6 Steps to a Sturdy ‘House’ for Population Health

To avoid ending up with a flimsy strategy, consider the philosophy used by Dignity Health’s population health department.

Julie Bietsch, vice president of population health management for Dignity Health in Phoenix, has a diverse background as a registered nurse as well as a longtime executive in the payer world. But to explain her health system’s philosophy toward population health, she points to a construction analogy.

“When we first launched our population health strategy, we used the analogy that we’re building a house,” said Bietsch last week during the HealthLeaders Media Population Health Exchange, a gathering of more than 40 invited senior health executives in Colorado Springs, CO.

“The first thing you have to know is what kind of house you want to build. We wanted to build a house that was affordable for patients, was of high quality, and met their needs and added value to them,” she said.

To do so, the team created the following elements:

1. Foundation

“Our foundation was our network—our physicians,” she said. This phase also refers to the time to determine the size and shape of one’s foundation or network.

2. Walls

Adding walls means selecting the right clinical pathways and platforms to share consistency across your clinical model. It must also be focused on the ambulatory market, she said.

3. Doors

Doors enable referrals, Bietsch explained. “What goes inside and outside of your house through the referral process?” 

You have a better chance of managing quality of care and cost efficiency if patients stay within your network.

4. Windows

The windows are your analytics. “How do you look into your house and outside of your house using analytics?”

5. Roof

The roof is made up of payers and patients and a plan for marketing to them.

Marketing can vary drastically among Medicaid, Medicare, Medicare Advantage, Medicare Shared Savings Plans, commercial plans, and direct-to-consumer products. “So we had to decide who we were going to sell this house to,” she said.

6. Decorations

Decorating must be the final step, Bietsch said.

“If we don’t have walls up, we don’t have windows up, and a vendor is trying to sell me an innovative patient engagement tool—and I don’t have a network and I don’t have a clinical program—I’m not ready to decorate my house yet,” she said.

“So if I buy a new tool, it’s basically going to sit on a shelf because I can’t integrate it with my clinical solutions and our network of providers will not use it.”

However, it’s important to get buy-in for your plans early on.

“If you don’t sell and have people invest in your house in the beginning, they’re going to build their alternative house,” she says. “And their house is going to be made of sticks—and cost the buyer more in the end.”