A Business Model for Our Time

Population health management (PHM) is a broad term that will generate untold millions in consulting fees in the years to come, but if you add “business model” to the back of the term, we start to get closer to how health care will make the transition from transaction to value. Inevitably, this appears to involve capitation and risk assumption. That's why Health CXO's case study on CareMore's Medicare Advantage plans makes compelling reading. Leveraging community-based clinics, predictive modeling software, and allied health professionals, the plans are targeting the frail elderly with what appear to be excellent results. What exactly is the state of the health of your community? If you are a non-profit hospital or health system, ACA requires your organization to conduct a Community Health Needs Assessment (CHNA) every three years. The temptation is to dismiss the CHNA as yet another burdensome regulatory hoop, but Community Hospital Consulting says the discipline presents an opportunity to refocus mission, something every health care provider should do periodically. Finally, many non-profit hospitals have been engaged in population health management for many years in the form of providing populations without access to federal safety net programs with indigent care. CIO and former HIMSS board chair Charles Christian provides a much-needed common sense approach to the complexities of sharing information across disparate entities as we move into the era of population health management. Risk assumption is risky business. Let me know how your organization is approaching the challenge and what you need from other stakeholders to succeed. I promise to share your thoughts in the next issue of Health CXO. Cheryl Proval cproval@healthcxo.com