The building blocks of population health management

Population health management shows promise in the quest for better health at a lower cost by creating an integrated system of care, rather than leaving consumers to fend for themselves. In 2013, expect to see more partnerships as companies build their population health infrastructure to include shared responsibility for patient outcomes and satisfaction, data collection and analysis, member education and engagement, and a focus on at-risk populations.

Collaborations can start small, targeting specific chronic diseases or patient groups. Bon Secours St. Francis Health System and Michelin North America collaborate to provide integrated care for Michelin employees and dependents with diabetes. Care ranges from coordination of specialists to buying groceries, providing education, and conducting work-site evaluations. Successes include patients who are able to stop insulin therapy and decreases in blood glucose levels, blood pressure, and weight.¹

Other partnerships allow large organizations to tap remote expertise. The Mayo Clinic Care Network connects nine systems, including Dartmouth-Hitchcock and Chicago’s NorthShore University HealthSystem. Patients and practitioners gain from Mayo Clinic expertise through e-consultations and an online database of clinical information. Members may refer complex cases to Mayo Clinic while providing follow-up care locally.²

Population health management sometimes involves co-management, giving physicians a governance role and basing compensation on outcomes. Geisinger Health System in Pennsylvania ties about 20% of physician pay to quality and efficiency and uses a bundled payment arrangement (ProvenCare) for some procedures, such as cardiac bypass surgery, reducing costs through fewer complications and readmissions and improved patient outcomes.³

But the shift to compensation based on value is only beginning to take hold. Only 47% of hospitals participating in a recent PwC Health Research Institute survey said they have a compensation plan based at least partially on metrics of quality, efficiency, or health outcomes.⁴

In some population health approaches, navigators or care managers assess the socioeconomic environment of patients and help remove barriers to improve adherence. A diabetic patient who keeps returning to the hospital might be taking insulin as prescribed but may not have a refrigerator to store it in or electricity to run the refrigerator—and insulin loses its effectiveness when exposed to excessive heat. Only when such underlying problems are identified and addressed will patients improve.

For care management, an Arizona hospital system contracts with Optum (of United Healthcare), providing Optum nurses access to patient electronic health records. The nurses consult with patients by phone, provide instructions, and set expectations for follow-up care. This has resulted in immediate responses to after-hours queries; reduced use of on-call physicians, ER visits, and hospitalizations; and improved patient satisfaction.⁵ Other insurers and providers are following suit.

Kindred Healthcare, a post-acute provider, reduced hospital readmission rates by more than 8% by forming “joint operating committees” with hospitals. One partnership discovered that a significant number of readmissions involved urinary tract infections acquired in the hospital. More active screening and treatment prior to patient discharge reduced readmissions.⁶

Implications

• Population health management requires major investments over multiple years, and requires trial and error. Convergence and consolidation must accelerate among otherwise disparate players.
• The push for higher quality and value requires standardization of processes and the ability to continually improve or risk losing reimbursement.
• Collaborations need a strong technology foundation, including web-based reporting tools that connect to clinical, financial, and administrative systems. Systems must support analytics across a wide spectrum of inpatient, outpatient, post-acute, and community services.