GE Healthcare Camden Group Insights Blog

8 Issues Affecting Population Health Management Right Now

Posted by Matthew Smith on Dec 16, 2012 10:55:00 PM

population health managementIn late 2011, the Care Continuum Alliance, an advocate for population health management, surveyed industry leaders to assess the market and predict key issues for 2012. According to the alliance’s white paper, two predominant themes were brought to light as a result of the survey.

“First, significant market movement will occur toward accountability and value creation in healthcare, driven partly by new physician-guided and collaborative models,” according to the report. “And second, population health management is well-positioned to add value to and support these emerging models, but must continue to build the case for wellness and prevention.”

Here are eight additional key issues, identified in the report, that currently affect population health management. 

1. Accountable care and the Medicare Shared Savings program. Many comments from survey respondents centered on accountable care and collaborative models, as well as federal support for both. According to the report, population health has a lot to offer collaborative care, such as health risk assessment and predictive modeling, HIT infrastructure, data analytics, care coordination and other core competencies. “But tempering optimism around accountable care models were caveats,” the report noted. 

2. Consumer use of mobile and eHealth technologies. According to the report, population health management has been both a driver and benefactor of the rise in eHealth and mHealth technologies. The demand for these technologies, said one respondent, will drive healthcare “to adopt … a patient-centered, consumer-empowered, pull-rather-than-push model, which has already been realized in the music, travel, book and news industries.” The importance of social media was also noted by those surveyed, and when coupled with mobile technology, will be used as a tool and patient engagement and shared decision-making. 

3. Reducing avoidable hospital readmissions in Medicare. The Hospital Readmissions Reduction Program (HRRP) could be a “big opportunity for companies who have developed proven strategies for reducing hospital readmissions,” wrote one survey respondent. The program includes Medicare tracking readmissions for three conditions – heart failure, acute myocardial infarction and pneumonia – within 30 days on or after Oct. 1, 2012. Medicare will then reduce payments to hospitals to account for excess readmissions. 

4. Quality improvement in Medicare advantage. The Medicare Advantage’s (MA) “stars” rating system was another topic of discussion. The program will award bonus payments to plans under the stars system to assess performance on a myriad of measures. “The developing stars system appears [to be] headed toward a structure consistent with industry-advocated changes, including additional wellness and prevention measures and retirement of process-related measures,” the report read. It added that, combined with continued growth in the Medicare Advantage population, the need for plans to demonstrate improvement in wellness and chronic care measures will drive “expanded opportunities” in the Medicare managed care market, according to industry experts. 

5. Opportunities to support insourced programs. “An industry challenged at times by payer decisions to build rather than buy care management programs could face additional competitive pressure in 2012,” read the report. An industry leader added that the market will continue challenging the value of each program and, with the consolidation in the [managed care] industry, will continue looking at insourcing versus outsourcing. “ACOs may be a greater opportunity, but … these groups will often favor their own solutions rather than those from the outside,” he added. To that point, the report said, many components of population health management will likely prove especially valuable to health plans in 2012, regardless of the build or buy decisions. 

6. Improving care coordination for dual eligibles. Dual eligibles, or those eligible for both Medicare and Medicaid benefits, “attracted significant attention from policymakers in 2011 as economic pressures created an imperative for savings in both programs,” the report read. The need to reduce costs associated with this population is high, and as one respondent put it, “focus on improved care coordination for complex, multi-morbid patients is a must.” The report added Congress and the administration recognized the savings possible through better care coordination for dual eligible by formalizing federal oversight of the population in the ACA. “This heightened federal recognition … places a premium on care coordination services, such as those population health management provides.” 

7. Federal support for prevention and wellness. Although the ongoing deficit reduction debate in Congress has jeopardized federal support for wellness and prevention, said the report, industry leaders are optimistic about federal program opportunities. “The $15 billion Prevention and Public Health Fund … is an important part of the deferral effort, but only one element of a broader prevention and wellness strategy encompassed by the ACA,” according to the report. Since the law’s passage, Medicare has added annual wellness visits and expanded coverage of obesity and cardiovascular disease prevention services, “and the federal government has made significant grant funding available to states and communities for prevention and care coordination initiatives.”

8. Development of ACA health insurance exchanges. According to the report, development of the reform law’s health insurance exchanges – scheduled to open their doors in 2014 – will draw significant attention in 2012. “Especially with respect to how CMS structures the essential benefits package all participating plans must offer,” it said. Industry leaders said the challenge is ensuring the package is comprehensive and plans don’t dilute population health services to maintain competitive pricing in the exchange market. 

Topics: Accountable Care, ACO, Medicare, ACA, Affordable Care, Population Health Management, Mobile Health

Affordable Care Act: Beyond the Initial Reactions

Posted by Matthew Smith on Aug 8, 2012 10:56:00 AM

Affordable Care ActIt's been nearly six weeks since the Supreme Court's Patient Protection and Affordable Care Act (ACA) ruling, and some physician-based organizations have had time to digest the intricacies of the resulting information that was released.

As a refresher, the new law will require most Americans to carry health insurance or pay a penalty beginning in 2014. The law also guarantees that health insurance will be available to those who are already ill or need expensive care, ultimately helping many poor and middle-class people afford coverage. All totalled, it is believed that hospitals can expect an influx of approximately 32 million newly insured patients. So the issue that has developed is, "How are physicians reacting to these changes?" To answer this question, the following are opinions delivered by the Presidents of three, large, physician-minded associations.

John R. Tongue, MD
American Academy of Orthopaedic Surgeons

Although the American Association of Orthopaedic Surgeons (AAOS) opposed much of PPACA, we recognize that there are provisions in the law that aim to help providers deliver high-value healthcare services, including the development and implementation of Accountable Care Organizations and other quality improvement efforts, and assistance for pediatric specialists serving underserved communities. In addition, there are valuable patient protection provisions within the law, such as enabling young adults to remain on their parents’ insurance policies, outlawing coverage denials based on pre-existing conditions, enforcing medical loss ratio requirements, and doing away with maximum coverage limits on insurance policies.

However, PPACA also contains some provisions that could greatly hinder providers’ ability to deliver patient care, thereby threatening patients’ access to the healthcare services they need. The AAOS, along with its more than 18,000 members, stands ready to work with Congress to address these detrimental provisions in the law, such as continuing efforts to repeal the Independent Payment Advisory Board (IPAB) and other administrative burdens that infringe upon providers’ ability to deliver safe and effective patient care. 


Jeremy A. Lazarus, MD
American Medical Association

While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system. We are pleased the law expands coverage to millions of uninsured who live sicker and die younger than those with insurance. It allows physicians to see patients earlier before care is more expensive, provides funding for research on drugs and treatments, increases Medicare and Medicaid payments for primary care physicians and includes Medicare bonus payments for general surgeons in underserved areas.

The AMA is working during implementation of the law to make changes like eliminating the Independent Payment Advisory Board. Lawmakers also must address two problems that predate the law, the broken Medicare physician payment formula and the flawed medical liability system.

Glen Stream, MD, MBI
American Academy of Family Physicians

The Patient Protection and Affordable Care Act has been a divisive issue not only in our country but also amongst our own membership. Clearly, it is far from perfect legislation. But now that the Supreme Court finally has issued its long-awaited rulingwe can move forward with needed health system reforms.

The Academy will continue to work to implement the best pieces of the ACA, advocate for change in provisions of the law that are flawed and address the law's two key deficiencies -- meaningful medical liability reform and a replacement for the sustainable growth rate (SGR) formula.

The ACA, even with its flaws, provides a pathway to reach the AAFP's vision of health care for all, a policy goal the Academy has been pursuing for more than two decades. By extending health coverage to roughly 30 million more people, the law will improve the health of the nation by ensuring access to basic primary care, including preventive services and chronic disease management.

The court's decision helps our patients by preserving provisions of the ACA that:

  • eliminate annual and lifetime coverage limits;
  • eliminate cost sharing for preventive services;
  • prevent payers from denying coverage based on pre-existing conditions; and
  • allow young adults to stay on their parents' insurance up to age 26.

For primary care physicians, the court's decision preserved provisions of the ACA that:

  • create Medicare primary care payment incentives; and
  • boost Medicaid payments for primary care services to Medicare levels.

For our workforce, the decision means investment in primary care education and training will continue through:

  • funding for teaching health centers;
  • scholarship and loan repayment programs in the National Health Service Corps;
  • support for the health professions grants for family medicine; and
  • establishment of the Health Care Workforce Commission.

The ruling also means that projects intended to align payment to support medical home transformation will continue. 

There is plenty to like, and dislike, about the ACA. The bottom line is that our Academy will work to maximize the provisions of the law that benefit family physicians and our patients while also addressing issues where the law is lacking or deficient.


So how about the rest of the country's physicians? In a survey conducted by Kantar Health and Sermo, Inc. following the Supreme Court’s decision to uphold the Affordable Care Act:

  • 71% of U.S. physicians want major changes to the law
  • 57% percent of the 1,500 respondents said they would like to see the law repealed altogether
  • 14% would keep the law but undertake major bipartisan revisions
  • 26% favor keeping the law and “fine tuning” it over time.

With the jury still out on the ACA, only time will tell if the ACA will deliver improvments and changes that the US health system needs.

Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, AAFP, Medical Association, Physicians

Part II: Reactions to Supreme Court's Affordable Care Act Decision

Posted by Matthew Smith on Jun 28, 2012 12:52:00 PM

Affordable Care ActAmerican Heart Association:

Because of this ruling, the Affordable Care Act can be fully implemented to help reach the American Heart Association’s 2020 goal to improve the cardiovascular health of all Americans and, more immediately, prevent 1 million heart attacks and strokes over the next five years through the Million Hearts initiative. Under the law’s robust provisions, we are expanding access to preventive care and medicines to reduce an individual’s risk factors; placing a stronger emphasis on community prevention and wellness; and providing access to the care patients need to recover after a heart attack or stroke so they can lead longer, more productive lives.

For the 122 million Americans with pre-existing conditions, including the 7.3 million with some form of heart disease or stroke who are uninsured, this decision will likely be met with a great sigh of relief.  No longer will they be denied coverage or charged higher premiums because of their health status.  Beginning in 2014, these Americans will finally be able to attain the lifesaving care they desperately need at a price they can afford.

Medical Association of Georgia:

The Medical Association of Georgia (MAG) is disappointed with today’s U.S. Supreme
Court ruling to uphold the Patient Protection and Affordable Care Act (PPACA), according to MAG President Sandra B. Reed, M.D. She also stresses that the decision is irrelevant as a practical matter unless the systems that the government and other third party payers use to pay physicians are reformed in a full and comprehensive way.

American Public Health Association:

The American Public Health Association heralds the U.S. Supreme Court ruling announced today upholding the Affordable Care Act, a landmark law enacted in 2010 to dramatically improve the health of all Americans and control health care costs.
Today’s historic ruling by the nation’s highest court marks a significant milestone in our national efforts to improve the delivery and financing of health services in the U.S. and to promote health and wellness rather than disease treatment. The Supreme Court’s decision allows for long-overdue changes made possible by the law to move forward without question or further delay. The law will bring relief to millions of Americans

American Cancer Society:

The ruling is a victory for people with cancer and their families nationwide, who for decades have been denied health coverage, charged far more than they can afford for lifesaving care and forced to spend their life savings on necessary treatment, simply because they have a pre-existing condition.

Massachusetts Medical Society:

Physicians in Massachusetts have been strong supporters of our state health reform movement from the beginning. Universal coverage has been better for our patients, and it’s been better for the practice of medicine. When people have insurance, they are more likely to get the care they need, when they need it. They are also more likely to discuss preventive care measures with their doctor … and that may lead to longer and healthier lives.

And when the public’s health is good, society is more productive, the economy is vibrant, and the social fabric of the community is as strong as it can be. That’s why is we are so pleased that the ACA was upheld. Universal coverage is a state-federal partnership – no state can do this on its own.

New York-Presbyterian Hospital

The constitutional question is over. Now, hospitals and medical leaders must continue to address the issues of access, affordability and quality. A lot has been done, but we have more to accomplish. NewYork-Presbyterian Hospital has taken many steps to improve medical care for our patients, drive innovation and hold down costs. We are not alone. 

Many hospitals, organizations and medical leaders have been taking similar steps with great results to improve medicine. The medical community is prepared to embrace change using best practices and rigorous scientific research. Everything we do must be focused on improving medical care for our patients.

Minnesota Hospital Association:

The biggest reaction right now is a sense of relief that now we know this piece of the puzzle is in place. But I think everybody understands it's a work in progress, that we have an election coming up...

Our members aren't saying they're going to do anything different tomorrow than they would have done if a different decision had been reached."

Topics: ACA, Affordable Care, SCOTUS, Cancer, Medical Society, Hospital Association, Medical Association

Early Reactions to Supreme Court's Affordable Care Act Decision

Posted by Matthew Smith on Jun 28, 2012 10:16:00 AM

Supreme Court Ruling, ACAAmerican Medical Association:

The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.

The AMA remains committed to working on behalf of America's physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation's health care system.

This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans. 

The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.

Ohio Hospital Association:

This ruling provides clarity to allow welcome and much-needed health reform efforts already underway to move forward. Ohio hospitals are committed to leading the evolution to value-based health care delivery. While the ruling is expected to increase demand for medical care, Ohio’s hospitals are pleased it will allow nearly one million uninsured Ohioans to obtain better access to essential care in the most appropriate setting. While some provisions of the ACA merit further debate and amendment, Ohio hospitals believe leaving such refinement to future legislative action is a wise decision,” said OHA President and CEO Mike Abrams.

American Academy of Orthopaedic Surgeons:

"The AAOS recognizes that there are provisions within PPACA that help providers deliver high-value health care services and offer musculoskeletal patients protections against insurance company abuse and educational tools to make better health care choices.

However, we cannot overlook provisions like the IPAB that threaten the doctor-patient relationship and the administrative burdens within the law that could greatly hinder providers’ ability to deliver quality care by infringing upon exam room time.

The AAOS will continue its efforts to achieve a patient-centered solution to health reform by working with Congress to best implement the beneficial provisions of PPACA; repeal the detrimental provisions that still exist, and; to solve critical issues, like achieving a permanent solution to the flawed Sustainable Growth Rate formula and addressing federal medical liability reform, that the law failed to address.”

Texas Medical Association:

“One thing today’s ruling has not, and cannot, change is Texas physicians’ deep commitment to care for our patients. The well-being of our patients comes first.

The Texas Medical Association has said since day one that we need to find what’s missing, keep what works, and fix what’s broken in the new law. We absolutely must reduce the law’s red tape and bureaucracy that interfere with patient care. Today’s health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients.

The court gave the states flexibility on Medicaid expansion. We desperately need a better system of caring for Texas’ large uninsured population. We need a local/state/federal partnership to design a fair and sustainable system. Top-down mandates are not the answer.

American Academy of Family Physicians:

  • The AAFP is praising a Supreme Court decision upholding all provisions of the Patient Protection and Affordable Care Act.

  • In a prepared statement, AAFP President Glen Stream, M.D., M.B. I., said that "as a result of this decision, more Americans will have access to meaningful insurance coverage and to the primary care physicians who are key to high-quality health services."

  • Stream cited various provisions in the Affordable Care Act that will strengthen the nation's primary care and family physician workforce and infrastructure.


Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, TMA, AAFP

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