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Population Health Evolved: A Provider Focus

By Josh Berlin, JD .

As seen in the Westchester County Business Journal and the Fairfield County Business Journal

‘Population health management’ has become such a commonly utilized and accepted term in healthcare today, that one could argue it is as often overused and ill-defined as the term ‘strategy’ is in general business. With its genesis largely in the public health world, often attributed in the early 2000s to Drs. David Kindig and Greg Stoddart at the University of Wisconsin, the focus historically included the following elements – health outcomes, health determinants and interventions, and policies linking health determinants to health outcomes.

Today, and particularly as it relates to healthcare providers, which includes hospitals and health systems, physician practices, and long-term care organizations, the concept of population health management (“PHM”) has evolved from a ‘system’ of measurement to include a variety of factors more relevant to a dynamically changing healthcare industry. The capability to execute with excellence on PHM has become one of the key drivers for success for healthcare providers, which will continue to grow measurably over time.

The healthcare landscape continues to evolve dramatically, significantly disrupting the business models and strategies that providers and payors have depended upon for many years. More specifically, the change in reimbursement from fee-for-service, in which volume is the key driver, to fee-for-value, in which high-quality care at lower costs propels reimbursement, has led to a tumultuous period in which healthcare providers have reassessed how best to compete. In this value-driven environment, it is no coincidence an enhanced focus on PHM has arisen, considering that requisite in the reimbursement shift is an orientation towards improved health outcomes for individuals over an extended period of time, underpinned by amplified quality measures and metrics, and assessment based upon performance rigor and discipline.

All to say, certain core components, at a minimum, are required for an organization to have sustained success with its PHM strategy. In particular, a provider organization desiring to amplify its PHM focus, should concentrate upon four areas, described as follows:

  • Enterprise Structure & Membership – including, but not limited to, leadership, education, human capital, organizational structure, and physician alignment
  • Clinical Maturity – including, but not limited to, clinical pathways/protocols, care management/coordination, and performance management/improvement
  • Information Management – including, but not limited to, infrastructure/interoperability, data integrity, tools/technology, and reporting
  • Contracting & Distribution – including, but not limited to, funding models, risk-based contracting, and alignment of financial incentives and funds flow

Developing a quantitative and qualitative understanding in these four areas has been critical for organizations to develop and evolve their PHM efforts. By evaluating the position of the organization in each of these areas, provider organizations can develop a highly-effective set of steps to advance the organization’s agenda moving forward.

The first area, Enterprise Structure & Membership, encompasses all of the activities an organization undertakes supporting its governance, design, and internal and external relationships, with a critical eye towards developing and integrating a sustainable PHM initiative. The second area, Clinical Maturity, spans those activities coordinating reliable and consistent clinical practices and programs, along with the rigor and discipline required to measure success in a PHM-concentrated environment. The third area, Information Management, embraces the need to understand an organization’s data and the tools required to move towards action, which accelerates and enables any PHM strategic initiative. Finally, Contracting & Distribution contemplates the funding models and financial risk sharing that underpin an outcome-oriented PHM program.

Just like with any strategy, defining the hoped-for future of an organization is an essential initial act in embarking on the development of a PHM initiative. It is far more effective and efficient to align the internal and external components required to achieve PHM success if you understand the direction towards which you want to drive. Given the core areas bulleted previously, an organization should be able to both identify opportunities for improvement and develop a path towards meeting its long-term desired goals and objectives. This initial evaluation by healthcare providers across these four key areas facilitates an understanding of areas in need of emphasis that exist between today’s operating agenda and tomorrow’s intended future, while leading the organization to set in motion solutions to bridge any current areas of weakness.

Finally, as with any deliberate initiative, it is important to consider the industry staying power and long-term relevance of PHM, as well as its importance for the success of the organization. The advancements of technology, including artificial/augmented intelligence and predictive cloud computing, along with the evolution of policy towards more incentivized arrangements, at least indicate that those provider organizations embracing sound PHM efforts will be better positioned, no matter the market/industry changes to come. As a result, fully embracing an overarching PHM perspective, inclusive of a view to the whole person, no matter as a patient, employee, member, consumer or beneficiary, will likely enhance an organization’s path to success over time.

Developing a robust PHM strategy is a decisive step for healthcare providers that aim for current and long-term relevance and sustainability. Starting with the four key areas described above, organizations can achieve uncovering their key PHM disparities and set in motion a process that leads to weaving PHM into their enduring strategic fabric, cascading the accompanying efforts throughout the four walls of an organization and well beyond.

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