Interest in population health isn't translating into action

Health care providers in the United States made little progress in 2019 toward greater population health even as health care costs continue to rise, a trend which may reverse in the wake of the novel coronavirus pandemic, according to the authors of a new study.

The 2020 Numeroff & Associates State of Population Health report, which surveyed around 500 C-suite health care executives between June and September 2019, found that the U.S. has made little progress toward meaningful implementation of population health.

More specifically, the study’s authors link population health to the adoption of risk-based health care contracts, that is, linking reimbursement to management of cost and quality. According to the report, the median percentage of revenue deriving from such contracts was 10% in 2019.

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Other forms of population health — such as utilizing inpatient care navigators and referring patients to community organizations like food pantries and prescription assistance programs — have seen increased use among health care providers. But just a quarter of respondents said that they utilize these programs regularly.

“It’s quite shocking to see that as hospitals and health systems continue to acquire independent physicians, they’re doing so without the processes in place to effectively manage physician cost and quality,” said Michael Abrams, managing partner of Numerof & Associates. “There’s been very little movement on creating care paths, flagging variation using order entry systems, equipping physicians with data, and tying physician payment to outcomes since our first survey in 2015, which points to a hugely overlooked opportunity to add value.”

Despite the lack of progress, there has been a general hunger for more movement toward population health and risk-based outcomes: 83% of respondents said that population health would be “very” or “critically” important going forward. Around 99% of the health care executives project their organization will have some revenue in models with upside gain and/or downside risk in two years.

But past studies have shown that willingness has often not translated into action. Two years ago, respondents predicted that median risk-based contract revenue would be triple what it was last year.

And by failing to link cost to quality, the health population suffers — especially in the era of COVID-19, the authors add.

“Fee-for-service reimbursement reinforces an approach that is fragmented, provider- rather than patient-centric, that has ignored social determinants of health, and that overutilizes and under-delivers as a result,” the study’s authors wrote. “This has created reservoirs of vulnerable subpopulations among the larger society, and we are all paying a price for that.”