Author:

Abstract

Introduction

Internationally, the pursuit of the Triple Aim is leading the reform of healthcare systems. To implement accountable care, a target population and its health assessment must first be identified. This assessment should address resource allocation, program planning, healthcare delivery, and measure outcomes to achieve value-based care. Health Needs Assessment (HNA) tools are around since the '90s, but gained policymakers' attention as the accountable care movement spreads. HNA systematically reviews a population's health issues by defining their unmet needs. This paper reviews HNA tools used internationally and their implementation to assess population health compared to accountable care requirements. The analysis of HNA tools considers both demand and supply and examines them through comprehensive international tools.

Methods

An Arksey-O'Malley approach was used in this scoping review. Electronic database MEDLINE and search engine Google were searched combined with snowballing strategies. HNA reports were included, and methodologies were extracted. The scoping review addressed four: 1) reviewing frameworks, domains, and subdomains deployed in HNA tools to assess needs, demand, and supply; 2) how the tools achieved population-health assessment vs. an aggregated measure of quality, access, and health services utilization?; 3) how tools were deployed in program planning and priority setting of interventions to improve population health?; 4) Who is accountable for measuring and improving population health?

Results

Results were organized in comparative tables benchmarking domains and subdomains of HNA for both demand and supply. Few tools assessed both demand and supply; however they relied on utilization data while using targeted surveys for an actual needs assessment. Supply tools result more developed with high accuracy in data collection to assess access, readiness, coverage, and targeted sub-populations. The institutional deployment of HNA tools focuses on program planning of health policies and interventions, while supply tools are exploited for benchmarking the productivity and availability of services. National tools are more accurate and calibrated on the local epidemiology and health services organization.

Discussions

The use of HNA to pursue accountable care remains limited. Tools retrieved measuring population health for accountable care were excluded from the review because they represent performance framework and not HNA. The use of HNA for implementing accountable care is expanding, exploiting health analytics and routine analysis, foremost applying utilization data. The development of comprehensive whole-population HNA tools to inform health policymaking and interventions is hampered by the time and resources required, especially for needs assessment and data available for routine analysis.

Lessons Learned

With accountable care, population HNA is a requirement. What matters is how to perform it on whole-population to inform the policymaking and health interventions. Multiple tools can be applied and combined to analyze the dimensions of supply, demand, and needs within the scope of ACOs. Nevertheless, a key challenge for a comprehensive assessment is the coordination and governance of data sharing from multiple stakeholders to collect community-level data. Collaboration among players is required for deploying HNA and sharing the accountability for measuring and monitoring. 

Limitations

The review included only published tools in English, which may undermine the collection of relevant experiences.