Population Health

John Studebaker, MD, MS

Forward Health Group, Inc.

Objectives

• Describe the concept of population health management

• Identify the importance of population health management in today’s healthcare climate

• List the approaches to implementing and using population health management

What is population health?

“The health outcomes of a group of individuals, including the distribution of such outcomes within the group.”

--Kindig, DA, Stoddart G. (2003). What is population health? American Journal of Public Health, 93, 366-369

Individual health

Panel

Clinic or System

Public Health

The space between individual health and public health

• Responsibility for a group of patients• NOT restricted by a disease, nor by a

demographic, nor by geography

Population health management

• A collection of physician-supervised interventions, implemented for populations defined by a healthcare need or condition, that help patients and caregivers optimize care, prevent future complications, and maximize opportunities for wellness

Why is population health important now?

• Evolution• Risk• Quality• Management

Evolution

• Current growth rate in health care spending is not sustainable

• Current system rewards treating illness much more so than preventing it

• Payers (including CMS) are motivated to try different approaches

• Improving the patient experience of care (including quality and satisfaction)

• Improving the health of populations• Reducing the per capita cost of health care

Evolution

• Groups that learn how to operate efficiently and effectively will have a distinct advantages– Negotiating power–Marketing advantage– Improved margin– Healthier patients

Risk

• Increasingly payers are shifting towards shared risk plans

• Healthy patients cost less to care for• Financially rewards both the payer and the

provider when patients stay healthy

• Concept of risk is well established• How do we apply to health care?– Diseases?– Hospitalizations?– Utilization patterns?– Genetics?

• Must have data

Quality

• Payers (including CMS) are examining methods to encourage improved quality

• Incentives to providers (and sometimes patients) who meet certain criteria

• Effective for process measures, more challenging for outcome measures

What is Quality?

• Determined by payers and national experts?• Determined by health systems?• Determined by patients?

Management

• How can risk be measured and managed?• How can quality be measured and managed?• How can compensation strategies engage

providers and care teams?

Timing is Everything

Timing is everything

• Transition from volume-based revenue models to value-based revenue models

• Practices must navigate carefully as the pendulum swings

• Must leverage available resources– People– Data– Dollars

What approaches are available to use/implement population health?

• Data• Analytic tools• Health care delivery methods• Reimbursement to support

Data

• Practice management systems• Claims• Electronic records• Health information exchanges• Registries

Analytic Tools

• Collect and organize• “Digest”• Identify and Display • Enable workflow • Engage clinical team

Data = Analytic Tools?

• Data is the input or analytic tools• Many try to use IT resources to yield analytic

capacity• Not scaleable• Not sustainable

Analytic tools for population health

• Use data from all your available sources• Common resource for your users• Organize into views that make sense• Track indicators of interest – measure what

you want/need to manage

Delivery

• Shifting from high volume to high value• Patient centered medical home (PCMH)• Population health nurses• Non-traditional “visits”

Reimbursement

• New structures - ACOs• Partnering with payers• Understanding risk-sharing contracts• Incentive programs

So, how do I implement population health management?

• Receptive leadership– Vision

• Engage the delivery team• Assemble the tools – Data collection and analysis–Workflow support

• Align incentives– Compensation– Revenue streams

W. Edwards Deming

Deming

• It does not happen all at once. There is no instant pudding.

• In God we trust, all others bring data.• It is not necessary to change. Survival is not

mandatory.• Does experience help? NO! Not if we are

doing the wrong things.

Improvement Approaches

• Lesson from Manufacturing– “The Toyota Way”– Lean– 6 Sigma

PDSA Cycle

Identify opportunityPlan change

Implement change

IntegrateStandardize

Collect dataAnalyze data

Summary

• Health care is evolving • Must be able to measure and manage risk for

your population(s)• Population health management is a necessary

element