey on population health management, 110 healthcare organizations weighed in on PHM tools and work flows, risk identification strategies, communication and engagement tools, program delivery modalities, results and challenges, and much more in response to an April 2016 survey by the Healthcare Intelligence Network. Targeted pharmacy interventions with non-compliant or uncontrolled patients, followed by pharmacy education of generic drugs, 90-day supplies, etc. [are our most successful PHM strategies]. > Hospital/Health System Use of registries to identify gaps in care resulting in outreach to close gaps and standing orders to manage a population of patients [are our most effective population health management tools]. > Physician Practice Patient engagement for patients that are part of the Chronic Care Management program [is our greatest PHM success]. > Hospital/Health System Financial restrictions allowing hiring of optimal number of care managers [is our greatest population health management challenge]. > Physician Practice 2016, Healthcare Intelligence Network 2

3 2016 Healthcare Benchmarks: Population Health Management This special report, based on results from the Healthcare Intelligence Network s industry survey on Population Health Management conducted in April 2016, is the latest installment in HIN S Healthcare Benchmarks series. Executive Editor Melanie Matthews HIN executive vice president and chief operating officer Project Editor Patricia Donovan Document Design Jane Salmon 2016, Healthcare Intelligence Network 3

4 Table of Contents About the Healthcare Intelligence Network... 6 Executive Summary... 6 Survey Highlights... 7 Key Findings... 7 Program Components... 7 Results and ROI...8 Most Effective Tools, Processes and Work Flows...8 About the Survey... 8 Respondent Demographics... 9 Using This Report... 9 Responses by Sector...10 The Hospital/Health System Perspective The Physician Practice Perspective Respondents in Their Own Words Most Effective Tool, Workflow or Protocol...15 Most Successful Population Health Strategy to Date Details of Future Programs Conclusion...19 Responses to Questions Figure 1: All - Current Population Health Program Figure 2: All - Planned Population Health Program Figure 3: All - Population Health Services Figure 4: All - Populations Served Figure 5: All - Health Risk Levels Served Figure 6: All - Targeted Health Conditions Figure 7: All - Population Health Team Members...24 Figure 8: All - Primary PHM Responsibility...24 Figure 9: All - Data to Determine Intervention Figure 10: All - PHM Delivery Methods Figure 11: All - Accountable Care Participation...26 Figure 12: All - Program ROI...26 Figure 13: All - Metrics to Measure PHM Success Figure 14: All - Top Population Health Challenges Figure 15: All - Sustainability of PHM Approach...28 Figure 16: All - Population Health Management Impact...28 Figure 17: All - Organization Type...29 Figure 18: Hospitals - Current Population Health Program...29 Figure 19: Hospitals - Planned Population Health Program...30 Figure 20: Hospitals - Population Health Services...30 Figure 21: Hospitals - Populations Served Figure 22: Hospitals - Health Risk Levels Served , Healthcare Intelligence Network 4

5 Figure 23: Hospitals - Targeted Health Conditions Figure 24: Hospitals - Population Health Team Members Figure 25: Hospitals - Primary PHM Responsibility Figure 26: Hospitals - Data to Determine Intervention Figure 27: Hospitals - PHM Delivery Methods Figure 28: Hospitals - Accountable Care Participation Figure 29: Hospitals - Program ROI Figure 30: Hospitals - Metrics to Measure PHM Success Figure 31: Hospitals - Top Population Health Challenges Figure 32: Hospitals - Sustainability of PHM Approach Figure 33: Hospitals - Population Health Management Impact Figure 34: Physician Practices - Current Population Health Program Figure 35: Physician Practices - Planned Population Health Program Figure 36: Physician Practices - Population Health Services Figure 37: Physician Practices - Populations Served Figure 38: Physician Practices - Health Risk Levels Served Figure 39: Physician Practices - Targeted Health Conditions Figure 40: Physician Practices - Population Health Team Members Figure 41: Physician Practices - Primary PHM Responsibility Figure 42: Physician Practices - Data to Determine Intervention Figure 43: Physician Practices - PHM Delivery Methods Figure 44: Physician Practices - Accountable Care Participation Figure 45: Physician Practices - Program ROI Figure 46: Physician Practices - Metrics to Measure PHM Success Figure 47: Physician Practices - Top Population Health Challenges Figure 48: Physician Practices - Sustainability of PHM Approach Figure 49: Physician Practices - Population Health Management Impact Appendix A: 2016 Population Health Management Survey Tool , Healthcare Intelligence Network 5

6 About the Healthcare Intelligence Network The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare. In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care. Executive Summary 70% of 2016 survey respondents have a population health strategy. Population health management (PHM) perpetually ranks as the healthcare space richest with opportunity, according to HIN s annual industry trends snapshot. But just how do healthcare organizations accrue clinical and financial gains from PHM s data-driven, risk-stratified care coordination approach? By providing chronic care management (CCM) services, say the majority of respondents to HIN s latest comprehensive Population Health Management survey. Ninety percent of respondents practicing PHM report a CCM component to their program, with 12 percent of those committed to CCM enjoying PHM ROI between 2:1 and 3:1. In condition-specific PHM metrics new for 2016, diabetes is by far the primary health target for PHM interventions, say 88 percent. Also paramount to PHM success under risk-based contracts is strategic oversight of the rising risk individuals with two or more unmanaged health conditions. One quarter of 2016 respondents focus PHM attention on their rising risk populations, the April 2016 survey determined. The survey also found that 70 percent of respondents have committed to population health management, up from 56 percent in At the same time, many responding organizations lament payor reluctance to cover essential PHM services like health coaching and group visits they see as critical care management touch points. The use of data analytics in PHM continues to rise, though more slowly than it did from 2012 to 2014, when EHR and registry use tripled. A health risk assessment (HRA) is the primary instrument for identifying individuals for PHM interventions, say 70 percent, as compared to 64 percent in And having stratified their populations, the majority of PHM outreach is delivered telephonically, according to 84 percent of respondents. Medication management as a PHM offering and the weight of quality rankings, utilization data and aggregate spending in PHM program evaluation were among new metrics identified by the 2016 survey. On program expansion: Our program has more than doubled every year for the last four years and will likely do so again. 2016, Healthcare Intelligence Network 6

7 Respondent Demographics Responses to the April 2016 Population Health Survey survey were submitted by 110 organizations. Of 80 respondents identifying their organization type, 27.5 percent were hospitals or health systems; 12.5 percent were physician practices; percent were either health plans, employers or disease management companies; 7.5 percent were independent physician associations, and 30 percent categorized their organization type as Other. 72% include case management in a population health program. Using This Report This benchmarking report is intended as a resource for healthcare organizations searching for comparable data and means to measure implementation and progress. It is also a helpful planning tool for organizations readying initiatives in this area. The initial charts and graphs presented here represent results from all respondents; images in subsequent sections depict data from high-responding sectors. (Figure titles begin with the segment they represent: for example, All, Health Plans, Hospitals, etc.) Often, one of the largest responding sectors is composed of respondents identifying their organization type as Other. In general, we do not depict results from this segment because it represents a wide range of organization types, including consultants and product vendors. However, you will always find a graph indicating the demographics of respondents. Here are some additional tips for using this report: 99 See how you measure up: Scan this report for your sector, and see how your program compares to others. Note where you lead and where you lag. 99 Evaluate your efforts: Think about where you have been focusing your efforts in this area. Look for trends in the data in this report. Look for benchmarks set by your sector and others. 99 Set new goals: Use the data in this report to set new goals for your organization, or to raise the bar on existing efforts. 99 Use it as a reference book: Keep this report accessible so you can refer to it in your work. Use these data to support your efforts in this area. If you have questions about the data in this report, or have feedback for our team, don t hesitate to contact us at info@hin.com or Most effective workflow(s): embedded care management. Shared savings. 2016, Healthcare Intelligence Network 9

8 Figure 11: All - Accountable Care Participation To which of the following care models do you belong? No Yes Clin. integrated network Medical neighborhood 27 8 ACO PCMH Total Responses HIN Population Health Management Survey April, 2016 Figure 12: All - Program ROI What ROI has your program generated? 1.6% 3.2% 12.9% 1.6% 1.6% None 2:1 to 3:1 3:1 to 4:1 4:1 to 5:1 50.0% Greater than 5:1 Don't know 29.0% Too early to tell Other 2016 HIN Population Health Management Survey April, , Healthcare Intelligence Network 26