Health systems and payors turning to population health management (PHM) to enhance the care delivery process, improve the health of their communities and manage the overall cost of care are encountering new challenges for which they may not be prepared. PHM uses risk-tailored approaches to promote individual involvement and proactively manage health, facilitate early intervention in acute and chronic care incidents, and promote wellness by focusing on root causes, such as nutrition and physical activity.

Making PHM a reality requires coordinating IT and clinical skills and insights with a rich dataset to guide the provision of health and wellness services to individuals and the entire covered population. One of the first challenges is to assess and group participating individuals into the appropriate risk-stratified groups, which may be defined by certain medical conditions, lifestyle characteristics, geography or other criteria. Individuals and communities are multidimensional, so a given individual may fall into multiple risk-stratified groups, with the composite leading to a risk profile for the individual and the community which is the basis for identifying targeted health and wellness services best geared to addressing the identified risks.

Once the appropriate health and wellness services have been defined, it’s essential to set, measure and monitor program outcomes. This requires the ability to gather, coordinate and collate data from care providers across the care continuum (e.g., hospitals, physicians, long-term care, rehabilitation, alternative care providers), local pharmacies, payors and data reported by individual population members. Gathering and leveraging this broad set of data requires capabilities beyond traditional clinical informatics. To achieve the benefits of PHM, health systems will need to expand partnerships to ensure access to rich data sources; develop web and mobile tools for consumer engagement; and build cross-disciplinary clinical, financial, regulatory and IT teams. Creating these teams often requires changes in organizational structure and reporting relationships, hiring or training individuals with new skills, and significant ongoing investment. 

CIOs will need to coordinate conflicting priorities, such as the degree of collaboration with payors, health systems covering the same communities and other important issues in the acquisition, analysis, definition and delivery of appropriate health interventions. Key issues like strategic ties, competitive relationships and regulatory limitations are integral to this discussion.

CIOs will need to manage the growth in the demand for IT services, including substantial increases in storage and processing capabilities, new tools, consumers as IT customers, the need to develop and deploy web and mobile tools to enable full consumer participation, and the rapidly increasing need for health information exchange (public and private). Building new models for data governance—with representation for all stakeholders—and crossing organizational boundaries is often particularly challenging, requiring coalition-building skills beyond what some CIOs currently possess.

Originally published in the CHIME CIO Connection.

3 December 2012