Healthcare CIOs are facing new challenges as their organizations shift toward a care delivery model known as \u201cpopulation health management,\u201d or PHM. Essentially, PHM aims to improve the health of a patient population in order to reduce the cost of caring for that population. Healthcare organizations are being forced to take this path because Medicare and private health insurers are replacing payments based on the volume of services with payments based on \u201cvalue\u201d \u2013 which roughly translates to \u201chigher quality at lower cost.\u201d\u00a0\nPHM requires a sophisticated health IT infrastructure. A key part of this infrastructure consists of clinical and financial analytics. These tools support the clinicians who manage population health and help financial executives manage within a budget, respectively. Supervising clinical and business intelligence for PHM was not even listed in a 2013 CIO job description from the Health Information and Management Systems Society (HIMSS). So while no CIO job requirement has been eliminated since then, a whole new domain has been added \u2026 in theory.\u00a0\nBut John Moore, founder and CEO of Chilmark Research, a firm that reports on the health IT business, says that, in reality, many CIOs are not directly involved in the new analytics work. \u201cThey pulled analytics away from the CIO because the CIO doesn\u2019t have the bandwidth to deal with it,\u201d he says.\u00a0\nAnalytics experts give CIOs no respect\nMoore recalls asking PHM analytics experts at a recent conference who they report to. Some said they reported to CFOs; others reported to chief medical officers (CMOs), to service line leads or to whomever had P&L responsibility for the accountable care organization (ACO) affiliated with their healthcare system. Only one analyst mentioned the CIO in her organization.\u00a0\n\u201cThe others turned around and said, \u2018Really? We can\u2019t give our CIO anything. They\u2019re so overwhelmed with the EHR [electronic health record] that they can\u2019t do anything right now. They\u2019re just keeping the lights on.\u2019\u201d Among the CIO\u2019s main tasks, Moore notes, are maintaining network services and security, implementing EHRs and upgrading their systems. PHM analytics are an additional layer of complexity they don\u2019t have time to deal with, he avers.\u00a0\nDennis Weaver, MD, executive vice president and chief medical officer, consulting and management division, for the Advisory Board Co., agrees that CIOs don\u2019t always supervise the analytics area in healthcare organizations. However, he doesn\u2019t see them being taken out of the loop. Instead, he says, the CIOs are working closely with the \u201coperators\u201d \u2013 the CFOs, CMOs and so on \u2013 to whom the PHM analysts report.\u00a0\n[Related: In pursuit of HIPAA, a new compliance gap arises]\u00a0\n\u201cThe best organizations are taking more of a dyad approach,\u201d Weaver observes. \u201cThe operator and the technologist are both at the table, having that conversation, so you\u2019ve got the right technology support to support the operator. A lot of times, the operator may be running the analytic shop. But one of the things we\u2019ve found is that while the CIO may not be running the analytics shop, the CIO is a critical partner. Because to do the analytics, you have to both collect the data and then pull it out of the operational data warehouse and put it into an analytic capability to be able to analyze it.\u201d\u00a0\nWhat happens in organizations where the analysts report to the operators and the CIO doesn\u2019t have input? \u201cThose places that have gone to the operator model find that begins to break if they don\u2019t keep a consistent relationship with the technology folks,\u201d he responds.\u00a0\nTension in the C-suite\nThere is a tension between everything that CIOs must do to keep the lights on in hospitals and other parts of healthcare systems and the complex demands of supporting PHM, Weaver acknowledges. \u201cBut it\u2019s not different than what else the CIO has to do,\u201d he says. \u201cThere\u2019s also a tension between the CIO and the CFO to make sure all the functions around revenue cycle management work. There\u2019s a tension between the CIO and the CMO when the EHR goes down. That\u2019s just the role of the CIO. I don\u2019t know that I see that tension has changed dramatically. Now there\u2019s the population health management component, which is the new \u2018customer,\u2019 if you will, and they\u2019ve got to service that as well. But the good CIOs do it.\u201d\u00a0\nWhere a lot of healthcare organizations go wrong, Weaver notes, is in not striking the right balance between clinical and business intelligence \u2013 which are closely interrelated in PHM. \u201cIn the clinical component, you\u2019re looking at [health] risk stratification, clinical decision support, disease registries, gaps in care, and outcomes measurement, but many organizations have focused too much on the clinical side and haven\u2019t focused enough on the financial side. What revenue is being generated, whether it\u2019s fee for service or risk-based revenue, and what\u2019s the cost of those operations?\u00a0\n\u201cHealthcare leaders are focused on population health and the analytics that go with it. But I think they\u2019re too focused on the clinical analytics and they need to focus more on the financial component.\u201d\u00a0\n[Related: FHIR blazes new (and needed) path in healthcare]\u00a0\nThese are the kinds of strategic decisions that C-suite executives must make as they enter the new, uncharted realm of population health management. Here again, they will need to rely on the expertise of CIOs who understand what is involved in analyzing data for both their clinical and financial implications.\u00a0\nIn interviews with InformationWeek Healthcare three years ago, leading CIOs said that they were taking an increasingly important role in their organizations\u2019 strategic decisions. For example, Ed Marx, then senior vice president and CIO of Texas Health Resources (THR), said he was helping to shape THR\u2019s business strategies as a member of its leadership council. He estimated that about 70 percent of his job was strategic and 30 percent was operational.\u00a0\nMarx also emphasized the need to ground health IT in clinical knowledge. He and his senior staff members all \u201crounded\u201d regularly with clinicians in one of THR\u2019s hospitals to understand the nuances of clinical workflow, he said.\u00a0\nA healthy dose of collaboration\nJoy Grosser, CIO of the seven-hospital Iowa Health System, said that her organization consistently sought feedback from its doctors, nurses and administrators to inform its strategy in population health management. This wasn\u2019t merely about preparing for the future; the Iowa Health System already had an accountable care organization with contracts covering about 100,000 people.\u00a0\n"We are an IT-enabled organization," she said, explaining how clinical and IT staff worked together. "We want our strategic plan to be enabled by IT and information, but not to have compromises to that strategic plan made by IT. We want to drive side by side with the providers: collaboration is what we're trying to accomplish."