PitchBook-人口健康計(jì)劃剖析（英）-2023

INDUSTRY

RESEARCHPitchBookData,Inc.John

Gabbert

Founder,

CEOAnatomy

of

a

PopulationNizar

Tarhuni

Vice

President,

InstitutionalResearch

and

EditorialHealth

ProgramLessonsinvalue-basedcarefromLehighValley

HealthNetworkPaul

Condra

Head

of

Emerging

TechnologyResearchInstitutionalResearchGroupAnalysisPitchBook

is

a

Morningstar

company

providing

the

most

comprehensive,

mostRebecca

Springer,

Ph.D.Senior

Analyst,

Healthcare

Leadrebecca.springer@accurate,

and

hard-to-find

data

for

professionals

doing

business

in

the

private

markets.pbinstitutionalresearch@Key

takeawaysPublishing?

The

developmentofLehighValleyHealthNetwork’s(LVHN)

populationhealthstrategyilluminatesthechallengesand

opportunities

thathealthsystemsfaceinpursuingvalue-basedcareand

presents

lessons

forinvestorsinhealthcareITandprovidercompanies.Designed

by

Chloe

LadwigPublished

on

July

3,

2023Contents?

Forhealthsystemsthathaveor

can

hirethenecessary

talentand

wantnimble,customizablesoftware,

solutionsthatprovidethenuts

and

bolts

ofdataintegrationand

enrichment

maybe

attractive.

Turnkeytechsolutionsmustfind

otherwaystoreplicatetheengagement

thatbuild-it-yourselfprojects

canengender

among

clinicalstaff.KeytakeawaysIntroduction122Background:

Population

health

atLVHN?

Itisdifficult

tounderstatetheimportance

ofchangemanagementfororganizationsundertaking

value-basedcareinitiatives—or,forthatmatter,anysignificanttechnology-drivenclinicaltransformation.We

believemanyhealthcareITstartups

willliveor

diebased

on

thequalityand

scalabilityoftheirimplementationservices.Technology

and

care

coordinationfoundations2In-house

tech

developmentCreating

clinician

alignmentNo

data,

no

deal4567?

Claimsand

EHR

dataintegrationisnecessary

but

notsufficient

forgood

value-based

contracting:Providerorganizationsneed

payersavvy.LVHN

benefitedfromleaders

withdeep

experienceinpayer-contractingprocesses

and

negotiations,inadditiontoarobust,

data-firstapproach.The

financial

tightrope?

Healthsystemspursuingapopulationhealthparadigmmust

walkafinancialtightrope;LVHN’ssuccessrequiredyearsoforganizationaleducationandalignmentwork.

Investorsshouldbe

confidentinthevalue-basedcaretransitionbut

cautiousinestimatinghowlongitwilltake.1PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

ProgramIntroductionValue-based

care

(VBC)

is

one

ofthe

secular

shifts

transforming

the

healthcareindustry

today,

alongside

AI

and

data

integration,

consumerization,

and

site-of-careinnovation.

We

havewritten

extensively

about

investable

opportunities

in

the

value-based

care

transition,

including

in

technology

providers

and

in

physician

groups.Investors

are

generally

familiar

with

the

numerous

VC-and

PE-backed

care

deliverycompanies

that

havesprung

up

since

the

mid-2010s

with

VBC-focused

models,

fromMedicare

Advantage

(MA)-focused

enablers

such

as

agilon,

to

Medicaid-focused

clinicbuilders

such

as

Cityblock,

to

chronic-condition

specialists

such

as

Monogram.

Theymay

haveless

familiarity

with

the

decades

ofwork

done

by

nonprofit

health

systems

tobuild

patient-centric

and

financially

sustainable

population

health

programs.For

PE

and

VC

investors,

understanding

how

health

systems

approach

population

healthis

critical

for

several

reasons.

First,

health

systems

are

the

key

customer

group

for

manytechnologies

and

ancillary

services.

Second,

health

systems

partner

with

technologycompanies

and

provider

groups

to

incubate

and

pilot

new

technologies—and

mayhavediverse

and

complex

reasons

for

choosing

with

whom

topartner

and

whether

topartner

at

all.

Third,

many

ofthe

challenges

faced

and

solutions

identified

by

healthsystems

in

implementing

VBC

are

applicableto

other

provider

types.Background:Population

health

at

LVHNThis

note

reviews

learnings

from

Lehigh

Valley

Health

Network’s

(LVHN)

populationhealth

program

as

a

case

study.LVHN

is

a

midsize,

13-hospital

system

in

easternPennsylvania,

with

its

flagship

campus

in

Allentown.

The

system

serves

a

populationofaround

1.5

million

across

10

counties.

In

2014,

under

a

newly

appointed

CEO,

thesystem

committed

toa

strategic

orientation

around

population

health.

LVHNleadershiprecognized

that

healthcare

delivery

in

the

US

was

shifting

inexorably

towardvalueand

that

the

long-term

survival

ofhealth

systems

such

as

LVHN

would

be

tied

to

thattransition.

Around

the

same

time,

LVHNalso

created

Populytics,

a

for-profit,

whollyowned

subsidiary

company

that

manages

LVHN’s

employee

health

plan

and

powersLVHN’shealth

data

analytics

capabilities.

Populytics

recently

began

marketing

third-party

health

benefits

services,

including

direct

contracting

and

an

employee

assistanceprogram,

toemployers.

In

addition

toPopulytics,

the

LVHNhas

invested

in

numerousadministrative

initiatives,

clinical

programs,

and

community

partnerships

whilegradually

expanding

its

value-based

contracting

with

a

growing

set

ofpayers.

Now,around

one-third

ofLVHN’s

core

(repeat)

patient

population

is

attributed

to

value-based

contracts,

and

these

contracts

havea

track

record

ofsuccessful

outcomes.Below,we

describe

key

elements

ofLVHN’svalue-based

care

journey

and

offertakeaways

for

investors

in

VBC

healthcare

IT

and

provider

companies.Technology

and

care

coordination

foundationsBuilding

a

successful

population

health

program

requires

considerable

upfrontinvestment

tomeasure,

predict,

and

improve

clinical

outcomes.

A

key

capability

ispopulation

risk

stratification

and

predictive

analytics.

Populytics

built

capabilitiesincluding:2PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

Program?

Service-line

specific

dashboards

tohelp

specialty

providers

manage

and

measurecompliance

to

optimal

inpatient

and

ambulatory

care.?

Contract-specific

dashboards,

both

financial

and

clinical.?

Care

management

registries

toidentify

and

direct

care

management

resourcestowardspecific

patients

to

prevent

higher

acuity

care

episodes.?

Evidence-based

inpatient

and

ambulatory

clinical

pathways

and

defined

careepisodes.

(Populytics

contributed

to

the

development

ofthese

care

pathways

usingvalue-based

data

and

metrics.)?

Clinical

indicators

such

as

ED

visits,

admissions,

and

care

gap

closures

tomeasure.?

Operational

indicators

such

as

care

alignment

(i.e.,

patients

receiving

care

outside

ofLVHN’s

network).?

Financial

indicators

such

as

patient

spend

(for

predicting

and

measuring

VBCcontract

performance).Populytics

custom-built

its

own

dashboards

and

visualizations

using

Tableau.

Thesesit

atop

a

data

mart

that

integrates

LVHN’selectronic

health

record

(EHR)

data

andclaims

data,

with

Optum

performance

analytics

and

risk-scoring

applications

usedfor

data

enrichment.

Other

back-end

functions,

such

as

hardware,

cloud

architecture,and

disaster

recovery,

are

also

outsourced,

and

Populytics

also

uses

other

third-party

analytics

tools.

Patients

are

stratified

by

risk

(including

low,

high,

or

rising)

aswell

as

projected

care

cost.

Recently,

Populytics

has

focused

on

building

increasinglysophisticated

predictive

capabilities.

For

example,

a

novel

capability

predicts

anelevated

risk

ofdeveloping

ketoacidosis,

a

life-threatening

complication

ofdiabetes,in

advance.

Another

near-term

goal

is

the

ability

tostratify

patients

not

only

by

riskbut

also

by

specific

value-based

performance

impacts

in

order

to

strategically

directresources

and

improve

contract

performance.Populytics

gradually

built

these

data

analytics

capabilities

as

more

and

larger

value-based

contracts

were

negotiated,

bringing

in

additional

data

types

and

expandingpopulation

visibility.

Recently,

Populytics

evaluated

social

determinants

ofhealth(SDOH)

data

vendors

and

explored

adding

social

screening

surveys

to

captureadditional

patient

demographic,

social,

and

health

history

data

at

intake.In

addition

tosignificant

data

integration

and

analytics

build-out,

a

successfulpopulation

health

program

must

leverage

those

data

resourcestodeploy

robustcare

coordination

and

transition-of-care

support.LVHN

built

an

Integrated

CareCoordination

department

that

provides

services

for

specific

populations

based

on

riskand

contract

attribution,

such

as:?

Community

care

teams—comprising

an

RN

case

manager,

a

pharmacist,

abehavioral

health

specialist,

and

a

social

worker—and

high-risk

transition

teams,both

ofwhich

help

patients

access

prescriptions,

behavioral

healthcare,

and

socialservices.?

A

transition-of-care

call

center,

which

reaches

out

topatients

after

hospitaldischarge.?

Surgery

navigation

teams,

which

provide

transportation

toand

from

appointmentsfor

specific

patients,

coordinate

durable

medical

equipment,

and

offer

other

servicesto

aid

post-surgery

healing.?

A

prescription

assistance

program,

which

helps

patients

access

manufacturerfinancial

assistance

programs

for

specialty

medications.3PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

ProgramThe

system

also

works

with

community

partners

to

provide

medication-assistedtreatment

to

individuals

in

underserved

communities

who

haveopioid

addictions.In

February,

LVHNannounced

a

partnership

with

UHS

to

build

a

new

behavioralhealth

hospitaltoenhance

its

ability

tocare

for

mental

health

patients

in

the

mostappropriate

setting.1In-house

tech

developmentHealth

systems

pursuing

population

health

can

select

from

a

growing

universe

ofhealthcare

IT

and

digital

health

solutions.

However,

LVHNfound

value

in

buildingits

own

analytics

capabilities

in-house

via

Populytics

for

several

reasons.

First,the

company

can

be

nimble

in

creating

bespoke

solutions

as

needs

arise.

Second,Populytics

was

ableto

hire

the

right

technical

talent,

including

data

engineers

and

full-stack

web

developers.

Third,

and

most

importantly,

Populytics’

leaders

worked

directlyComponentsofapopulationhealthprogramValue-basedcontractingClinicalpathwaysEngagementand

accessSDOHData

and

analyticsOrganizational

buy-inwith

LVHN

providers

to

develop

a

clear

understanding

ofexactly

what

information

theywould

need

tosee,

and

how

they

would

want

tosee

it,

in

order

toorient

their

practicetowardpopulation

health.

They

then

worked

backward

from

the

clinicians’

needs

tobuild

bespoke

data

solutions.

Leadership

determined

that

the

ability

to

fully

control

datapresentation

was

worth

the

effort

ofbuilding

front-end

tools

from

scratch.

Moreover,the

process

ofbuilding

dashboards

in

consultation

with

clinicians

helped

toincreaseprovider

buy-in.Health

systems

regularly

incubate

technology

companies

that

go

on

toraise

VCfunding

and

offer

third-party

services

to

other

systems.

Recent

examples

includeInbound

Health,

a

hospital-at-home

startup

that

raised

$20.0

million

from

FlareCapital

Partners

and

McKesson

Ventures

as

a

spinout

from

Allina

Health

in

December2022,

and

CodaMetrix,

a

coding

automation

tool

developed

at

Mass

General

Brigham1:

“Lehigh

ValleyHealth

Network

and

Universal

Health

Services

Announce

Plans

toBuild

New

Behavioral

Health

Hospital,”

UHS,

February

13,

2023.4PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

Programthat

raised

$57.4

million

in

a

SignalFire-led

round

in

February

2023.

LVHN

initiallyexplored

a

Populytics

spinout

before

deciding

that

the

company’s

greatest

value

(forthe

time

being)

would

be

in

focusing

on

enabling

LVHN’s

mission-critical

populationhealth

transformation.

Populytics’

recent

expansion

ofthird-party

employer

servicesrepresents

a

new

growth

opportunity

based

on

the

success

ofLVHN’s

own

populationhealth

program.Leadershipdeterminedthattheabilitytofullycontroldatapresentationwasworththeeffortofbuildingfront-endtoolsfromscratch.Moreover,theprocessofbuildingdashboardsinconsultationwithclinicianshelpedtoincreaseproviderbuy-in.Key

takeaways

for

investorsHealthcare

IT

vendors

sometimes

bemoan

health

systems’

propensity

to

buildtechnology

capabilities

in-house

rather

than

purchasing

third-party

solutions.The

factors

that

droveLVHN’sdecision

tobuy

rather

than

build

are

instructive.

Forhealth

systems

that

haveor

can

hire

the

necessary

talent

and

want

software

withcustomizability

and

nimbleness,

solutions

that

provide

the

nuts

and

bolts

ofdataintegration

and

enrichment,

such

as

Health

Gorilla

and

Zus,

may

be

attractive.Additionally,

turnkey

tech

solutions

must

find

other

ways

to

replicate

the

engagementthat

build-it-yourself

projects

can

engender

among

clinical

staff.

If

physicians

are

notinvolved

in

the

actual

creation

ofthe

product,

what

other

ways

can

they

be

included

inthe

implementation

process

in

order

toensure

buy-in?LVHN’sexperience

with

Populytics

also

highlights

challenges

for

investors

that

seekto

spin

out

companies

based

on

solutions

developed

in-house

by

health

systems.While

there

are

certainly

successful

examples

ofthis

model,

in-house

solutions

mayrely

heavily

on

internal

IP

and

organizational

buy-in

that

are

difficult

to

replicate.

Moreimportantly,

the

health

system

that

developed

the

solution

may

be

more

interested

ineither

directing

resources

inward

or

disseminating

them

through

other

means,

such

asby

open-sourcing

code

or

by

expanding

its

own

network,

as

with

Kaiser

Permanente’screation

ofRisant

Health.Creating

clinician

alignmentPhysician

buy-in

undergirds

all

successful

population

health

programs

becausepracticing

collaborative,

data-driven,

prevention-focused

care

often

requiresmodificationstoworkflows

and

treatment

patterns.

For

providers

already

operatingwithin

staffing

constraints

and

shouldering

significant

EHR

documentation

burdens,change

can

feel

disruptive

and

burdensome

if

not

underpinned

by

a

conviction

that

newapproaches

will

improve

patient

outcomes

and

provider

experiences.LVHN

took

a

thoughtful

approachto

culturally

aligning

providers

with

its

populationhealth

transformation,

starting

with

leadership

and

organizational

decisions.

LVHNshifted

awayfrom

the

academic

model

ofhealth

system

organization—discrete,hierarchical

departments

organized

by

specialization—to

operate

under

five

broaderservice

lines

that

promote

interdisciplinary

collaboration:

acute

care,

specialty

care,women’s

health,

psychiatric

and

community

health,

and

primary

care.

Five

institutes(oncology,

orthopedics,

neurology,

cardiology,

and

surgery)

and

the

system’s

pediatrichospital

are

carved

out

from

these

service

lines.

Institutes

are

overseen

by

Physicians-in-Chief,

while

service

lines

are

overseen

by

Chief

Medical

Executives.

These

leaderswork

in

partnership

not

only

with

SVP-

or

VP-operations

leaders

but

with

two

physicianleaders,

a

Chief

Quality

and

Patient

Safety

Officer,

responsible

for

driving

quality,

and

aChief

Value

and

Ambulatory

Care

Officer,

responsible

for

driving

value.

This

structure5PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

Programfacilitates

alignment

around

shared

VBC

key

performance

indicators.

It

also

ensuresthat

physician

(rather

than

nonphysician)

leaders

are

designing

and

presenting

datato

other

physicians

to

highlight

problem

areas

and

rationalize

changes,

which

helpsincrease

trust.

LVHNhas

seen

high

physician

engagement

with

Populytics

dashboardsand

visualizations

as

a

result,

with

physicians

proactively

studying

and

raising

questionsabout

the

data.Compensation

has

also

been

an

important

tool

in

building

clinician

alignment

at

LVHN.The

system

now

compensates

all

employed

primary

care

providers

using

value-basedperformance

incentives

rather

than

relative-value-unit-based

incentives.

Achievingthe

organizational

buy-in

toimplement

this

program

required

years

ofeducation

andfoundational

work.

This

augments

work

that

the

Leghigh

Valley

Physician

HospitalOrganization

has

undertaken

over

decades

toeducate

and

incentivize

its

members(both

employed

and

independent)

to

improve

performance

in

quality

and

value-basedcontract

arrangements.

In

addition

tocompensation,

LVHN

provided

medical

scribestoease

clinicians’

administrative

burden

while

implementing

new

value-based

careworkflows.Key

takeaways

for

investorsIt

is

difficult

tounderstate

the

importance

ofchange

management

for

organizationsundertaking

value-based

care

initiatives—or,

for

that

matter,any

significanttechnology-driven

clinical

transformation.

We

believe

many

healthcare

IT

startupswill

liveor

die

based

on

the

quality

and

scalability

oftheir

implementation

services.Simply

offering

training

and

troubleshooting

support

is

often

not

enough.

Is

the

valueproposition

for

the

changes

being

proposed—not

justto

the

bottom

line,

but

to

patientexperiences,

population-level

outcomes,

and

provider

work

satisfaction—clearlysupported

by

data?

Is

that

data

presented

in

a

waythat

is

intelligible

to

clinicians?Does

the

technology

or

project

align

with

provider

incentives—both

compensation

andwork/life

balance?Itisdifficulttounderstatetheimportanceofchangemanagementfororganizationsundertakingvalue-basedcareinitiatives—or,forthatmatter,anysignificanttechnology-drivenclinicaltransformation.We

believemanyhealthcareITstartupswillliveordiebasedonthequalityandscalabilityoftheirimplementationservices.No

data,

no

dealIn

setting

up

value-based

contracts

that

would

position

its

population

health

programfor

clinical

and

financial

success,

LVHNbenefited

from

leaders

with

deep

experiencein

payer-contracting

processes

and

negotiations,

in

addition

toa

robust,

data-firstapproach.

The

contract

negotiating

team

takes

a

“no

data,

no

deal”

stance,

insistingthat

payers

share

historical

claims

data

to

facilitate

a

two-sided

discussion

regardingrisk

adjustment.

This

demanded

a

team

that

was

equipped

to

work

with

claims

data

onthe

Populytics

side

and

required

that

payer

claims

data

be

kept

solely

within

Populytics’database

architecture

to

avoid

broader

exposure

ofproprietary

data

withinLVHN.(Populytics

is

currently

evaluating

technical

and

payer

requirements

for

moving

itsdata

storage

processes

to

LVHN.)

The

Populytics

team

examines

payers’

own

assignedrisk

scores

and

compares

their

patient

population

to

that

ofpeers

for

commercialplans

or

calculates

historical

medical

loss

ratios

for

MA

plans.

For

negotiations

withMA

plans,

they

also

delve

into

the

payer’s

bid

process

with

the

Centers

for

Medicare

&Medicaid

Services.6PitchBook

Analyst

Note:

Anatomy

ofaPopulation

Health

ProgramEven

for

an

experienced

population

health

program,

predicting

outcomes

in

shared

riskcontracts

is

difficult.

LVHNhas

a

rigorous

quality

measurement

program

and

has

beenable

to

consistently

hit

contract

quality

targets.

Total-cost-of-care

measures

in

sharedrisk

contracts

are

more

difficult

topredict

because

circumstances

outside

the

system’svisibility

or

control

can

shift

population

health

dynamics

year

to

year.

COVID-19

isthe

obvious

example,

but

the

phenomenon

is

not

limited

topandemic-scale

events.Recognizing

this

inherent

uncertainty,

Populytics

runs

Monte

Carlo

simulations

tounderstand

potential

outcome

scenarios

and

sets

conservative

projections

for

thepurposes

offinancial

planning.

LVHNhas

performed

extremely

well

in

some

contractsand

has

had

mixed

results

in

others;

in

the

latter

case,

Populytics’

capabilities

allowleaders

to

pinpoint

and

address

drivers

ofunderperformance.Key

takeaways

for

investorsMany

provider

startups

and

PE-backed

groups

seek

to

take

on

value-based

contractsas

a

key

part

oftheir

business

model

or

value

proposition.

These

groups

cannotbe

successful

unless

they

havea

robust

understanding

ofhow

payers

approachnetwork

and

plan

construction

and

underwriting

and

can

mirror

payers’

own

actuarialcapabilities.

On

the

technology

side,

this

requires

the

ability

to

integrate

claims

withEHR

data.

Healthcare

IT

vendors

that

enable

this

integration,

such

as

Cedar

Gate

andArcadia,

should

continue

tosee

strong

demand.Claims

and

EHR

data

integration

is

necessary

but

not

sufficient

for

good

value-basedcontracting:

Provider

organizations

need

payer

savvy.

In

building

its

value-based

carecapabilities,

LVHN

hired

payer-experienced

population

health

experts

tohelp

buildits

applications.

Care

delivery

startups

should

consider

hiring

leaders

who

havespentsignificant

portions

oftheir

careers

in

relevant

roles

on

the

payer

side.

Wealso

believethat

contract

enablement—not

just

in

terms

oftechnology,

but

actual

negotiation—isone

of

the

key

“moats”

for

value-based

care

enablement

companies

in

the

agilon

model.ClaimsandEHRdataintegrationisnecessarybutnotsufficientforgoodvalue-basedcontracting:Providerorganizationsneedpayersavvy.The

financial

tightropeHealth

systems

pursuing

a

population

health

paradigm

must

walk

a

financial

tightrope.On

one

hand,

these

systems

invest

heavily

in

data

analytics,

care

coordination,

andSDOH-related

initiatives

to

improve

outcomes

across

their

patient

census.

This

resultsin

some

increased

primary

care

utilization—but

primary

care

is

a

low-margin

specialty,accounting

for

a

minute

fraction

ofa

system’s

revenue.

At

the

same

time,

successfulpopulation

health

efforts

can

actually

decrease

utilization

ofhigh-revenue

fee-for-service

(FFS)

service

lines,

such

as

orthopedics

and

oncology,

because

preventativecare

and

appropriate

screenings

reduce

high-acuity

episodes

and

slow

diseaseprogression.

Winning

back

that

missed

revenue

through

value-based

contracts

isdifficult

because

the

system

must

progress

slowly

into

greater

risk,

adding

payersone

at

a

time

and

building

out

new

capabilities

as

it

goes.

Early

on,

population-leveloutcome

improvements

may

be

financially

rewarded

in

contracts

representing

onlya

small

fraction

ofthe

system’s

revenue.

Health

systems

must

enable

a

total

financialstrategy

toensure

that

the

overall

system

margin

is

not

compromised

by

the

impact

ofpopulation

health

efforts.

The

financial

difficulties

that

hospitals

havefaced

in

the

post-pandemic

period

exacerbate

this

tension.7PitchB