Accurate and current data is essential from everyone participating in this program, says Armstrong. Payers and providers must find a way to aggregate data so the information can drive better treatment and results. Moreover, the payer must accurately identify the population to manage by acuity as well as the cost of the care to the overall system.
"As a well-known 2003 RAND study showed, patients receive only 55% of recommended acute, preventive, and chronic care.… In a PBPH [practice-based population health] framework with ACO financial and clinical performance requirements, patients who have all the precursors of high-cost/high-risk conditions will have to be identified and managed," the AMGA report states.
Moreover, the AMGA report says, "For patients with multiple chronic conditions, the number of 'care gaps' increases significantly. Overall, a PBPH practice will have thousands of care gaps to identify, manage, and close to achieve compliance across its population. … Validated Health Risk Assessment (HRA) instruments have been incorporated into the health benefits packages of many employers and third-party insurers, producing a lot of data demonstrating the magnitude of health risk in our populations."
Data can bedevil pilot PHM programs. Though in theory payers and providers are willing to work together, in practice data sharing can be a hurdle, especially with so many IT systems in use across the healthcare industry. Typically some type of shared technology system is needed.