Adapting Population Health Strategy in a Changing Environment

Although the future of the Affordable Care Act and other regulations may be uncertain, certain strategies remain highly important for healthcare leaders to consider. In particular, major trends in health care point to the continued need for population health management.

Efforts to control healthcare spending have accelerated the move to a value-based system. As of January 2016, the government had transitioned 30 percent of Medicare payment to value-based models. And that transition can be expected to continue under the Trump administration, as its underlying aim of reducing the cost of health care while improving its quality has enjoyed broad bipartisan support.

Such support also has been extended to initiatives such as bundled payments and the Medicare Access and CHIP Reauthorization Act (MACRA), which changes the way Medicare pays for physician services. In fact, steps for success under MACRA, such as reducing care variation and improving access, also are objectives of population health management.

And given that commercial health plans also are collaborating with healthcare organizations around managing patients’ health, population health management isn’t likely to lose the support of these health plans, even if government support were to fade.

Therefore, given that an industry focus on population health management is here to stay, healthcare organizations should seize opportunities to take population health management to another level, based on lessons learned from advanced adopters and the ways in which health care is evolving. Four strategies lay the foundation for healthcare organizations’ future success.

Refocus the Clinical Strategy

It’s time for health system leaders to think differently about their clinical strategy—to envision their organizations as systems of care rather than as aggregations of parts. This more holistic viewpoint will better position leaders to make decisions that result in a seamless care experience for patients wherever they travel within the health system. Managing and facilitating the spaces before, between, and after the bricks and mortar, and changing the organization’s point of view from “patients” to “people” and from market share to attributed lives will provide a new focus on the populations served, which is the essence of population health management.

For example, research tells us that millennials want a healthcare organization that feels connected at each point of their healthcare journey. They don’t want to wait for care; many would prefer to get their care online to avoid visiting a healthcare facility. Millennials also prefer to use mobile apps to manage their health and health data. In fact, according to a 2015 Salesforce/Harris Poll survey, 60 percent of millennials are interested in using telehealth options to eliminate in-person physician visits; a 2016 update to that research found that 70 percent of millennials would “choose a primary care doctor who offers a patient app (which allows patients to make appointments, see bills, view health data, etc.) over one that does not.” ^a

We know, too, that patients don’t think of themselves in terms of where they fall on the “bricks and mortar” continuum—i.e., whether they are a hospital, a rehab, or a homecare patient. They think of themselves as people with health challenges who require assistance from healthcare professionals.

Adopting a population health mindset requires administrative and finance leaders to develop a new partnership with physicians and clinicians across the continuum of care with a focus on finding ways to build long-term relationships with people and encouraging ongoing engagement with them, rather limited interactions with patients occurring solely when they are sick. Pursuing these goals requires finance leaders and clinicians alike to give deliberate thought to how all the pieces of care and services an organization delivers fit together from the patient’s perspective. Supportive care coordination and management programs that are integrated with the system’s care delivery network can be highly effective in accomplishing these goals.

Maintaining a patient-centered view results not only in improved outcomes and higher-quality care but also in greater operational efficiency and increased capacity, and in work that is more rewarding for physicians, clinicians, and employees. Well-managed patient care can reduce patients’ need for high-intensity services, which ultimately will decrease hospital volumes. Long-term relationships with broader populations help offset this lost volume by allowing organizations to serve larger populations overall with the right care, at the right place, and at the right time. Essential strategies that can replace this lost volume through new demand from new attributed lives include growing attributed populations by developing strong primary care networks; demonstrating high performance on quality, cost, and experience outcomes; and building tight network relationships that keep patients in network. Thoughtful strategic planning to ensure that the system’s service offerings are sized and organized to meet the needs of the new healthcare marketplace also is essential.

One way to refine a provider’s clinical strategy is by partnering with other healthcare or community organizations to determine ways to make a deeper impact on population health. Here, cultural alignment is key. For collaborative initiatives to work well, healthcare leaders should reach out to other organizations and say: “We want to work together across a greater geography and make a greater impact than is possible on our own. Let’s determine how we’re going to measure our success and align culturally. Let’s establish a shared vision.”

Form Cross-Divisional Clinical Service Lines

Developing a clinical strategy for population health management requires buy-in and input from everyone across a health system—from physicians and clinicians to operations, finance, and IT. And the ability to execute that strategy requires a nimbleness that can be achieved only when the right people are brought together at the right time to develop solutions to challenges and implement them successfully. Forward-looking, cross-divisional service lines can be key drivers of the changes needed to succeed.

A major stumbling block to population health management is the mindset that “the clinical people are going to do clinical work, the finance people are going to do finance work, the operations people are going to do operations work, and nobody’s going to mess with my work.” In this siloed model, clinicians who attempt to design work without the input of finance specialists or operations professionals may effectively deprive themselves of a well-rounded view of the types of approaches that are available to be considered, which could be obtained only through a collaborative approach. Subsequently, operators who lack the benefit of clinical insight could determine that the approach developed solely by the clinicians is impractical, resulting in incomplete or inconsistent implementation of the clinical model.

The most successful organizations bring representatives from all necessary specialties together around a topic to drive clinical change. This clinical and operational alignment approach ensures key input is not left out of the design and decision-making processes, dramatically increasing the likelihood of successful implementation.

The implications for clinical service line leadership are far-reaching, and success stories are emerging. In one healthcare organization, for example, 200 physicians have volunteered to be part of a clinical design initiative that encompasses 14 hospitals across a broad geographic area.

In another story, a group of health systems collaborated recently to analyze population health data and opportunities to make a significant impact. As a part of this effort, physicians, clinicians, performance improvement specialists, and data analysts work together to suggest five to seven actions health systems can undertake to support enhanced health and outcomes. Then, performance improvement specialists work with IT professionals to determine how best to track specific measures, as well as with operations team members to ensure processes are integrated into daily work flow.

As yet another example, a health system with multiple facilities has improved its clinical, operational, and financial performance by building collaboration into its structure. Each service line is led by a clinician president and an operations vice president who work with physicians and representatives from nursing, performance improvement, and data analytics to define clinical workflows that should be integrated and implemented across the entire organization.

Develop an Infrastructure That Supports Population Health Initiatives

One of the biggest obstacles for healthcare organizations in developing population health management solutions is a lack of required infrastructure or resources. Such circumstances put organizations at risk of negative outcomes, including loss of top talent. Often the issue comes down to staffing resources, particularly around process improvements.

For example, consider that the team determining best practices for a population health strategy recommends that each patient visit should include a review of the patient’s medications. But a physician may not have time to take on this task within the space of a 10-minute visit without support from another team member. To implement this change, someone must review the workload to find a way for the medication reviews to be performed without adding FTEs, possibly through elimination of redundancies in processes. In short, specialists in performance improvement or project management are key to an organization’s ability to organize around population health management for the long term.

Many healthcare organizations hire executives to oversee their population health strategy. Such leaders bring together team members skilled in care design across the continuum, care management, data analytics, and managing utilization for effective care not only of patients with chronic illness but also of patients at risk of developing a chronic condition. These leaders also can serve as integration points for contracting and value-based care strategies that align with their organization’s population health strategy.

Technology also is critical to any population health program. For example, electronic health records that have been expanded with tools to power sophisticated utilization management and seamless care coordination support enhanced quality of care and reduced cost. Tools to integrate information across settings and systems are equally important to a population health strategy, as are workflow management tools that streamline and integrate work. Although technology is not the sole factor in enabling “population health management,” such tools and enablers are critical to attaining clinical consistency and reliability. To fully realize the impact of these tools, an organization must implement a robust informatics program that features comprehensive, integrated clinical and claims data and an advanced analytics process that both identifies performance gaps and interprets the data and makes them actionable.

Engage Patients and Families More Effectively

To successfully engage patients, healthcare organizations must find ways to connect with people at all stages of care and align the resources they need across the continuum of care, ensuring that care is well-coordinated and appropriately managed.

Technology may be helpful in this area, particularly when solutions are easily integrated into a patient’s life. For example, one app enables people to triage themselves on their phone. It advises them when they should seek treatment at an urgent care center and when they should be taken to the emergency department. The response rate to such guidance is quite high. There also are apps that remind patients to complete their physical therapy exercises or take their medications at specific times.

These tools enable people to live their lives with minimal interruption while they are under care. When patients have tools that make it easy for them to stay well, manage their health conditions, or recover from an illness, they’re more likely to take an active role in their own care. Take, for example, the adoption rates of tools such as mobile apps that facilitate self-care decision making for its users. And these interventions are effective: A meta-analysis of 23 years of studies in the Journal of the American Heart Association found that participants in mobile device interventions were able to increase their physical activity and lose body fat. ^b

Boldly Rethinking Population Health

Although there almost certainly will be changes in the healthcare environment under a new administration, the drivers that led hospitals and health systems to adopt population health management—such as the need to reduce healthcare costs, improve outcomes, and decrease utilization—will remain. And because support for value-based initiatives has come from both sides of the aisle in Washington, D.C., the question is less about whether to move forward with population health than how.

Healthcare organizations should be prepared to adapt their existing population health management strategies to meet the challenges of a changing environment. A focus on clinical strategies that enable other key activities, such as creating consistent and reliable care in hospitals to reduce the cost to treat, integrating care across the continuum to enable in-network utilization and drive growth, and creating efficient care delivery models in settings across the continuum, will be key.

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Katherine W. Ziegler, BSN, MHA, is a director, healthcare strategic solutions, Navigant, Minneapolis. 

Footnotes

a. “2015 State of the Connected Patient,” Salesforce; “2016 Connected Patient Report,” Salesforce.

b. Afshin, A., Bablola, D., Mclean, M., et al., “Information Technology and Lifestyle: A Systematic Evaluation of Internet and Mobile Interventions for Improving Diet, Physical Activity, Obesity, Tobacco, and Alcohol Use,” Journal of the American Heart Association, Aug. 31, 2016.