Population health is in a major state of change
CHICAGO -- Change is dominating the state of population health management in 2017. Whether it's large transformations, such as massive patient engagement initiatives and big investments in new population health IT platforms, or small shifts in clinical workflow and tweaks to EHR templates, the industry is in a state of flux.
It's an interesting fact, since healthcare has traditionally been "very resistant to change," said Cliff Frank, executive director of Somers Point, New Jersey-based Shore Quality Partners, speaking Monday at the HIMSS Pop Health Forum in Chicago. "We don't do change very well."
But though the shift has begun, it’s not exactly moving quickly. "We think we're changing really fast," said Frank. "The auto and technology industries would love to have five years to develop a new product, or 16 years to move to a new model of care."
But change is necessary to survive in this new reimbursement landscape, said Susan Hawkins, senior vice president of population health at Detroit's Henry Ford Health System.
"We're all playing in a bigger sandbox now. It's not just our four walls."
Susan Hawkins, Henry Ford Health System
"Value-based care is here to stay," said Hawkins. "It really doesn't matter what happens with repeal-and-replace." Whatever the political maneuverings on Capitol Hill, her job as a population health leader is to stay the course, charting new innovations toward greater access to higher-quality care for lower costs, she said.
In this new era, the key for providers and payers alike is to be agile enough to sense where changes are happening and adjust strategies accordingly, said Joel Gleason, global head of provider market at Cognizant Healthcare. A crucial example of that, he said, is to "tune our systems and models to focus on outcomes."
Another innovation he's seen more of lately is a more holistic approach to data aggregation and integration, with payers working to ensure that they and providers are seeing information – not just clinicals and financials, but increasingly sociodemographic and geographic data – "through a single pane of glass."
Similar efforts to ensure uniformity are are underway at Chicago's NorthShore University Health System, said Smita Patel, a neurology, integrative medicine and sleep disorders specialist at NorthShore Neurological Institute.
"We're creating a practice-based network, where all our providers use the same structured document" as they spend their days logging data into the EHR, she said. "We all have same forms, same measures."
For its part, Henry Ford Health has been changing its focus in recent years, said Hawkins, keeping close watch on three specific areas to drive improvement in population health management.
But homing in on complex chronic disease, the health system has been able to realize a 20 to 40 percent reduction in ER utilization, she said. That's encouraging, but it's still what she calls "low-hanging fruit."
More ambitiously, Henry Ford has been looking closely at medical variation – building protocols into its EHR that alert clinicians when to seek consultations from specialists, or order certain tests – and also at post-acute care, which has enabled reductions in lengths of stay in its skilled nursing facilities.
There have been changes on the technology side of the equation too, said Gleason. While there was something of a gold rush five or so years ago toward emerging population health tools, he sees the market maturing and thinks there's "going to continue to be a consolidation of unique standalone offerings."
More population health vendors will be working to offer "more offerings under one tent," as the need for "data liquidity and KPI-based usability" continues to increase, he said. APIs will be critical to connecting various components – analytics, care management and more – and serving up data where and when it's needed.
At Henry Ford, for instance, Hawkins said the health system has two different predictive analytics tools, with 10 percent overlap. "That's not going to help us," she said.
But other technologies are already bringing pop health returns. Henry Ford offers asynchronous e-visits through Epic's MyChart, for example. Patients can email providers and get back same-day responses with prescriptions, treatment recommendations and more.
Mobile visits, where patients are linked with physicians "in real-time on the phone," are another promising development. But "some insurers are paying for that, and some aren't," said Hawkins.
Mental health – psychiatric consults for certain patients right at the point of care – is another area Henry Ford is exploring, she said.
Addressing social determinants is a key part of any successful pop health program, she added, noting that Henry Ford is working with a company that's helping it identify a broader array of socioeconomic factors for patients – not just their ethnicity and the language they speak at home, but information about how stable their housing is and their access to reliable transportation.
"Those are all non-clinical in nature but they have a tremendous impact," said Hawkins.
By assessing those social factors, as well as the patient's motivation to change unhealthy habits – smoking cessation, for example – the health system can often then connect them to a community resource for help, she said.
"We're all playing in a bigger sandbox now," said Hawkins. "It's not just our four walls."
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