Winning Across the Continuum: Partnering for Population Health in a Time of Shifting Reimbursements

Winning Across the Continuum:Partnering for Population Health in a Time of Shifting Reimbursements

WHITEPAPERathenahealth, Inc. | Published: October 2014

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Winning Across the Continuum: Partnering for Population Health in a Time of Shifting Reimbursements

2| athenahealth.comathenahealth

Winning both ways: partnering for population health in an era of shifting reimbursementsAt varying paces nationally, payment models are shifting from fee-for-service to fee-for-value, including new models in which leading provider organizations take on the financial risk of providing health care to a pre-defined population. While many agree that value-based reimbursement will become increasingly common, fee-for-service contracts remain the dominant form of reimbursement in most markets. A recent poll found that 81 percent of health systems and hospitals are participating in a mix of value-based reimbursement models combined with fee-for-service.1 For the foreseeable future, hospitals, health systems and other large provider organizations will have a foot in two boats and the engines in both must be able to run efficiently.

Fortunately, many of the capabilities required to succeed under risk and other value-based models can also benefit health systems under fee-for-service contracts. Undertakings such as improving patient access and quality, and achieving greater physician alignment boost the bottom line regardless of reimbursement type. After all, the overarching goal for providers in any setting should be to deliver quality care while controlling costs. Patients who are generally healthy

should receive essential screening tests. When patients fall ill they should receive appropriate, high quality care. And those with chronic illness should receive effective and coordinated help in managing their condition. No matter their payment mix, provider organizations success for the foreseeable future will hinge on their ability to effectively follow their patients and coordinate their experience across the entire continuum of care.

Thats easier said than done, of course.

Beyond big dataFor years the technologies did not exist to assist organizations looking to capture value from both fee-for-value and fee-for service contracts. Thats changed. A recent report by KLAS found that 69 vendors now offer population health management products and services for organizations taking on risk-bearing arrangements and other value-based reimbursement contracts.2 However, not all technological solutions are created equal. Many technology vendors have rushed to develop solutions that aggregate data from various care settings and then provide analytic reports. Some of these tools even use algorithms to identify people most likely to utilize services so that providers can (in theory, at least) intervene and minimize the heavy utilization of costly services by the sickest.

Figure 1. Revenue is shifting toward global payments

2011 2012 2013

ACO Formation by Type - 2011-2013

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

300

250

200

150

100

50

0

# o

f A

CO

s

Physician Group

Hosptital System

Insurer

Other

109

206

147

145

159

197 201

197

203

203

260

55

53333229

504946

156

353173

11 12

150

238

2011 2012 2013

Source: Leavitt Partners http:/healthaffairs.org/blog/2014/01/29/accountable-care-growth-in-2014-a-look-ahead/



Such analytical tools are not enough. They are a necessary but not sufficient element of a holistic population health management solution that can succeed under a variety of different reimbursement arrangements. A complete solution must not only aggregate data from disparate sources and provide analytics but ensure that insights are translated into action that drives results. Insight is useless without action. At the end of the day, its results that matter.

Population health management requires a huge amount of effort and work, operating at scale, to drive results: calling patients to get them in for care, pre-registering and pre-certifying them before their appointments, ensuring optimal scheduling and referral patterns among physicians, and so on. Therefore, executives and administrators should seek partners that integrate services with

technologyin short, partners able to deliver not just reports but measurable results. Working with these partners, health care organizations looking to succeed in the shifting reimbursement landscape should focus on four crucial tasks:

Identify and engage patients in need of care.

Align physicians and care teams.

Create seamless transitions in care.

Optimize revenue and efficiency.

This whitepaper will examine each of these tasks in detail.

Figure 2. Population health requires a holistic approach to the full cycle of care across critical steps

Optim

ize revenu

e and efficiency

Engage patients

Align physicians and ca

re team

sCrea

te se

amle

ss t

rans

itio

ns in

car

e

Identify gap in care

Provider refers patient to a specialist and schedules

appt

Insurance clearance,

referral-on-file, prior authorization, or pre-certification

completed

During patient visit,

provider views longitudinal

patient record

Clinical and financial results are tracked and

optimized

Reach out to patients

Patient schedules appointment

Specialist receives

secure message with link to

longitudinal patient record

Patient reminded of

appointment

Pre-register patient and

collect patient financial

responsibility

Source: athenahealth



1. Engage patient populationsHealth systems looking to optimize rewards from both value- and volume-based contracts must first ensure they have the technology to identify patients in need of routine care, such as physicals, mammograms, colonoscopies and other screenings. The importance of this patient stratification should not be overlooked: For health systems juggling multiple reimbursement contracts, full visibility into a patient base can concurrently improve population health and enhance revenue by driving the necessary care that increases responsible volume. Identifying patients in need of care enables improved outcomes and clinical quality and in turn drives financial performance whether your compensation is value-based or volume-based.

Health systems should also be able to identify patients who have received care from out-of-network providers so they can be offered appropriate care within network where it can be more closely coordinated. They should also be able to identify patients who have received care but arent yet attributed to a risk contract (so they can be added to prescribed lives of a population health contract)both are crucial for maximizing clinical outcomes and the value of risk-sharing reimbursements. More complicated stratification involves risk adjustment (the normalizing of costs and outcomes based on the number and severity of co-morbid conditions).

Why analytics isnt enough

Predictive analytics is in vogue as reports of IBMs Watson and other expensive systems garner press attention.3 These systems purport to predict high-cost episodes of care (such as hospitalization or re-admission) before they occur. While promising, true predictive analytics is in its infancy when it comes to identifying patients who do not heavily utilize services today but will in the future. And a basic truism holds for all analytical toolsthey are essentially worthless unless patients can be engaged and influenced. A recent spot-test of athenahealth clients, drawn from our analysis of providers on our cloud-based network found that 85 percent of eligible Medicare beneficiaries had not complied with free wellness visits. This represents a missed opportunity for preventive care and revenue. There are doubtless others in most health systems.

Perfecting patient engagement requires practice, expertise and trial and error over many repetitions. Too often, provider organizations build in-house capabilities, including expensive call centers and patient-access departments, when partnering with a technology-enabled service provider that has scale and expertise in patient engagement would be more cost effective.

Figure 3. Technology use is evolving Recent surveys from the Pew Research Center indicate that a majority of U.S. adults use technology to engage in their health care:

63%of adult cell

owners use their phones

to go online

Has doubled since 2009 34% mostly go online using

their cell phone 21% do most of their online

browsing using their mobile phoneand not some other device such as a desktop or laptop computer

69%of U.S. adults track a health indicator like

weight, diet, exercise routine or symptom

Half track in their heads One-third keep notes on paper One in five use technology

to keep tabs on their health status

35%of U.S. adults have

gone online to figure out a medical

condition

Of these, half followed up with a visit to a medical professional

39%of U.S. adults

provide care for a loved one

Up from 30% in 2010 Many navigate health care

with the help of technology

Source: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/



The patient will see you now

Patients are increasingly acting like true consumers, and demanding the convenience and value they experience in other areas of their lives. Winning their business requires catering to this shift. As an executive at a multistate health system recently said, succeeding at patient engagement means moving from an attitude of telling a patient the doctor will see you now to one of telling the doctor the patient will see you now.4

Succeeding at patient engagement means moving from an attitude of telling a patient the doctor will see you now to one of telling the doctor the patient will see you now.

The best practice for patient engagement is both high-tech and high-touch, a practical blend of technology and human interaction. Health care is an intensely personal experience, so communication with patients should be personalized, too. Whether email, text or voice, each contact with the patient should convey to the patient that the provider organization cares about them, and wants to see them receive the care they need. At the same time, a new generation of health care consumers (and even more senior consumers) have the expectation of self-service. Patients expect to schedule appointments the same way they can now reserve a table at their favorite restaurant through OpenTable, an online scheduling platform that shows availability and enables table reservations at eateries by time, cuisine or location. Patients should have a similar scheduling experience when booking medical appointments, tests, and treatments. Layered on such a service should be sophisticated nudge tactics designed by behavioral psychology experts to ensure that patients take action, eventually building a sense of goodwill and loyalty.

A smart scheduling approach:

Identify patients in need of outreach.

Contact them through various channels including email, text message and voice.

Offer immediate convenient, online scheduling.

Continuously improve outreach to best cater to certain demographics and patients with specific conditions.

A final, but important point: Identifying and activating patients in need of care can backfire unless providers are able to match provider and facility supply against the newly generated demand. A successful campaign to ensure eligible women are notified of their need for a

mammogram, for example, will not be effective if the women are unable to secure an appointment in a timely manner. Successful patient engagement requires that administrators can have insight into clinicians schedulesinsight that a vendor should be able to provide.

2. Align physicians and care teamsSuccess under multiple reimbursement models requires physicians to embrace a team mentalityany strategy launched by central administrators will fail unless the physician community embraces it. Physician alignmentthe ability of hospital executives to engage physicians and other clinicians in redesigning carecan be challenging, but boils down to three principle variables: economics, mindset, and convenience. Compensation is important, but it isnt everything. Physician governance can help ease the transition to accountable care. Providers must have a seat at the table and a voice in major decisions. Weve found that a council modelin which the CEO or other designated individual retains decision-making authority, but decisions are shared and discussed in fullto be a particularly successful model of shared governance.

Information technology has a role to play, too. In most health systems today, providers work in segregated information silos created by disparate health care IT systems that do not enable efficient communication. This increases providers feeling of disconnection from the overall health system and each othermaking physician alignment and loyalty harder to embed as the dominant organizational mindset. Physicians already face a great deal of administrative work, which makes it even more important to provide them with technology that not only assists them with existing tasks but also removes other, unnecessary work from their practices. No physician should have to chase down a peer due to poor or complicated communication tools, for example.

Effective communication is foundational to good teamwork. To embrace coordinated care, clinicians require systems that facilitate communication and collaboration. An integrated view of patient data across the continuum of care allows the care team to view information from disparate clinical systems without multiple logins. Providers should also be able to securely text message one another from their desktop or mobile device about specific patients. The software platform should also allow clinicians to set up messaging delegates so that lab or pharmacy staff, for example, can receive and send messages with providers as well.

Communicating across the entire care continuum

Increasingly, physicians need to communicate with a host of providers, facilities, and remote devices that may well be part of a different health system or practice. Retail clinics, nursing facilities, visiting palliative care providers, and family care-givers checking in from around the world are all part of a care continuum that is growing larger and more diverse thanks to increasing consumer demand for convenience and lower cost. In a recent survey by PricewaterhouseCoopers,



respondents were presented with a series of familiar medical tests and treatments, from strep throat diagnosis to administration of chemotherapy, in new settings closer to home and often enabled by technology. About half indicated they were likely to choose these alternatives over traditional care settings.5

While many vendors claim their software can communicate freely, cloud-based health information technology systems that connect providers through a single, shared instance of software are strong enablers of interoperability among a wide range of systems. This is because (1) the cloud provides access to secure data from any device, in any location, at any time via a modern web browser, (2) the cloud company can readily harmonize data from multiple sources (e.g., EHRs, practice management, payers and stand-alone HIE platforms) and (3) creating interfaces for participating providers is more cost-effective, since an electronic connection only needs to be built once from the cloud architecture to each trading partner. Cloud-based services enable a single source of truth for users on the network. Providers can remain on a legacy EHR while embracing the value of true integration with vendors, partners and others in the network.6

Most IT vendors are still firmly attached to their walled-garden business model. They are unable to prove their promised interoperability beyond their own systems. That is a huge impediment to gaining full transparency across the continuum of care, from the home to the provider to the hospital, and so on, a Texas-based CEO of a hospital system said.7

But while communication outside of the health system is increasingly becoming essential, providers must also have insight into referral

patterns to identify when patients are being sent by physicians out of network. athenahealths data from its network of clients suggests that as much as a third of specialty care at systems is referred out of network for no good clinical reason. As discussed above, understanding clinicians capacity and gaining transparency into their schedules and referral patterns will be essential to succeed under fee-for-service contracts while also driving the right patient care and utilization goals present in a fee-for-value environment.

Most IT vendors are still firmly attached to their walled-garden business model. They are unable to prove their promised interoperability beyond their own systems.

Physician scheduling has traditionally been a delicate subject as physicians are often highly protective of their schedules, but providers are often more willing to make concessions around scheduling if they understand clearly why doing so is in the interests of their patients. That is to say, physician alignment follows patient satisfaction. As T. Clifford Deveny, senior vice president for clinical integration for Colorado-based Catholic Health Initiatives recently explained, Physicians are trying to understand how they go from being just a commodity and become a value-added partner.8 athenahealth regularly hosts advisory panels with health care leaders and one of the recurring themes is that physician alignment improves when physicians see the satisfaction among their patients that comes from truly integrated and coordinated care. Build a world-class patient experience, and doctors will want to ensure their patients are part of it.

Figure 4. The failure rate for information exchange is unacceptably highInterface Measure Failure Rate

Physicians Laboratories Lab results available during physician visit 17%

PCPs Emergency Departments

Medical record and laboratory results available upon ED visit 33%

PCP informed of care delivered during ED visit 30%

PCPs Specialists

Specialist consultation report sent to PCP within four weeks of specialist visit 45%

Patient information sent to specialist upon referral 49%

PCPs Hospital Physicians

PCP provided with discharge plan and medications in recent hospital stay 50%

PCPs provided with discharge plan within one week of hospital discharge 80%PCP Primary Care Physician; NEJM New England Journal of Medicine Source: T. Bodenheimer, Coordinating Care A Perilous Journey through the Health Care System, NEJM.

5 Essentials for Surviving and Thriving as an Independent Practice


Case Study: Creating actionable patient data and care plans for better patient care at lower cost

Dr. Michael Cantor, Chief Medical Officer of New England Quality Care Alliance (NEQCA) in Braintree, Massachusetts, needed a tool that would assist his organization in delivering its vision of comprehensive, innovative, high quality and affordable care especially after signing a payer contract emphasizing cost, utilization, and quality metrics.

Cantors physician network is affiliated with Tufts Medical Center and has nearly 1,800 multi-specialty physicians with 460 practices throughout Massachusetts, caring for about 475,000 patients.

NEQCA initially hired an outside firm to build an internal population management tool. Patient data was stored in several locations and not easily accessible. It required several confusing steps to analyze complex data sets and population reports could only be generated manually. As the organization began to scale up, the amount of patient data turned out to be too volumunous for the care providers to use.

Thats when they turned to a cloud-based service that transformed population health data into a single, consolidated workflow for care teams, allowing providers and staff to monitor and manage patient populations more easily while ensuring quality care and quality-aligned revenue.

NEQCA now can analyze and seamlessly distribute patient information across its network, an impressive feat considering the use of more than 30 different EMR systems.

Patient populations needing certain carefor example breast cancer screeningsare identified by providers through the population health management tools and then contacted to schedule an appointment. Once that appointment has been completed, quality metrics are tracked in the system via the claims data.

NEQCA care managers drive improved patient outcomes using data to stratify and target those at highest risk.

NEQCA also more easily supports chronic care and disease management, understands cost, and utilization trends, which in turn allow the physicians to identify areas to improve the clinical integration of care, opportunities for utilization improvements, and maximize the networks pay-for-performance agreements.

That pro-active population management strategy has resulted in increased revenue and quality bonus funds earned.

In addition, the network worked with their health technology vendor to develop a care management module to continue to drive its care management programs in a coordinated way. Care plans, developed by care managers working with patients, are given to patients at the conclusion of their visits. The plans empower patients to become more independent and take control of chronic illness, such as diabetes, hypertension, or obesity. If we can take their goals and break them down into small steps it makes it really easy for patients, says Jeanne Kelly, one of NEQCAs nurse care managers.

The population health management tools help care managers support patients and communicate effectively with physicians and other care team members, Kelly says. Because of that, care providers, including Kelly, are freed up to devote more of their time and efforts to develop care plans for at-risk patients.

Using its population health management tools, NEQCA delivers a higher quality patient experience and higher quality patient outcomes, all at a lower cost.



3. Create seamless transitions in careEffective care coordinationand the satisfying patient experience it engendersrequires the removal of all barriers to effective patient care and follow up. It may sound simple, but achieving seamless transitions is a strategic challenge for many health systems and hospitals. All our strategic discussions at the moment are around care relationships and IT and how were going to connect people, connect physicians and use data, a CEO of an Alabama-based health system recently said.9 That sentiment is shared by many executives interviewed by athenahealth.

One key enabler of seamless care coordination is network-wide scheduling, whereby credentialed providers or their staff can see and directly schedule all outpatient and most inpatient appointments and tests while the patient is still in the care settingor when they leave the care setting through mobile-ready scheduling solutions. Referral management can also help ensure physicians open their schedulesphysicians are more likely to engage if they know their referrals are being managed effectively and the referral number is on file for every visit scheduled so they can be properly compensated.

Finally, physicians need to be kept apprised of all their in-network options and reminded that other in-network providers share quality and experience goals and can deliver coordinated care and a more streamlined patient experience.

The importance of financial guidance

Another, often-overlooked barrier to patients getting the care they need is that they are often uncertain of their payment responsibility before their visit. This uncertainty is a driver of cancellations and no-showswhich represents a major breakdown in continuity of care. Pre-visit services precertification, prior balance presentation, financial counseling and pre-registration of the financially cleared patientcan be extremely effective in ensuring that patients dont fall through the cracks. A recent study found that a third of patients dont know what they will owe out-of-pocket at the time of care.10 This phenomenon will only increase as high deductible plans become more prevalent, and more and more patients become de facto self-pay clients. Compared with copays (which almost never get written off) deductible dollars take more than four times as long to collect, and are far more likely to be written off.11 One industry analyst reports that in some facilities up to 50% of hospital bad debt is now with insured patients.12

A holistic solution should ensure that patients not only are briefed on their financial obligations but are pre-registered with prior authorization from payers. This will be key to avoiding leaving money on the tablesomething that no provider or health system can afford. A holistic IT solution should also include a patient portal that allows patients to view their own relevant and timely clinical and financial information from across the continuumand provide direct access to

patient representatives who can explain financial obligations in detail. A cloud-based service can ensure patients receive a complete financial picture by taking information from inpatient and outpatient remittances and delivering an integrated patient statement, reducing duplicative statements and patient confusion.

4. Optimize revenue and efficiency The transition from fee-for-service to capitation and other forms of risk presents enormous financial challenges to health systems. Reductions in utilization must be balanced against the need to preserve hospital revenue in a near zero-sum game. In community hospitals, for example, the American Hospital Association reports that 37 percent of available-bed-days are unused around the country at any given time, making further reductions in inpatient days challenging.13 Provider organizations in risk-bearing arrangements must follow a financially sound, step-wise program that begins with understanding utilizations and costs around all at-risk beneficiaries.14 The good news is that many organizations have substantial room for improvement. In a recent survey, only 12 percent of operational accountable care organizations and six percent of hospitals and physician groups sitting on the ACO sidelines believe they have the adequate combination of technology, outsourced services and consulting to be successful in the long term.15 Thats a challengebut its also an opportunity.

Administrators should seek out technology and services that can consolidate claims and clinical data into a single source of truth. With insight into the operations of the organization, managers can compare utilization and capacity against benchmarks and reduce waste and unneeded overhead, redeploying resources to higher-value areas of the operation or simply cutting costs. A utilization-management tool identifies where patients seek care, how much care they receive, and which areas of the health system are used most. This clinical analytics is critical to drive organizational change and enable success under any payment model.

Nearly every risk-based contract in the U.S. includes some set of quality goals. Meeting or exceeding these goals can lead to additional revenue, or in some case represent quality gates whereby providers failing to meet goals do not share in any cost savings as in the Medicare Shared Savings Program. It is essential for administrators and clinical leaders to monitor performance by provider, department, facility, or health system to applicable quality measures throughout the year, to ensure month-to-month progress against goals. Finally, a holistic technology solution should look at the full downstream financial consequences of every ordering decision made (or missed) and build new insight into medical-record ordering pages so that providers are always current, in the moment of care, with the best referral choiceincluding what to order, where to order it, and when to schedule it.



Three myths of population health

Myth #1: Population health issues wont affect my organization.Reality: The entire health care industry will be affected by population health through reimbursement models that reward better clinical outcomes at lower cost. The question is: how will you be prepared to thrive in the new environment, and do you have a holistic technology partner who can help you succeed under a mix of reimbursement models.

Myth #2: We can address population health by buying a software solution that gives us access to a large amount of patient data.

Reality: The most common perceived solution is to invest enormous capital into the purchase of a single, on-premises instance of softwareand then to force patients, doctors, and ancillary caregivers onto that platform. That strategy is proving financially and culturally disastrous for hospitals and health systems and their providers and patients. These negative outcomes will only worsen as the cost of debt for an enterprise software purchase rises and as the software itself slides into obsolescence. No matter how hard they try, hospitals and health systems wont be able to buy everyone, so choosing a system that provides easy and inexpensive interoperability with other providers will be a key to success. Whats more, insight without action is worse than useless; its a waste of money. A technology solution should take responsibility for delivering both insights and results.

Myth #3: Our current health information technology (HIT) can handle population health, with a few adjustments.

Reality: Transitioning to population health requires more than HIT. It will require a cultural shift in the health care industry to emphasizing prevention, patient engagement, care coordination, and health outcomes. Your organization must have a plan to drive revenue while providing coordinated, high quality care that includes interventions for certain groups. Most EHRs are not equipped to help do that.



The ACO option: Five steps to ACO successAn increasing number of providers who are looking to make population health management pay are considering forming ACOs. Success will demand that providers deliver quality care while controlling costs. These steps can help ensure your success:

1. Understand Your Costs

Understand your total medical expenditure and cost drivers across your population of patients under contract. Relying on payers to report costs and quality to providers is insufficient. Access to payer claims-based data is essential to understanding the total cost of care delivered by providers inside and outside the ACO, and to accurately attribute the costs of interventions to rendering providers.

2. Reduce Out-Migration from Your Network

Pay yourself, rather than a competitor, for care you can provide. While your system may not be able to provide everything to your beneficiaries, make every effort to reduce leakage of services you can perform. For example, establishing or increasing after-hours care can go a long way to reducing emergency room visits. Patient loyalty is key: The goal should be to become the best hospital for patient experience in your market area. Understanding where costs are high outside your network may reveal opportunities for new lines of business, or the establishment of new contractual relationships. Providing cost and quality transparency to providers in your network will help them make the best decisions for patient care.

3. Maximize Pay-for-Performance Reimbursement

Monitor your population directly against contracts and get every dollar available by closing gaps in care. Depending on the payer contract, pay-for-performance will be either upside (higher rewards for better care) or downside (declining or no reimbursement at the end of the contract year). Proper screening of and managing the primary health needs of a patient population saves money by keeping chronic diseases in check

and by helping patients avoid expensive hospital or emergency room visits. You should identify a vendor that can offer the tools and knowledge necessary for complete reporting, tracking and benchmarking of your financial and clinical performance. Youll need to know where youre doing well, and where you can improve.

4. Identify Early Opportunities for Utilization Reductions

Target reductions where there are clear opportu-nities for savings. Under new contracts, 30-day readmissions, the occurrence of never events in hospitals and the development of complications are increasingly uncompensated. Gaining control of and reducing these events is critical to reducing needless expenditures. It also makes sense to reduce durable medical equipment expense by utilizing low-er-cost suppliers. In situations where you must refer patients to out-of-network services, utilizing higher-quality, lower-cost providers is essential.

5. Support Chronic Care and Disease Management

Use cost savings from steps 1 through 4 above to fund disease-management programs. Once care management is implemented, it is essential to target patients with meaningful opportunities for cost reduction. For example, the vast majority of diabetic patients will not contribute to substantial costs, so diabetes programs should be targeted at patients who are heavy users of ED or hospital services. Conversely, costly programs aimed at patients in the pre-terminal stages of chronic illness are rarely successful at reducing costs. Many of these patients would be better served by appropri-ate referral to hospice care. Finally, keeping a high-touch, consumerist relationship with even your healthiest patients pays dividends in their loyalty and commitment to seeking care within your system when they do progress along a disease state.



A Patient-Centered ApproachWith health care costs under scrutiny, pressure is mounting in the U.S. to provide quality care while controlling costs. Health care organizations are looking for streamlined approaches to managing the health of their populations. To succeed, health care systems must build an approach that brings more patients in need of services into the health system, that keeps quality high, revenue strong, and that drives patient satisfaction. Leading organizations are learning that a seamless patient experience, happy providers, high-quality care and financial success all go hand-in-hand and are reinforcing.

While the industry demands a new class of software-enabled services to meet the new reimbursement realities, the market remains undifferentiated and filled with complicated, expensive software solutions. Most of these are unproven, require specialized teams to implement, and offer little more than analytics without any accountability for actions or results. Too often, big data or predictive analytics is pitched as the panacea for the challenge and an end-state unto itself. With little experience supporting providers in global capitation, vendors often receive 50% or more of the five-year cost of the software even before go-live, leaving clients to struggle on their own.

The truth is that the work to maximize value and clinical excellence in a complex reimbursement landscape is more than a single software solution or individual provider organization can solve alone. Effective population health management requires the marriage of data-driven insights and robust, scalable services. A holistic vendor offering should provide both. Health systems who choose software to install over comprehensive services aimed at outcomes will find themselves inundated with data without the ability to put that insight into action at sufficient scale. Cloud-based services are best positioned to ensure that, in all senses of the word, care can be connected.



Endnotes 1. The State of Value-Based Reimbursement and the Transition from

Volume to Value in 2014, McKesson Corporation, 2014).

2. KLAS Perception Report, Population Health 2014 Perception: Who Are Providers Betting on?, 2014.

3. See, for example, Doug Henschen, IBMs Watson Could Be Healthcare Game Changer, InformationWeek, February 11, 2013

4. athenahealth interview conducted on condition of anonymity

5. PWC Health Research Institute, Healthcares new entrants: Who will be the industrys Amazon.com?, April 2014.

6. For these reasons and more, KLAS recently ranked cloud-based athenahealth as the number one EMR vendor for overall contribution to interoperability success. Source: EMR Interoperability 2014: Where Are We on the Yellow Brick Road?, KLAS, October 2014.

7. athenahealth interview conducted on condition of anonymity. For more detail into interoperability issues involving IT vendors, see Julie Creswell, Doctors Find Barriers to Sharing Digital Medical Records, The New York Times, September 30, 2014.

8. Michael Zeis, How the Dynamics of Physician Alignment Are Changing, Media Health Leaders, September 13, 2013

9. athenahealth interview conducted on condition of anonymity

10. InstaMed, Trends in Healthcare Payments Annual Report 2011

11. Kim Lafontana and Kim Williams, Practice Management Lab: Finding Success with Self Pay, Physicians Practice, July 15 2006.

12. athenahealth interview with strategy consultant, conducted on condition of anonymity

13. Figure derived from Table 2.2 and Table 3.1 of the AHA Chartbook, 2013.

14. As discussed above, the most meaningful initial opportunity for health systems is to understand which patients and providers are utilizing out-of-network services. While direct control of referrals is the province of the clinician, administrators and other executives should identity and improve access to service lines.

15. PrWeb, Value-based Financial Services and Software Investments Advancing Maturation for Large Accountable Care Organizations; Small ACOs Lag Far Behind, Finds Black Book Survey, July 24, 2014.

Notes



we connect careA leading provider of cloud-based services and mobile tools for medical groups and health systems. Our mission is to be the most trusted service

to health care providers, helping them do well by doing the right thing.

2014 athenahealth, Inc. All rights reserved.

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Winning Across the Continuum: Partnering for Population Health in a Time of Shifting Reimbursements