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Four Keys to Insourcing Population Health Management Operations

Over the past several years, what started as a small wave of population health-specific management and IT vendors has grown into a tsunami. Most of the growth in this emerging sector of the industry can be explained by the continuous evolution in healthcare reimbursement, the growing involvement of venture capital firms, and the dollar values at stake with each new deal.

But the tide is turning. Healthcare systems are now shifting their population health management services internally. Due to continuous consolidation and other M&A activity drivers, many healthcare systems that are currently engaging operational vendors believe they possess the resources and experience to perform the same services in a more efficient way.

Before deciding to invest resources in developing internal population health management services, there are key considerations to take into account.

Patience in the Transition Period
Unwinding contracts with population health management vendors and bringing operations in-house takes time. You can expect a minimum of a twelve-to-eighteen-month transition once your organization decides to build its own capabilities. However, this is in addition to any time required to establish the business case and make appropriate preparations for significant organizational change.

Finally, and perhaps most crucially, understand that the return on investment will take time, both in terms of the financial impact and improved patient outcomes.

Vendor Contract Terms or Renegotiation
Initially, it may not be realistic to go cold turkey from your population health management vendor. Depending on your system’s capabilities and the services the vendor has been performing on your behalf, you may not be prepared to transition every service covered by the contract in-house.

If your goal is a complete transition to in-house activity, determine a realistic timeline for that goal. If the relationship with your vendor has not gone as planned, a quick and comprehensive transition via agreement termination is likely best. However, selecting specific population health functions to transition on a team-by-team basis may cause less interruption to your operational rhythms. Through the right renegotiation process, the latter option may provide a more manageable timeline for both you and your vendor.

Priority Identification
Due to the large operational scale of a comprehensive population health management strategy, few organizations have all the resources and infrastructure needed to successfully complete a single-step transition. While bringing operation in-house, most health systems will need to decide where to deploy resources first.

Ask these questions:

  • Do you have the regulatory expertise required to maintain compliance with state and federal reimbursement programs?
  • Are you willing to risk a discontinuation of clinical support for your patients if there is disruption in one of your care management programs?
  • Without your vendor, will you have the IT and data analytics required to be successful or will you need to find a different vendor to fill a gap in your capabilities?
  • Are your physicians benefitting from regular population health-specific engagements that you would like to continue uninterrupted throughout the transition?

Focus on Your Why
For many systems, insourcing population health management operations means building an entirely new vertical. Flexibility during the transition is paramount, as is leadership’s embrace of value-based care models. If system strategy is going to accommodate a value-based infrastructure, leadership must be willing to think of the future of the organization from both the existing viewpoint as well as from a population health perspective.

How can KSMC Help?
KSMC has extensive experience assisting organizations to make the transition to in-house population health management services. From provider engagement strategies to clinical programming solutions, our team is dedicated to helping you maximize your financial savings, and ultimately, help you improve patient outcomes. Contact us today to learn more about how we can help your organization begin the transition.

Michael Bratcher is the Senior Manager of Healthcare Services for KSM Consulting, LLC. In this role, Michael supports healthcare providers with change management in the healthcare system. Connect on LinkedIn.