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In 2016 Population Health Metrics, Risk-Based Payment Models Shift Scrutiny to "Rising Risk"

New population health management metrics from the Healthcare Intelligence Network (HIN) indicate that healthcare organizations are doubling down on the "rising risk" - individuals with two or more unmanaged health conditions - to maximize value-based reimbursement.

Sea Girt, NJ, May 24, 2016 --( To head off costly and extended health episodes, one quarter of healthcare organizations now aim a laser focus on 'rising risk' populations to optimize reimbursement under payment contracts that are increasingly risk-based, according to the April 2016 Population Health Management (PHM) survey by the Healthcare Intelligence Network (HIN).

In order to accrue clinical and financial gains from PHM's data-driven, risk-stratified care coordination approach, a majority employ chronic care management (CCM) services, say 90 percent of respondents to HIN's PHM benchmark survey.

In condition-specific PHM metrics new for 2016, diabetes topped the list of clinical targets for PHM interventions, say 88 percent.

The survey found that 70 percent of respondents have committed to population health management in 2016, up from 56 percent in 2012. At the same time, many responding organizations lament payor reluctance to cover PHM services like health coaching and group visits they see as essential and critical care management touch points.

Download more metrics from the complimentary HINtelligence report, Population Health Management in 2016: New Payment Models Mean More 'Rising Risk' Scrutiny, at

The use of data analytics in PHM continues to rise, albeit more slowly than it did from 2012 to 2014, a period when EHR and registry use tripled. A health risk assessment (HRA) remains the primary instrument for identifying individuals for PHM interventions, say 70 percent.

Having stratified their populations, the majority of respondents conduct PHM outreach telephonically, according to 84 percent.

Medication management as a PHM offering and the weight of quality rankings, utilization data and aggregate spending in PHM program evaluation were among new metrics identified by the 2016 survey.

News Facts: HIN's white paper, Population Health Management in 2016: New Payment Models Mean More 'Rising Risk' Scrutiny, summarizes April 2016 feedback from 110 hospitals and health systems, health plans, physician organizations and others on their population health management approaches.

This 2016 PHM snapshot also captured the following trends:

- Three-quarters of responding PHM programs serve commercially insured populations;

- The primary care physician has principal PHM responsibility, according to 40 percent of respondents;

- Ninety-eight percent believe a population health management approach is sustainable; and

- Patient satisfaction is the key metric evaluated to measure PHM effectiveness, say 83 percent.

Download more metrics from the complimentary HINtelligence report, Population Health Management in 2016: New Payment Models Mean More 'Rising Risk' Scrutiny, at

"With CMS's aggressive value-based payment agenda, fee for value is here. Health risk-based population health management, built on a robust data analytics platform, is the key to attaining the clinical and quality benchmarks inherent in these emerging reimbursement models."
- Melanie Matthews, HIN Executive VP and COO

For Melanie Matthews' profile, visit Please contact Patricia Donovan to arrange an interview or to obtain additional quotes.

About the Healthcare Intelligence Network - HIN is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare. For more information, contact the Healthcare Intelligence Network, PO Box 1442, Wall Township, NJ 07719-1442, (888) 446-3530, fax (732) 449-4463, e-mail, or visit
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Patricia Donovan

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