Everything you may know about Population Health (PH) is wrong. I wrote about the complexities associated with PH in the ACO Survival Guide (the Guide). The Guide describes the moving parts necessary to succeed using the accountable care model including data analytics, care coordination, quality metrics and, of course, a deep understanding of HHS' evolving reimbursement regulations. Certainly, any knowledgeable observer could review the Guide and conclude that the ACO model was fraught with complexity and there were plenty of opportunities for false starts and outright failures, potentially costing an organization tens of millions of dollars.
In my new book (yet untitled) I will explore the individual points of failure that will lead to many organizations experiencing failed ACO implementations. Here's my thesis in a nutshell: Effective Patient Engagement is ALL that Matters. Although the thesis may seem obvious to knowledgeable observers, more ambiguous are the kinds of impediments and outright roadblocks that vendors put in the way of achieving this mission, combined with a specific kind of talent deficit in provider organizations that will collectively lead to less than optimal results (understatement). Now, this is not simply evil vendors looking to make a quick buck (although many obviously are) but rather that the vendors seek to impose their innovation agenda on providers and most providers are not knowledgeable enough to understand that the vendor's agenda probably (almost certainly) does not align with their own.
Healthcare providers are not savvy consumers of information technology. In fact, quite the opposite is true. Must providers have been laggards in adopting information technology. We need look no further than the fact that it took the HITECH Act (under its meaningful use provisions) to push providers into adopting electronic health records en masse. In short, even if the vendors and provider's agendas were aligned, the healthcare industry is not poised to innovate anywhere near the pace that vendors are attempting to push it. This cognitive dissonance will cause billions of dollars to go up in smoke industry-wide as population health initiatives are foisted on the marketplace not by the government, but by competitive pressures that have now been unleashed.
Not only are providers experiencing a talent deficit of a significant magnitude, but vendors themselves struggle to attract and retain the talent necessary to succeed on their own agendas, let alone delivering enough talent to support their customer’s success as well. Why is that? Part of the answer is that the healthcare industry is enormously complex; therefore, attracting talent with both information technology skills and healthcare subject matter expertise is daunting. For those of you in the middle of PH initiatives, just review how often project managers have to be swapped, clinical consultants have to be replaced, and projects are delayed due to lack of technical expertise related to one of perhaps dozens of applications that need to be modified in order for the initiative to succeed.
Lastly, technology projects, for example data warehousing/business intelligence projects, often fail (across industries) not because of algorithmic complexity but rather as a result of two principal factors: (1) data complexity (i.e. semantic challenges upholding a single source of truth); and (2) the multiplicity of interfaces between applications requiring integration. In healthcare, these two factors are critical for supporting effective patient care. So why are the blind leading the blind? Because neither vendors nor providers collectively share the same vision or agenda that powers the end game – Effective Patient Engagement.
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