Population health needs to be managed at all levels
Jonathan Niloff, MD, is vice president and CMO for McKesson Connected Care & Analytics. He was the founder and CMO for MedVentive, which is now part of McKesson. In his current role, Niloff is responsible for the strategic development of population health analytics and solutions. His core areas of expertise include accountable care, population health, improving the quality and efficiency of healthcare delivery, helping organizations become clinically integrated and improving cost of care among at-risk populations and networks.
Q. What are the top foundational strategies for managing population health?
A: Well, I think we’re in the second generation in this business of population heath and it’s largely been driven by the reemergence of value-based contracting.
The first wave was in the 80s and 90s with the managed care model. Now, I think this newer version initially started with the CMS shared-savings program along with lots of other types of insurance models.
There are several important strategies for managing population health. Most importantly, it is necessary to achieve organizational alignment around a population health strategy. Secondly, it is key to align the organization around how they deliver care and to be consistent with population control. And, you need to control care across the continuum. Think about care dollars for seniors and acute care. You need to manage ambulatory care, home rehabilitation or whatever their needs might be.
On a more granular level, population health falls into three categories. Population management, which is focused on care coordination, a team-based approach to care and identifying high-cost patients, and focusing your resources on those with the highest costs.
Secondly, you need to emphasize programs that focus on cost and utilization and identifying where money is going and take advantage of opportunities to influence cost and quality.
Lastly, you need to manage practice pattern variation, by which I mean profiling different providers, understanding how care is delivered and looking for areas ripe for improvement.
In the end, you need physician engagement and patient engagement programs. You need everyone playing or you won’t get anywhere.
On top of this, it is key for organizations trying to do this to have an IT infrastructure that gives them a platform to stand on in a cost-efficient fashion. It means being able to acquire data across the care continuum, which is always a challenge. It means being able to access the care registry and care programs.
In an optimal world, all of the solutions would be interoperable with one set of truths and you would be able to leverage a good platform to drive particular efficiencies and generate more operational efficiencies.
Q. How do you ensure that all parties within a healthcare organization – from the executive team to the clinical and administrative teams – are on the same page when it comes to population health?
A. This is a question of leadership and communication. Whoever is setting the strategy, it is their responsibility to do their homework and get people on the same page. They will need to recognize that when an organization like a healthcare facility is undergoing a change like this, there will be challenges such as decreased volumes. You’re going to have to address this and make sure people from the C-suite to the care management team can still perform and misaligned objectives or expectations aren’t created.
Q. What are the best ways to engage or incentivize a physician to participate in a population health program?
A. There a couple different things. Physicians need to get one message. They can’t live in a selective world where someone is telling them to create more images and another person is telling them something different. Most physicians practice one way, and that’s the way it should be.
Physicians need good education about what the transformation means. Why is it good for patients, what does the business case mean for them (physicians) and you need good leadership delivering this message.
For physicians, it often boils down to incentives. A compensation model that shows rewards for better health outcomes and costs should be rewarded in a meaningful and impactful way. It’s also about making it easy for them -- putting the right processes in place to practice population health and leveraging those processes with the team so it becomes standard operating procedure and using technology to make it as easy and second-nature as possible. In other words, the most important information you need should be readily available and all of this should be presented in a workflow that makes it easy as possible.
Q. Was there a major turning point in 2014 in terms of a population health? Did you observe any provider success cases and what they did?
A. I think there has been a turning point generationally. In the 80s and 90s we had a gatekeeper model that was all about restricting care at the healthcare model. Now, the systems implemented are health registry programs that are designed to bridge the EHR and open up access to users up and down the enterprise.
What has struck me is in previous iterations, identifying high-cost patients and assigning care managers tended to be a late phenomenon and also tended to be done centrally. What I see now is a practice transformation and team approach much earlier. I would say deploying care managers, as part of the care team has become a core function.
It’s not just about the providers either. The community at large benefits by greater interaction with the healthcare facility while working with social agencies and creating more opportunities for the population. This has been a ground-level transformation.
While it’s not a turning point, seeing some of the non-traditional and off-site care centers is a real opportunity, as well. This is an excellent chance to keep patients out of the ER during off hours, and that’s good from a patient perspective.
A mature and strong IT platform is important for all these things because if you aren’t able to tie the information together from these disparate wellness sites, you create a bigger problem with gaps in data. Overlaying technologies are more important than ever.
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