Population Health Really Does Work

Philip Betbeze, January 22, 2016

At self-insured Houston Methodist, a population health pilot designed for staff members saw 50% of high-risk participants move into the low-risk pool within the first six months.

Houston had a problem.

Julia Andrieni, MD, went to Houston Methodist from UMass Memorial Medical Center two and a half years ago to see if the work she had helped pioneer under former Massachusetts Governor's namesake 'Mitt Romney' insurance plan, would also work in a market where population health wasn't necessarily dictated by payment policy.

Romneycare, you'll recall, was the model after which Obamacare, (the Patient Protection and Affordable Care Act) was patterned.


Julia Andrieni, MD

"In Massachusetts, I was there at a time when everyone had to have primary care overnight under the Mitt Romney plan," she says. "We realized immediately the need for new models of team-based care, the patient-centered medical home, [advanced-practice registered nurses, and] nurse practitioners as we were developing our primary care network."

So why come to a market where none of that was in place?

"I love a challenge," she says.

Signing on with Houston Methodist, the hospital where Michael DeBakey, MD, pioneered open-heart surgery, was especially exciting and challenging for Andrieni, given the hospital's history as a surgical specialty-oriented medical center.

As the new vice president of population health and primary care, she was tasked not only with building population health-based teams and treatment protocols, but also with building up a primary care network that didn't really exist when she arrived.

In the northeast, Andrieni says hospitals and physicians were already accountable for outcomes. "It started with process measures, then moved to outcomes measures," she says. "The expectations were that you had to reach them."

In contrast, fee-for-service is booming in Houston, just like the local economy, despite the recent oil market crash. That means a lot of independent physicians aren't feeling the pressure from payers to be in any type of risk arrangements.

Yet Houston Methodist brought Andrieni in because senior leadership realized that their days of risk-free provision of services are numbered, and without a primary care network, the health system is vulnerable.

Here and now, Andrieni's experience in risk contracting is on the back burner as she works to build an employed primary care network and an alignment model for those who want to stay independent.

Those physicians, in addition to the employed cohort, make up the Physicians Alliance for Quality, an internal physician organization at Methodist. Employed and independent doctors work together to improve handoffs and the care continuum generally, and independents pay a small membership fee to be part of it.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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