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Intelligence Report: Toward Population Health

Michael Zeis, for HealthLeaders Media, October 14, 2013

>Scale requirements. Hospitals and health systems are examining their served markets and admission levels to glean insight into scale requirements. Lancaster Health serves a community of 500,000, and counts annual admissions at just under 40,000. "We have about 18,000 patients in fee-for-service Medicare," says McGowan, "patients who are managed by primary care physicians who are fully aligned and employed by us. Some may say that may not be enough scale to take financial risk like the health plans take, because they spread the risk over a region or over the nation."

Among the options to consider for increasing scale are partnerships and joint ventures, mergers and acquisitions, and becoming more integrated with care partners. McGowan observes, "Some think that you have to be really big. Some think that you have to be fully owned and integrated with a health plan like those providers that own a plan." She notes that in Pennsylvania, where Lancaster competes, two high-profile health systems are developing scale by acquiring additional hospitals.

Providers know healthcare

Payers may know the data, the population, risk, and risk assessment. But healthcare is the domain of providers. Early steps toward population health can yield valuable learning about both the nature of risk and the nature of the changes required to deliver healthcare in a more efficient fashion.

"Payers are not well orchestrated across the care continuum. Providers have touch points with patients throughout their lives, within the community," McGowan says.

Providers working together in an ACO agreement, for instance, can align themselves with population health objectives while gaining exposure to delivering care in a shared-risk environment, she says. Working toward population health objectives means that partners will modify care delivery in concert. For instance, nearly half (49%) expect to deploy health coaches or patient navigators within the year, a sign of willingness to invest along with partners in the care continuum. Respondents expect to improve access to primary care through outreach with community organizations (45%), primary care redesign (42%), and pursuing relationships with clinics and walk-in centers (40%).

According to McGowan, providers should expect to make some investments to enhance the care-delivery system. "There will be a number of things like the care processes and the support associated with managing high-risk patients or people with chronic conditions." She sees the patient-centered medical home as an environment that is adaptable to population health management, possibly evolving out of primary care practices. "Providers can expect to help rebuild the primary care office, perhaps reengineering primary care into patient-centered medical homes, so that care providers can do a better job at managing panels of people and spend more of their time on health promotion."

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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