I recently had the opportunity to attend the second half of the Advisory Board’s two-day national meeting in Seattle where the presentations went deeper on the central theme of how health systems must adapt to the shift in how they are paid. These systems face four imperatives necessary for success in the new world—competitive unit prices, total-cost control, geographic reach and clinical scope, and clinical and service quality. These are the attributes necessary for providers to succeed by, as noted in David Lee’s blog, winning at two distinct points-of-sale:

1) They must be the network chosen in risk-based agreements with payers and employers

2) They must be chosen by patients who need healthcare services

One requirement to winning the first point is assembling a low-cost, high-quality network. Recruiting the appropriate providers is dependent on the evaluation of clinical performance data, e.g. mortality rate, complication rate and readmission rate, making sure that providers included in the network can deliver the high-quality care expected by payers and employers. Other factors for evaluation include their per-capita cost of care, efficiency of care utilization and care experience—helping to make sure that the providers included also can deliver low-cost care.

Assembling the appropriate network is also critical to building the geographic reach and clinical scope to provide healthcare access that meets the demands of patients. In addition to competing on price (driven by increased price transparency) and convenience (offering services that meet diverse patient demands), health systems can differentiate themselves from their competitors by offering enhanced management. Increasingly, employers are purchasing health management solutions for their workforce, and patients are opting for direct primary care and concierge services. Successful networks need providers who can deliver services such as preventive screening, disease treatment and lifestyle management.

Once assembled, it is important to continuously monitor and manage the network. Quality analytics are required to identify gaps in care or measures and surface them to providers so the gaps can be closed. Performance analytics are necessary to measure the behavior of providers and evaluate patterns of activity for areas of improvement. Utilization analytics are needed to monitor network leakage and promote appropriate steerage—driving patients to seek care within the network of low-cost, high-quality providers.

The Advisory Board meeting provided a good perspective on the state of the industry leading in to HIMSS15. Caradigm will be hosting several panel discussions in our booth (#7307) that will feature industry experts as well as the sharing of third-party survey research related to population health, ACO best practices, DSRIP and Data Privacy and Security. You can check out the full schedule of Caradigm events at HIMSS here.