Whether you call it population health, accountable care or a value-based reimbursement model, the structure and requirements around the delivery of patient care in our country are changing.
While there are precious few with broad experience in the field, there are a multitude of vendors and consultants offering the “perfect solution” to executive leaders at hospitals. They must sort through a dizzying array of names and solutions while working to set a direction that helps the organization develop processes and capabilities that will deliver positive ROI and flex with the evolving landscape.
To be clear: This is difficult work and no one vendor has a magic bullet solution. But there is a roadmap.
Where to begin?
Let’s start by simplifying. First, focus on how you will measure success. There are countless measures used to evaluate value and quality (screening rates, hospital readmissions, patient satisfaction, emergency care utilization, etc.). It can be daunting to solve for everything at once. Regardless of what you call it, the goals of population health are in essence the same: give patients a high quality care experience, increase the operational efficiency of the care that is delivered, and improve the overall health management for the specific population that is being managed.
Next, find a testing ground. Identify a population for which you can test different approaches and create a management process to gain competencies required for total care management. One strategy is to start with the employees and dependents that are part of the hospital’s self-funded health plan.
With this population segment as the target, it is possible to evaluate recent claims data and assess the key drivers for cost and opportunities to develop management models for improved care coordination. While there are certainly different success criteria between an employee population and Medicare, Medicaid or even other commercial populations, focusing on an organization’s own employees still allows for the development of key capabilities and tools that can transfer well to these other segments.
Starting with your own employees provides the best opportunity to identify and develop provider leadership and to test management, workflows and systems that can then be scaled more effectively as the health system is required to take on new populations.
Once this path is selected, real work can begin.
Finding opportunities for proactive care
Leveraging a combination of clinical and claims data, as well as analytics tools, it is possible to identify that subset of the population that represents the greatest care complexity and highest costs, and the greatest opportunity for outcome improvement. From these insights, your organization can begin transitioning toward a proactive care posture and address potential gaps such as medication compliance issues, vaccinations, preventative check-ups and screenings, etc.). A comprehensive care coordination model that focuses on a high-priority population subset is the most powerful tool that any organization can develop towards achieving success in total care management. Of course, competency here is difficult and requires significant time, effort and resources.
Hospitals and physicians can move from dependence on fee-for-service models to a role as complete care managers for a community. This capability will have long-term value – to health plans that require financial predictability or local government entities that, in addition, want a better healthcare experience for their employees and their families. Doing so will allow provider systems to control a larger portion of the healthcare dollar and, through careful care management, help to offset the reduction in admits and perhaps avoid the low-cost vendor role that they could be forced into by health plans and other payers. This not only gives these systems more to offer health plans and government payers, but also tools for self-funded employer groups to better manage costs and experience through a local solution.
Photo: Flickr user Charles Nadeau
Frank Bird serves as Principal of Health Care Strategic Consulting at Vizient, Inc. With more than 20 years of experience serving in executive positions with health plans responsible for contract negotiation, development of delivery systems and networks, reimbursement and operational models and strategy, he expanded and built new and existing networks for commercial, Medicaid and SPD networks.
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