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What You Need to Know About Population Health

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Population health improves treatment outcomes among specific patient groups in the community by promoting better treatment outcomes and lower costs associated with delivering services. In the past, there has been a disconnect between technology and clinical practice. This circumstance has made it a challenge to coordinate medical services and resulted in suboptimal treatment outcomes. Alternatively, population health management helps care provider organizations overcome these barriers by improving patient satisfaction and reducing medical costs.

Promoting Population Health with Value-Based Purchasing

To encourage the shift toward service quality, the Centers for Medicare and Medicaid Services has launched four initial value-based programs: Hospital Value-Based Purchasing (HVBP), Value Modifier (VM) Program or Physician Value-Based Modifier (PVBM), Hospital Acquired Conditions (HAC) Program, and the Hospital Readmission Reduction (HRR) Program. [1] The models are part of the CMS’s larger strategy to improve the quality of medical services delivered to program participants. A few other similar value-based payment models are the End Stage Renal Disease (ESRD) Quality Initiative Program, Skilled Nursing Facility Value Based Program (SNFVBP), and Home Health Value Based Program (HHVBP). The purpose of payment models such as these, are to form a correlation between service quality and provider reimbursements. In unison, these programs work to promote improved quality of service and population health.

A New Fee Schedule for Hospitals

The integration of behavioral health treatment into mainstream practice has posed a challenge for care providers for some time. As a result, the CMS has introduced a new collaborative care model along with the addition of the four behavioral health reimbursement codes will assist providers in making great improvements in the wellness of the population in the United States. The agency has confidence that facilitating the treatment of physical and behavioral conditions in the primary care setting will greatly enhance the overall well-being of patients.

To facilitate the integration of behavioral health treatment into primary care, the agency finalized the Physician Fee Schedule in late 2016. [2] The change reflects the agency’s emphasis on promoting better management of treatments and improved integration of behavioral health services into the primary care environment in the United States. The CMS believes that this value-based reimbursement will improve care across the continuum of services, reduce financial expenses, and result in a healthier population.

The Transition to Value-Based Care

Value-based care rewards providers for working together to coordinate treatments, administer the correct services, and improve overall population health. As time goes on, insurers will continue to base care provider reimbursements more on treatment quality than quantity.

The positive outcomes that have resulted due to value-based programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last seventy-five years. Soon, valued-based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.

Population Health versus Public Health

Public health encompasses a much wider scope of interest. [3] While population health and patient health fall in similar realms, it’s important to understand that there are subtle differences between the two terms:

• Population health encompasses the condition of a specific group of individuals such as those who live in a specific city, county, or state.

• The discipline involves a focus on the treatment outcomes of individuals within one of these specific groups.

• Population health researchers evaluate how differences in income, education, and medical talent affect the well-being of a specific group of individuals.

Individual citizens might experience the influence of public health research through initiatives designed to improve personal habits such as hygiene and diet. However, local care providers and health agencies might establish such initiatives in recognition of a threat that affects the entire population of the United States. Many times, such efforts are mandated by legislators to protect public health.

When communicating with peers, it’s important that current and future health care administrators use the terms population health and public health in the proper context. Additionally, medical professionals must understand how the outcomes of individual treatments affect population health. Armed with this knowledge, future care providers can contribute to the well-being of the population one patient at a time.

Learn More

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Recommended Readings

Telemedicine: An Emerging Medical Advancement 4 Challenges Facing the Health Care Industry
Improving Patient Care through Clinical Integration
Improving Patient Safety


[1] Centers for Medicare and Medicaid Services
[2] Becker’s Hospital Review
[3] Advanced Data Systems Corporation