August 24, 2021

Sixth annual study by Numerof & Associates illuminates healthcare executives’ perspectives on population health and alternative payment models

Most hospitals across the country suffered major financial damage when COVID-19 forced the shutdown of elective procedures. Despite this, a new report released today by healthcare strategy consultancy Numerof & Associates finds that few took away any lessons about mitigating business risk inherent in fee-for-service.

Numerof’s Sixth Annual State of Population Health Survey report provides the industry’s most comprehensive look at the progress of U.S. healthcare delivery organizations in integrating population health principles into routine operations. The latest administration was conducted online between September 2020 and February 2021. Of the approximately 300 healthcare executives who responded, the vast majority (99%) reported yet again that they expect their organization to have some revenue in models with upside gain and/or downside risk in two years – even though their expectations have consistently fallen short of reality in years’ past.

“Progress toward improving population health is still moving at a frustratingly glacial pace,” said Rita Numerof, PhD, the firm’s president. “Like many, we hoped that this year’s survey would show some progress toward value-based practice integration, yet we found many executives still failing to see the shortcomings of the fee-for-service status quo. This unwillingness to see and address these now obvious, fundamental issues is exactly why government bailouts cannot continue – especially without any requirement to prevent this from happening again in the next pandemic!”

When asked whether they think that the pandemic will accelerate at-risk contracting, a near-even share of respondents answered “agree” (39%) “neutral” (30%) and “disagree” (31%). Similar results were found when respondents were asked whether capitated models would be more attractive as a result of COVID, with 36% answering “agree,” 31% “neutral” and 33% “disagree.”

Nevertheless, almost all respondents (93%) rated population health as being “moderately” to “critically” important to their future success, with their primary reason being “Better control of clinical costs, quality and outcomes.” Again, according to Numerof’s data, this sentiment appears at odds with current reality.

“It’s long been known that the most expensive piece of equipment in the hospital is the physician’s pen,” said Michael Abrams, managing partner of Numerof & Associates. “Yet, in our sixth annual survey, 62% of respondents rated their organization’s ability to manage variation in cost at the physician level as “average” or “worse than average”. If executives have so little insight into the cost differences between physicians, how can they possibly expect to control them?”

Respondents were more confident in their organization’s ability to manage variation in clinical quality at the physician level, however. More than two-thirds of respondents rated their organizations’ ability to manage variation in quality at the physician level as “better than average”.

”Once again, Rita Numerof and her team have taken the pulse of our industry, and while the pulse is strong, there are some worrisome skipped beats,” said David B. Nash, MD, MBA, Founding Dean Emeritus of the Jefferson College of Population Health, with whom Numerof conducted its sixth annual study. “Quality and outcome measures are more important than ever, but the pandemic has overshadowed decades of progress in this arena. One thing is clear, however: We need great leaders, and this report helps to clarify the role of our emerging population health leaders better than any other piece of research that is extant in the marketplace.”

The full report is available for download at: