AHRQ: Health IT, incentives spur practice-based population health
Practice-based population health (PBPH) may become a more widely viable option for primary care providers, according to a report released last month by the Agency for Healthcare Research and Quality (AHRQ).

The report, prepared by the National Opinion Research Center (NORC) at the University of Chicago, claimed that technology advances and incentives established to foster this type of care will help PBPH contribute to transforming primary care and to improving healthcare quality, patient outcomes, provider satisfaction and the efficiency of the healthcare system.

PBPH is defined as an approach to care that uses information about a group, or population, of patients within a primary care practice or group of practices to improve the care and clinical outcomes of patients within that practice. NORC identified five domains of information management functions that support proactive population management. The domains are:
  • Identify subpopulations of patients: Practices can target patients who require preventive care or tests;
  • Examine detailed characteristics of identified subpopulations: Information management systems can allow practices to run queries to narrow down the subpopulation of patients or to access patient records or additional patient information;
  • Create reminders for patients and providers: Information on patients can be made actionable through notifications for patients and members of the practice;
  • Track performance measures: Practices can gain an understanding of how they are providing care relative to national guidelines or peer comparison groups; and
  • Make data available in multiple forms: Information may be most useful to practices if it can be printed, saved or exported and if it can be displayed graphically.

According to the research, practices with EHRs and registries are currently performing more PBPH functionalities than paper-based practices, but no practice is performing all of the functionalities. “More widespread adoption of PBPH will require technological innovations, greater availability of usable data, new methods for reimbursement of primary care, and changes in physicians’ views of care delivery and their practice workflow,” the report stated.

The movement toward healthcare reform and recent federal investment in health IT provides a window of opportunity for transforming primary care, according to the report. To increase the adoption of PBPH, incentives for proactive population management can be incorporated into policies related to provider payment, the related provisions in the American Recovery and Reinvestment Act of 2009 and efforts to strengthen the primary care workforce.

To engage in PBPH, practices need accurate data in a discrete form, according to the report. “Providers … explained they often are able to run queries only on billing data, which may be inaccurate and insufficient for supporting PBPH,” the authors wrote. “Because clinicians are trained to provide individualized care to one patient at a time, changing providers’ focus to the population level will require a paradigm shift."

Because of the shift, clinicians interviewed were concerned with the disruption of workflow PBPH could cause because of the time needed to collect and analyze data on the patient population and the increased need for appointments that more proactive care requires, the report found.

“Further research may also be important in fostering PBPH,” the study concluded. “To make population management tools more useful to primary care providers, research could be conducted to advance learning in a number of critical areas – how to automate preventive care or disease management services, to improve natural language processing for converting text into discrete data elements in real time, to develop case studies of best practices in PBPH and to compile specific data elements for PBPH tools.”