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BMA ALLY BLOG: Deploying Value Based Care Contracts Under the Umbrella of Population Health Management: A Must for Success

The following article was published by the Better Medicare Alliance and was authored by Rose Maljanian, Chairman & CEO HealthCAWS Chairman of the Board at the Population Health Alliance. PHA is an active member of BMA’s Ally Network, and the original posting can be found here.

Join us in Washington, DC on October 29th for PHA’s Innovation Summit and Capitol Caucus to hear directly from both Rose and BMA’s President and CEO Congresswoman Allyson Y. Schwartz as they take a deeper dive into the innovations in population health management for senior populations. Register today and use promotional code BMA20 for a special 20% discount off registration.

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August 14, 2019
Rose Maljanian, Chairman & CEO HealthCAWS
Population Health Alliance

The evolution of our nation’s healthcare system and ecosystem from fee for service to value based care has only just begun, and while the goal is to rapidly accelerate the membership under value based care payments, it will be a long journey to refine the model. Legislation, market driven mergers and disruptive innovation from industry veterans inside and outside of healthcare focused on the consumer are contributing to what at times feels like a roller coaster ride. At the center of all of this is the growing population of seniors who largely receive their health benefits from the government, either directly or indirectly, through managed Medicare, Medicaid or Dual-eligible programs. Seniors as customers want and demand choice, convenience and value as consumers do in other markets and industries. The focus on these three elements is fundamental to any business strategy. However, necessary but distracting details, including type of legal entity, payment rates, payment flow, shared savings methodology and disbursements can completely envelop the airtime in leadership meetings. Alternatively, framing value-based care under the umbrella of population health management supports a focus on seniors’ needs and wants and the strategies that result in affordably achieving optimal health for these populations.

Understanding payment models as financial lever of alignment

Value-based care payment models have been aggressively advanced by CMS and commercial payers over the last several years. CMS’s stated purpose is to transform the health care system through innovation by paying providers for quality versus quantity of services delivered. Whether the program is a CMS program such as Advanced Payment Models (APMs), Merit-based-Incentive Payment System (MIPS) or a value-based contract as part of a commercial payer network, the payment method is simply put, the financial lever to align the care provided with outcomes-quality, experience and cost of care savings.

Virtually all value-based care models promoted or reporting positive results deployed the key elements of the population health management model to achieve success. Under current CMS value-based payment models1 and those proposed for 2020 and beyond2, quality improvement strategies and population health metrics such a readmission rates are prescribed with advancing flexibility to reduce burden and achieve desired value.

In terms of results, Humana reported significant improvements in numerous quality metrics and 23.4% fewer inpatient hospitalizations and 15.6% fewer emergency room visits under value-based care arrangements in Medicare Advantage members. In their report3, they attribute the improvements to population health management infrastructure and strategies such as proactive outreach and whole person management. Aetna similarly cited tools, infrastructure and approaches common to population health management as important to the success of their accountable care organizations. With Banner Health for example their Aetna Whole HealthSM program achieved 24 percent decrease in avoidable surgery admissions, a 4 percent increase in generic prescribing, and a 11.5 percent overall reduction in medical costs.4

In order for the end result to be a value-based contract that produces a positive net income versus one that adversely effects the organization financially, a solid population health management strategy must be deployed, tightly managed and iterated as populations and market conditions evolve. Furthermore, without a positive consumer experience and health outcomes, retention of patients/members in a practice or plan is likely to suffer, further eroding the chance of success.

Staying true to the principles of population health management (PHM)

There are three enduring components of the population health management model:1) defining and understanding the population for which the organization holds accountability; 2) a portfolio of evidence based solutions that can be tailored to individual need at any given point in time and 3) measureable outcome results. The Population Health Alliance outlined a value focused framework for Population Health Management more than ten years ago that included these elements with consumers at the center.5

Defining the population up front (assigned vs attributed) allows organizations to understand their populations, stratify risk and preference for engaging so that when crafting and triaging individuals to programs and tools, the programs and tools are those that consumers want and need.

Programs and tools must be available to address the full continuum of care whether to maintain health, address an acute event, support chronic care management or support comfort at end of life. Furthermore, solutions must include a multifaceted approach depending on where an individual is on the care continuum, their life goals and their preferred means of engaging. Studies by the PEW Research Center have demonstrated consistent increasing uptake in technology for seniors6,7 including 53% owning a smart phone and 59% having broadband access.7 Addressing barriers such as trust, cost and tech support will likely fuel further adoption among all income and educational levels. In recognition of this trend, many organizations are deploying blended high touch and high tech strategies in their senior health programs.

Finally, a focus on the endgame of outcomes across populations will ensure success with multiple value based contracts. The population health management model has always had a focus on outcomes that include clinical, utilization, satisfaction and experience of care and cost metrics. When staff deploy consistently high quality evidence based care that achieves consumer goals, the likelihood of missing mutually agreed-to standard metrics in a value based arrangement as a result of inconsistent care, lack of consumer engagement or gaps from confusion when doing different things for different populations is bound to decrease.

Executing well on solutions that solve needs and preferences

The need to execute well in a world of high visibility of alternatives for care, experience ratings and mounting pressure on cost transparency cannot be overemphasized. Executing well no longer means getting ID cards and EOBs out on time and finding an opening for the consumer in the same week to be seen by a PCP or specialist. It will command listening to what consumers desire to achieve, such as return to playing tennis, being able enough for air travel, controlling their diabetes versus diabetes consuming their life with too many appointments and tests, reducing days not feeling well enough to enjoy getting out and living life or just living long enough to see a marriage or birth. Furthermore, living life involves conserving seniors’ financial resources as well through optimized care, lower total cost of medications and value-added supplemental benefits such as concierge services and care management, home modifications, light housekeeping, transportation and nutrition support. Scan Health Plan recently announced expanded benefits for seniors to age in place at home. This followed a market survey confirming the trend in which 88% of their addressable market in Southern California expressed a desire to stay in their homes.8

As leaders, promoting common understanding of what it means to deliver value and how to get there

As leaders we need to guide the discussion on value amongst our colleagues, all payers and the public at large. Value based care is not about the contract itself. The contract is a financial lever under the umbrella of population health management. it is about delivering value (quality and affordability) to each healthcare consumer, the payer customer, and keeping those that bear risk whole and flourishing as they serve at the front line of healthcare transformation.


  1. CMS Value based care programs https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/value-based-programs.html updated 5.17.2019.
  2. CMS QPP Resource Center https://qpp.cms.gov/about/resource-library updated 7.29.19.
  3. The Intersection of Heath + Care: Value Based Care Report 2018. http://valuebasedcare.humana.com/wp-content/uploads/2019/04/2018-VBC-Report.pdf
  4. Accountable care organizations: Transforming care delivery to support members, increase cost savings https://news.aetna.com/2018/02/accountable-care-organizations-transforming-care-delivery-support-members-increase-cost-savings/ February 12 2018
  5. Population Health Alliance Population Health Management model https://populationhealthalliance.org/research/understanding-population-health/
  6. Anderson M and Perrin A. Tech use climbs among seniors. Pew Research Center May 17, 2017 https://www.pewinternet.org/2017/05/17/technology-use-among-seniors/
  7. Anderson M. Mobile Technology and Home Broadband 2019 Pew Research Center June 13, 2019 https://www.pewinternet.org/2019/06/13/mobile-technology-and-home-broadband-2019/
  8. SCAN Health Plan Addresses Seniors’ Desire to Remain at Home With Expanded Benefits, Reduced Costs Nov 14, 2018, https://www.prnewswire.com/news-releases/scan-health-plan-addresses-seniors-desire-to-remain-at-home-with-expanded-benefits-reduced-costs-300750108.html
0 comments on “HealthEC Joins Population Health Alliance”

HealthEC Joins Population Health Alliance

Washington, DC, August 01, 2019 — Population Health Alliance (PHA), the health care industry’s only multi-stakeholder professional and trade association solely focused on population health, today announced that HealthEC (HealthEC.com) has joined the organization as a member.

A 2019 Best in KLAS provider of population health management technologies, HealthEC helps customers succeed with value-based care by offering a flexible, single-platform solution that aggregates clinical, claims and quality data, and provides actionable insights that can improve health care outcomes. KLAS recognition is important to population health technology providers because it is a third-party validation of service quality and acknowledges provider efforts to help health care professionals deliver better patient care.

“We are pleased to welcome HealthEC as a member of the Population Health Alliance. We were impressed with their KLAS ranking as well as the tremendous leadership that President and CEO Arthur Kapoor provides to the industry at this important juncture for digital transformation,” said Rose Maljanian Chairman and CEO of HealthCAWS and Chairman of the Board for the Population Health Alliance. “We look forward to Arthur and his executive team participating in important PHA initiatives including policy and advocacy, quality and research, and uniting the population health community through membership, learning and networking events,” added Maljanian.

“Advancing population health and value-based care is a top priority for HealthEC and we are pleased to align with an organization dedicated to these objectives,” said Kapoor. “The Population Health Alliance plays an important role in our evolving industry and we invite our fellow population health solution providers to join us at PHA.”

PHA represents stakeholders from across the health care ecosystem that seek to improve health outcomes, optimize medical and administrative spend, and drive affordability.

Population Health Alliance
Brent Ling

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PHA Announces 2019 Innovation Summit and Capitol Caucus in Washington, DC

Improving Health Through Financial Security: The Common Denominator Across Social Determinants and Populations

Washington, DC — The Population Health Alliance (PHA) announced today that their annual Innovation Summit and Capitol Caucus will be held on October 29, 2019 in Washington, D.C. This year’s theme, “Improving Health Through Financial Security: The Common Denominator Across Social Determinants and Populations” will give the much needed focus to the latest risk-analyses, innovative intervention efforts, and targeted health and cost outcomes achieved, presented by our group of national experts; including:

Congresswoman Allyson Y. Schwartz, MSW – President and CEO, Better Medicare Alliance
Peter Skillern – Executive Director, Reinvestment Partners
Patricia Hasson – President and Executive Director, CLARIFI
David Hoke – Sr. Director, Associate Health and Well-being, Walmart
Ralph Gildehaus, JD – Senior Program Director, MDC Inc.
Laura Samuel, PhD CRNP – Assistant Professor, Johns Hopkins School of Nursing
Mike Criteli, JD – Retired CEO from Pitney Bowes, Entrepreneur, Health Care Consultant, Feature Film Producer, Speaker

The Population Health Alliance Innovation Summit & Capitol Caucus 2019 will gather key stakeholders from across the health care industry and D.C. area policymakers committed to driving innovation in care management, wellness, and prevention for focused briefings on high-impact legislative and regulatory issues. PHA members will focus the critical discussion on social determinants of health on the heels of the release of the Quality and Research Committee’s eBook, “Social Determinants of Health and Health Disparities,” and will have substantial opportunity to network with the event speakers, PHA Board of Directors, and a diverse group of industry leaders and policy decision makers.

“The theme of our Innovation Summit this year could not be more timely as the industry has been awoken by the evidence linking financial security and other nonclinical factors to health and cost outcomes. The issue is cross cutting amongst employees, seniors and others participating in government sponsored programs. PHA members and constituents are leading action with innovative solutions to solve this important problem.” Rose Maljanian Population Health Alliance, Chairman of the Board.

Join us at the Population Health Alliance 2019 Innovation Summit and Capitol Caucus to engage in in-depth conversations about pressing population health challenges and solutions. To register for the Innovation Summit and Capitol Caucus 2019, visit https://www.eventbrite.com/e/pha-innovation-summit-and-capitol-caucus-2019-tickets-62271226916.

Not a PHA member? Join PHA Today!

About Population Health Alliance:
Population Health Alliance (PHA), a corporate 501(c)6 nonprofit organization, is the industry’s only multi-stakeholder professional and trade association solely focused on population health management, representing stakeholders from across the health care ecosystem that seek to improve health outcomes, optimize the consumer and provider experience and drive affordability.

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Population Health Management –Toward a Life Centric Model with Consumer as Co-Creator of Value

Rose Maljanian Chairman & CEO HealthCAWS and Chairman of the Board Population Health Alliance

Population Health Management strategies continue to gain recognition as must haves versus nice to haves in order to survive and thrive in a value based health care environment. The mainstay component parts of upfront analytics, targeted and individually tailored interventions and outcomes1 continue to evolve as new science and technology becomes available. Each member of the healthcare ecosystem has an important contribution and is poised to be appropriately compensated based on the value that they contribute.

Forward thinking health systems, ACOs and new entrants to the health care space continue to push the boundaries on moving care and support services out of the traditional hospital environment where possible into the community where life happens. Like time spent with an accountant filing taxes or a day in the garage getting a car fixed, as an industry we have come to accept that most always a good day for a consumer does not include a trip to the emergency room, hospital, laboratory, or doctor’s office but rather optimizing time spent doing what they like to do, feeling as good as they possibly can.

Furthermore, consumer engagement and experience has taken center stage as consumers publically rate providers, facilities and health plans and more easily can take their business elsewhere if their needs are not being met. In addition, the shift to value based payments has aligned incentives for providers to more proactively and effectively engage their consumer patients in their care, leveraging extender digital tools and care team members to take their reach beyond the visit time and beyond the walls of the healthcare environment.

A finer point on the need to engage consumers was made by Alan Weil in his 2016 Health Affairs editorial entitled the Patient Engagement Imperative when he stated- “There is recognition that the patient is co-producer of the outcomes for which the physician is now being held accountable”. Translated to all stakeholders – the patient, the member, the consumer, the community resident is co-value creator and not only is the physician held accountable but the hospital, the health plan, the employer, the business associate partners all have performance targets to meet related to their roles in optimizing health, cost efficency and the consumer experience.

As I said to a recent audience of thought leaders gathered to share innovations in population health-“think about this quote- no matter how great you are; no matter how great your programs are; you cannot produce the desired outcomes without the consumer”. 3

If all stakeholders come together around this Life Centric model and partner with consumers as co-creators of value to them and the system overall, we will see movement from a costly, mediocre quality and full of hassle system to one recognized for being a high value, desirable when needed solution, that enhances versus disrupts life.