August 18, 2020

Conducted before the Covid-19 pandemic, fifth annual study by Numerof & Associates finds providers are still falling short of making a meaningful commitment to population health

Progress in implementing population health has remained limited, according to the fifth annual State of Population Health survey by healthcare strategy consultancy Numerof & Associates. But lessons learned from Covid-19 suggest that may soon change.

The latest Numerof report is based on an online survey of approximately 500 C-suite healthcare leaders with deeper insights gathered from open-ended interviews with selected executives. The survey, which provides the industry’s most comprehensive look at the population health plans and progress of U.S. healthcare delivery organizations, was conducted between June 2019 and September 2019, approximately six months before Covid-19 made its way to the United States.

As in prior survey administrations, the median percentage of revenue from contracts linking reimbursement to management of cost and quality was 10%; two years before, respondents projected this figure would be three times higher.

This lack of progress stands in contrast to 94% of respondents saying that population health is important for their future success, and even more than the year prior saying it is “critically” important.

The risk of performance-related reimbursement penalties remained the chief obstacle to providers making a deeper commitment.

“One of the greatest ironies in all this is that because of Covid-19, people are realizing that there’s just as much – if not more – risk in staying in an antiquated, fee-for-service model than there is in embracing an alternative,” said Rita Numerof, Ph.D., the firm’s president. “We expect to see the sentiments surrounding risk shift significantly next year, especially as awareness of providers’ success with capitated payments during the pandemic becomes even more mainstream.”

The survey also found that respondents’ assessment of their organization’s readiness to be accountable for cost and quality is more wish than fact: 66% said their organizations were “moderately” to “completely” prepared, but when it came to managing cost at the individual physician level, only 35% said their organization was better than average.

“It’s quite shocking to see that as hospitals and health systems continue to acquire independent physicians, they’re doing so without the processes in place to effectively manage physician cost and quality,” said Michael Abrams, managing partner of Numerof & Associates. “There’s been very little movement on creating care paths, flagging variation using order entry systems, equipping physicians with data, and tying physician payment to outcomes since our first survey in 2015, which points to a hugely overlooked opportunity to add value.”

Numerof conducted the study in collaboration with David B. Nash, MD, MBA, Founding Dean Emeritus of the Jefferson College of Population Health.

“The healthcare system that brought us to the edge of the abyss cannot be the system that propels us to the future; we have to transform the system,” said Dr. Nash. “Transforming the system will require new leadership structures, and because of the pandemic’s increased attention on social determinants of health, we anticipate the role of the Chief Population Health Officer to evolve to the Chief Health Officer.”

Numerof’s fifth annual State of Population Health survey report summarizes responses from approximately 500 executives in urban, suburban and rural areas across the United States. These individuals represented a wide range of delivery organizations, including standalone facilities, small systems and IDNs; for-profit, not-for-profit and government institutions; and academic and community facilities. The full report is available at: