Population Health management has been around for decades and continues to evolve with changing regulations, advancing technology, improved data collection and analytics, and the rapid emergence of new Value-Based Care (VBC) programs and models of care.

Overall, the promise of Value-Based Care (VBC) remains both straightforward and steadfast: through the transformation of healthcare delivery to prioritize clinical quality and outcomes while managing costs, patients stand to reap profound benefits, experiencing a marked improvement in care. Sectors of the industry are working overtime to find better ways to serve patients. Programs offering advanced preventative care, promoting wellness, and providing both routine and episodic care in more convenient settings can significantly decrease costs for all participants, including patients and payors while reducing burden and improving the experience for providers.

Data-driven, Socially Determined, and Collaboratively Delivered Community Healthcare

“We are in an era of ongoing change,” said Sadie Howes DiAdriana, Chief Marketing and Experience Officer at Arkos Health, a pioneer in the VBC space. Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations within an integrated system of care comprised of clinical and social services backed by a robust system of technologies and innovative platforms. “Consumers’ demands from the system and value-based care models continue to increase while regulators continue to drive changes that significantly impact the playing field. Delivering value-based care, therefore, requires a level of sophistication and intentionality it has not previously.”

Elaborating on what she means by “intentionality,” DiAdriana explained that good cultivation, stewardship, and deployment of data would make VBC programs successful in both the near and far terms—specifically emphasizing that Clinical and SDOH data must be used in concert to understand better patient behaviors and psychology along the continuum of care. Organizations that can effectively leverage data to reimagine programs, interventions, and clinical care to be more engaging across all settings and access points will ultimately find it easier to influence utilization behaviors, thereby reducing costs and driving better outcomes.

“Value-Based Population Health already takes a more holistic approach,” DiAdriana said. “But the successful programs going forward will be those that leverage data to work collaboratively within the communities they serve to co-create solutions. Additionally, programs that can maximize access at the convenience and preference of the consumer are more likely to succeed. This means maximizing care delivery across all channels: virtual, mobile, community-based, in-clinic, etc. Data must inform the opportunity areas, potential pitfalls, and barriers to entry, but the ultimate solution cannot be derived from the corporate “ivory tower.” It must include those it impacts in the process.

Retail-based clinics, free screenings, community-based education, and remote monitoring service options are all great with loads of potential, but if the data and/or population isn’t demanding, responding, or connected to that offering, it will not make the relevant impact. This makes intuitive sense, but what ultimately proves programs are working is the results. These efforts need to be tracked, evaluated, and optimized promptly and consistently.”

DiAdriana is not alone in her passion for applying VBC principles to Population Health. “At a time where dissatisfaction with large corporations and conglomerates is at a peak, consumers are becoming increasingly open to new ways to find and receive care, even increasing their healthcare literacy through unconventional means like social media and digital communities,” DiAdriana explained. Medicare Advantage enrollment has more than doubled since 2010,[1] with over 50% of the Medicare population is enrolled in a Medicare Advantage plan, and further growth expected through 2030[2].COVID skyrocketed the adoption of telehealth for millions of people, and even with the return of in-person services, utilization remains higher than pre-pandemic levels[3]. Consumers are willing to shop for care, and according to a May 2023 McKinsey study[4], 89% are willing to shop for medical services in at least one category if given the option.

“Healthcare needs to meet the patients where they are at. That’s why Arkos brings nurses, nurse practitioners, doctors, pharmacy support, dieticians, social services, and other care support into the home and community. This can be far more convenient for individuals and families. Some members, however, still prefer clinic settings and more traditional care channels. We must be able to respond to, support, and optimize that experience as well. The easier we make it for the population to engage both traditionally AND in new ways so that it is more on their unique terms, the more successful we will be at addressing Population Health challenges. Data provides us with a framework and direction, but we then partner with the members and community directly to cultivate effective programs and solutions; we will be able to more efficiently and effectively serve them.”

Earlier this month, Walmart Health announced the closure of all its locations. This is amid a seeming collapse of the retail health model. “It is a disappointing blow to what seemed like a promising solution for access in rural & underserved communities,” DiAdriana said. While Walmart has publicly announced its retail clinics were not a sustainable model, industry speculation suggests they may have failed to overcome a variety of challenges, from provider and staffing shortages to underestimation of the challenges to delivering care and achieving profitability in today’s tough environment. “Walmart theoretically had all the right tools and levers at their disposal to succeed in this space. They had the physical infrastructure and money to build the operational prowess. So, for me, with a bias towards consumer experience,” she chuckles, “it does beg the question whether the retail model was ever really that well aligned to the data AND the demands of consumers?”

While it may be easy to get bogged down in pessimism surrounding this potential demise of a seemingly hopeful model of care, the accessibility challenge always maintains glimmers of hope for the technology sector. Given more accessible and powerful technologies and platforms, including mobile apps, cloud computing, affordable data storage and processing, and increasingly intelligent analytics and Artificial Intelligence (AI), a solid computing and communications infrastructure is slowly becoming the baseline.

“There is no shortage of data or technology in healthcare. Those are the easy parts in some respects,” DiAdriana said. “The devil is in the detail of how we cultivate that data and technology to implement Value-Based Care and Population Health Programs. It requires varied expertise across technical, clinical, and social parameters, proven methodologies, and a healthy dose of creativity. That can be a tall order, with stakeholders often at odds for limited precious resources. Not to forget, even with the stakeholders and resources aligned, getting there requires continuous training, education, and genuine engagement from all parties – the people behind the technology and processes, those who are on the front lines, in medical offices, and in the homes as well as the people and communities receiving care.”

“The good news is that despite the at times steep uphill battle, the level of understanding and willingness to make a full commitment to these programs is rapidly growing after what seemed like a prolonged adoption period for Value-Based Care,” DiAdriana said, while also noting that the landscape is rapidly changing given the stunning results of large projects in many of the most heavily populated communities in the U.S. These include commercial shared-risk savings and full-risk capitation within Medicare Advantage.

Arkos has led successful programs in multiple markets across the country because of its ability to cultivate data into action across the ecosystem of care collaboratively. “Arkos Health sits in the middle of it all and can help bridge the gaps. We can be the rising tide that lifts all boats, as the saying goes.”

“A robust collaborative approach is necessary because reviewing individual patients’ cases using Electronic Health Records (EHRs) and Electronic Medical Records (EMRs) only goes so far. Impactful and relevant data comes from a variety of far-reaching sources. “When that data is aggregated well, meaningful trends and insights surface that allows for more impactful interventions,” DiAdriana said. “When you start to layer in quality and social data, we can look across the entire continuum, to start understanding which measures and treatments are working and for whom, which leads to more informed and efficient care not just for one, but for many.

To learn more about Arkos Health, Value-Based Care, Population Health, and the power of data in reducing the cost of care while improving people’s health, please visit arkoshealth.com

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[1] 10 Reasons Why Medicare Advantage Enrollment is Growing and Why It Matters | KFF.

[2] Figure 2 (Same as above)

[3] Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs (epicresearch.org)

[4] The implications of US healthcare price transparency | McKinsey