Population Health Management Vendor Selection

As more and more organizations embrace population health management as a strategy to succeed in the emerging new paradigm of value-based payment, many are facing the next big question, “What tools do I need to support population health?” They are turning to population health management software solutions to fill these needs, but picking the right one(s) can be a big challenge.

There are currently over 100 population health management vendors. Some have had decades of experience in managing populations. Others are very recent entries, hoping to ride the tidal wave of interest. The current market is immature and highly-evolving and as of yet no clear vendor/product market leader is emerging. Part of the reason for that is that the market is still trying to define population health management. What it takes to manage an Accountable Care Organization (ACO) is still unclear. Most population health management vendors have entered and continue to have strengths primarily either on the analytics side or on the care management side. Few do both well. Few vendors have a multitude of existing clients.

Here are some steps you can take to select the vendor that is the right fit for your organization

• Identify key stakeholders. Who are the key people in your organization that need to inform the decision? Do your executives know what is needed or do you really need to reach down to the next layers of your organization to those that know what happens on the front lines? Put together a vendor evaluation team.
• Develop an understanding of key population health requirements. Now that you’ve selected your team, educate the team regarding the tools necessary for success in population health management. These include:
  • EHR – While you should not expect your population health management software to also be your EHR, it is worth taking the time during this educational phase to discuss some of the key capabilities of the EHR that are foundational to population health management like having a common or interoperable EHR across the continuum of care, e-prescribe and formulary support. If your organization has already implemented an enterprise EHR solution, it is a good idea to explore whether your EHR vendor offers population health management solutions that you can take advantage of as well.
  • Data Management/Exchange – The ability to aggregate data, including both claims data and various forms of clinical data is critical to being able to manage populations.
  • Registries – Registries will be the key tools you will use to identify patients at risk based on disease processes or other criteria, and identify care gaps. Ideally care managers should be able to place orders and communicate with patients directly from the registry.
  • Care Management Tools – Care management tools like longitudinal care plans, documentation and communications tools, work queues, and discharge planning applications are essential.
  • Patient Engagement Tools – No attempt at population health management can be successful without the ability to engage patients. Key tools for patient engagement include patient portals for secure messaging, patient scheduling, refill requests, patient education and health maintenance reminders. The ability to integrate virtual visits and tele-monitoring as well as mobile health applications is emerging as a requirement as well. Another key functionality for your organization will be the ability to manage referrals and track system leakage.
  • Clinical Decision Support – Identifying patients at high or moderate risk won’t mean much unless you can identify best practices for treating those patients to improve outcomes and drive compliance with those practices at the point of care. Functionality like health maintenance reminders, care pathways, best practice alerts, drug/drug and drug/allergy check all help to support clinical best practices.
  • Analytics – Sometimes known as “Business Intelligence analytics is critical to your population health management program. Analytics software gives you the ability to analyze and segment populations, understand sub-populations and design target services for those sub-populations. Using predictive modeling your organization can predict those patients more at risk of readmission, sepsis, or high resource use.
  • Reporting – Along with analytics you will also require considerable reporting, for instance to report longitudinal utilization, total cost of care and quality performance measures.
• Develop an organizational specific population health management definition. Nationally the definition of population health management is widely variable and there is no generally accepted definition. Every organization has different needs based on the specifics of patient population and payor arrangements. Developing your own definition of population health management is the first step in establishing an organizational vision for population health.
• Develop a strategic vision for population health management in your organization. Begin by asking the following questions:
  • What do we want to do?
  • For what population(s)?
  • In what time frame?
  • Where?
  • What functionality do we need to do this?
  • Do we need partners? If so, who? To do what?
  • Do we need new roles? If so, what are they?
  • What percentage of value-based payment do you anticipate in 3-5 years? (ACO, Bundled Payments, Risk-based Contracts)

• Evaluate the current state of your organization. Do an inventory to determine what functionality you already have in place.
• Perform a gap analysis. Identify your gaps. These are the functionalities you need to focus on when evaluating population health management vendors.
• Develop a vendor “scorecard.” Base the scorecard on the vendor’s ability to perform each functional area identified, and prioritize or weight the scoring based on organizational needs.
• Evaluate four to six vendors. Do your research to find vendors that have the functionality likely to meet your organization’s needs. Independent research organizations like KLAS and Chilmark publish research on population health vendors regularly and are a good starting place. From this research narrow the field to four to six vendors and request information and demonstrations from the vendors. Give the vendors a script of what you desire to be demonstrated so that the stakeholders attending vendor demonstrations can score the vendors and be able to appropriately compare them. Don’t forget to assess not only their functionality but also how they are doing in the market. Who are their key clients and who have they sold to recently? How many clients do they have? What has their growth rate been over the past few years?

By the end of the vendor demonstration process your organization will likely have narrowed the contenders to just one or two that are most likely to meet the needs of the organization. The final decision can then be made based on other factors such as cost and time to value (implementation time and time required to affect positive change in outcomes).

The population health vendor selection process can be daunting, but with a well thought out approach you’ll be able to “hang ten” to ride the population health wave.

This content originally appeared in For the Record magazine. You can view the article here and for more information on Population Health consulting services, click here.