Medical malpractice insurance companies are enthusiastic about practices that improve healthcare and patient safety. Sometimes that enthusiasm results in lower medical malpractice insurance premiums for physicians, but sometimes companies’ rates are slower to respond to new innovations than healthcare providers would like. With the current push toward a goal of improving quality of care while reducing costs, Population Health Management (PHM) is presented as one way to reach that goal. While providers are eager to see lower premiums, most medical malpractice insurance companies are taking a wait-and-see approach. The insurance carriers want to see if patients are experiencing better outcomes and improved health, and if so, if that will result in lower risk and fewer medical malpractice claims for healthcare providers.
Population Health Management: What is it?
The term “Population Health Management” is credited to David Kindig, M.D., PhD, and Greg Stoddart, PhD when they proposed the definition in 2003: “The health outcomes of a group of individuals including the distribution of such outcomes within the group,” according to Health Affairs Blog. This definition and the meaning of the phrase, PHM, has changed over the years, and seems to mean different things to different people. Healthcare IT News in 2015 reported the findings of a survey conducted by the Milken Institute School of Public Health at George Washington University quoting: “While interpretation and understanding of the phrase “population health management” differed greatly in the responses we received, many did view it as an opportunity for health systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve.” While there are differences in interpretation, most agree that PHM is the aggregation of patient data from multiple resources, which is analyzed as a single patient record, and used to improve health outcomes and reduce cost, according to Philips Wellcentive.
What is the Goal?
The goal of PHM is to improve the quality of care and the health of a group by closely tracking and analyzing data on the individuals in that group. A group can be defined by geography, or by what specific health system they’re treated in, or by which specific health insurance company they’re covered by. The Institute for Healthcare Improvement (IHI) states that Population Health Management is defined by the measures used such as life expectancy, mortality rates, disease burden, and behavioral factors. The IHI has developed what it calls the Triple Aim, which is Population Health, Experience of Care, and Per Capita Cost. You can learn more about the Triple Aim in IHI’s white paper: A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost.
According to IHI: “Effective population [health] management will require new partnerships among providers and payers, integrated data support, redesigned IT structures, a focus on non-traditional health care workforce, new care management models, and a shift from fee-for-service delivery to bearing financial risk for the populations served.” The lofty goals of improving health outcomes and reducing the cost of healthcare along with this type of collaboration all sound great on the surface, but what many are wondering is if the underlying motivation for physicians to achieve these goals is really just to get higher reimbursements. And if that is the case, will outcomes actually be better, and will risk for medical malpractice claims really be reduced?
As the healthcare industry knows, the Medicare Access and CHIP Reauthorization Act or MACRA changes the way physicians are paid, and is designed to promote quality of care while lowering costs. But medical malpractice insurance companies want to know if practices are just marking items off of a checklist to prove better quality of care so they can get the highest reimbursements, or if the goal of better outcomes, better health, and fewer medical malpractice claims can be achieved.
Until there is enough data to show, the jury’s still out on whether or not medical malpractice insurance premiums will respond favorably due to Population Health Management. In the meantime eQuoteMD will keep monitoring the industry and the insurance market to inform our clients about trends in healthcare. eQuoteMD is dedicated to serving physicians, groups, and hospitals in every state and every specialty. Providers look to eQuoteMD for the best coverage and value in medical malpractice insurance. Call or click to get a quote today.
