Intelligence Report: Toward Population Health

Michael Zeis, for HealthLeaders Media , October 14, 2013

Healthcare providers appear willing to embrace the new model of population health, but the first order of business for many is to sort out the financial issues.

This article appears in the October issue of HealthLeaders magazine.

Population Health

At its most basic, population health involves improving the health status of a given population by ensuring that members of the population are receiving the healthcare they should be receiving. How? First, one has to define the population. Then one must know what care the population is receiving. Next, identify gaps by comparing the care the population is receiving with the care the population should be getting. Finally, the care delivery system must be able to address care gaps.

Although the tactical implications of these simple statements are considerable, the first order of business for many healthcare providers is to try to sort out financial issues.

With 61% of respondents to our Population Health Survey saying they have selected a patient population and are working to improve the health of that population, it is clear that healthcare leaders recognize the importance of population health management.

However, improving the health of a defined population requires a complex set of activities, many of which are new to healthcare providers. As one might expect with an initiative that seems to have the flavor of a concept rather than a business plan, our research demonstrates that providers have more command over disciplines that have a ring of familiarity, and we see lower comfort levels with newer tasks.

For instance, more than half of respondents (57%) are offering a wellness program now or within the next 12 months. But fewer (48%) expect to take on data analytics functions, a task that most would consider to be more challenging than data integration.

Reduced utilization

Providers face a set of finance-related decisions, mostly having to do with the risk-sharing assumption that gives healthcare reform its foundation. "Health reform is all about practicing population-based medicine. And the only way we're going to bend the cost curve is by keeping people out of the hospital, reducing unnecessary utilization," says advisor David B. Nash, MD, MBA, founding dean of Philadelphia-based Jefferson School of Population Health—one of six schools and colleges that constitute Thomas Jefferson University, which partners with Thomas Jefferson University Hospitals to care for its patients along with healthcare education and research. "So that means we have to be in the health business, not the sick business. To do that, we're going to have to think about what our community connections are like."

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1 comments on "Intelligence Report: Toward Population Health"

bob sigmond (10/14/2013 at 11:19 AM)
The best and easiest way for hospitals and health systems to embrace the new model of population health is to collaborate with a Blue Cross plan or other insurer which already understands population heath. Together the two organizations can design a strategic plan for transitioning to population health and agree on an annual provider budget that carries out that strategic plan. This will work best if the hospital turns over its entire billing and collection function [and collection staff which remains at the provider site] to the collaborating third party payer organization which takes over all collections and pays the hospital/health system a single monthly check that covers all the provider organization's expenditures. This avoids the provider organization having to duplicate all the initial preparatory work that the third party payer organization has gone through in becoming expert in population health. With no more involvement with fee-for-service and collections, with no more uncompensated care, and with no more worry about the bottom line, the collaborating provider organization can concentrate on incrementally transitioning into population health, with its collaborating third party payer organization, with goals of increasing quality and access while reducing expenditures. Clearly, many details have to be worked out, including [a] the method for making adjustments whenever the expenditure budget estimates turn out to be too low, [b] how to divide up any net gains or losses at the end of the year, etc. But with trust between the two collaborating organizations, the transition to population health will be remarkably easy and effective. For more information about this approach, call me at 215-561-5730 or e-mail. Right on! Bob




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