The document discusses predictions for trends in healthcare and population health management in 2015. It predicts that health insurers and providers will take different approaches to risk-based contracting, including some fully embracing value-based payment while others take a more tactical approach. It also predicts that evaluation of patient population risk will shift from being actuarially driven to clinically driven. Additionally, healthcare networks will look to expand their coverage by partnering with outside hospitals and physicians to close coverage gaps.

1. ―Dr. David A. Burton

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Predictions Against the Unknowns
Predicting healthcare and
population health management
trends is somewhat difficult due
to the unknown variables.
How the Supreme Court rules
on the Affordable Care Act (ACA),
could have major impact.
Can the Republican-controlled Congress find sufficient
override-veto support from their Democratic counterparts?
Here’s what I predict we’ll see happen in healthcare in
2015 in terms of the building blocks of population health
and other factors.

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2015 Predictions:
At-Risk Contracting
Health insurers and delivery systems seem to be falling into
three camps for at-risk contracting:
Those who embrace
the concept of value-
based payment and
are fully committed to
making a transition
from fee-for-volume to
value-based payment.
Strategic Thinkers
This group is smaller
than the first group.
They are taking a
tactical, defensive
approach to value-
based payment, only
dabbling in it.
Bet Hedgers
Those in denial with
their heads in the
sand, doing only the
necessary to avoid
penalties imposed by
the federal or state
governments.
Ostriches

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2015 Predictions:
Population Risk Evaluation
Payers and providers embrace
“shared risk” with little analytic ability
to predict outcomes.
Critical success factors include
better analytics infrastructure,
transparency and trust.
Underwriting will begin to shift from
actuarially driven to clinically driven.

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2015 Predictions:
Population Risk Evaluation
Clinically driven services seek to
reflect the cost of clinically relevant
underwriting buckets so the delivery
system is taking risk for buckets of
cost around which it can organize
clinical improvement projects.
Insurers are much better equipped
and have more experience
managing financial risk.
Providers are much better equipped
to manage utilization of services.

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2015 Predictions:
Population Risk Evaluation
Payer, providers and analytics
vendors can team up to construct
better risk models to which both
payer and provider can relate.
Forward-thinking providers will look
at changing risk parameters before
inpatient care becomes necessary
and treat first in clinic.
Some “super high risk” patients can
shift to hospice care rather than
taking a tour-de-force approach.

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2015 Predictions:
Network Optimization
Sponsors feeling the cost patients
going outside their network of
hospitals and clinicians will begin to
look for gaps in coverage.
Strategies will evolve to augment
their owned network of providers
with non-owned, affiliated hospital
facilities and/or physicians.
These expansions will bring issues
related to data integration from
disparate EMRs and networks.

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2015 Predictions:
Network Optimization
In the coming year some shared
accountability sponsors will begin
to grow weary of bearing all the
risk and will look to participating
physicians and clinicians to share
more of the risk burden.
To establish trust in these new
partnerships we must fix data
quality issues rather than pay lip
service to the problem.

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2015 Predictions:
Quality and Safety
We will continue to make progress
in measuring and improving
clinical effectiveness and safety.
The availability of flexible analytic
software will increase, as will
evidence-based best practice
starter sets, which can jump start
clinician engagement.
Patient injury prevention will begin
to shift from incident reporting to
regarding it as a process failure.

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2015 Predictions:
Cost Reduction
Driven by the need to improve cost
structure in order to be financially
viable under at-risk contracts,
organizations will begin to focus
on three waste variables:
1. Ordering waste
2. Workflow waste
3. Defect waste
Providers will begin using analytic
tools used to wring out undesirable
variations in all three waste areas.

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2015 Predictions:
Infrastructure
As healthcare systems get further
and further into improvement
initiatives during the coming year,
they will discover these new
requirements will demand a robust
electronic infrastructure to provide
the analytics and information
needed to manage such a
complex system and deal with the
ever-changing landscape and
complexity of patient care.

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Summary and Conclusion
Times of turbulence and change
are times of opportunity and
2015 appears to me to provide
great opportunity for those who
are prudently adventurous.
It is a great time to be working in
healthcare as the shift from
volume-based to value-based
care takes place.
The future belongs to those who
can think outside the old box.

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More about this topic
Population Health Management: Implementing a Strategy for Success
Dr. David A. Burton, Sr. Vice President
What Is Population Health and How Does It Compare to Public Health?
Leslie Falk, RN, MBA, PMP, Vice President
The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement
Bobbi Brown, Vice President Finance, and Jared Crapo, Vice President
What Is an ACO? A Definitive Guide to Accountable Care Organizations
Dr. John Haughom, Special Advisor, and Dr. David A. Burton, Sr. Vice President
A Best Way to Manage a CMS Hospital Readmission Reduction Program
Bobbi Brown, Vice President Finance
ACO Success Requires Precise Patient Population Definitions
Luke Skelley, Vice President
Link to original article for a more in-depth discussion.
2015 and Beyond: 6 Predictions for Healthcare and Population Health

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For more information:

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Other Clinical Quality Improvement Resources
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Dr. David A Burton is former Executive Chairman and CEO of Health Catalyst, and currently
serves as a Senior Vice President, future product strategy. As a senior leader of the Health
Catalyst team, Dr. Burton has been instrumental in helping define and design all elements of
the Health Catalyst strategy, including our future product roadmaps, our advanced
deployment and operational processes engaging executives and clinicians in data-driven improvement
methodologies, and our content strategy for integrating best practice and evidence-based guidelines
into our product categories. Previously, Dr. Burton was as a Senior Vice President of Intermountain
Healthcare, where he served in a variety of executive positions for 23 years and co-developed
Intermountain's Clinical Integration strategy, including advocacy of the EDW, which supported it. Dr.
Burton is the former founding Executive Vice President of Intermountain's managed care plans (now
known as SelectHealth), which currently provide insurance coverage to approximately 600,000
members. He holds an MD from Columbia University College of Physicians and Surgeons and did his
residency training at Massachusetts General Hospital in internal medicine. He was a charter member
of the American College of Emergency Physicians and was Board Certified in Emergency Medicine.
He practiced emergency medicine and was president of a single-specialty group of 20 emergency
care physicians before joining the executive team at Intermountain. He holds an MD from Columbia
University College of Physicians and Surgeons and did his residency training at Massachusetts
General Hospital in internal medicine. He was a charter member of the American College of
Emergency Physicians and was Board Certified in Emergency Medicine. He practiced emergency
medicine and was president of a single-specialty group of 20 emergency care physicians before
joining the executive team at Intermountain.