6 Not-So-Good Reasons for Avoiding Population Health

HealthLeaders Media shows many health systems embracing strategies intended to improve the health of populations. But is it hype or reality?

One question I always try to ask senior leaders when interviewing them on any subject is how their organizations are progressing on population health initiatives. Sometimes the answers are short, sometimes they go on longer, but they're always illuminative. Mostly, leaders can point to a number of initiatives that add up to the magnitude of organizational restructuring necessary for competing in a population health-driven marketplace. More than occasionally, however, I hear that they're not doing much at all beyond CMS core measures.

Their reasons for holding back vary. Here are a few common ones:

• We're too small
• My state's dominant health insurer isn't interested in risk contracting
• None of our major employers are large enough for direct contracting or to put payers under pressure for value
• We can't afford the investments necessary
• We'll cannibalize our still-dominant fee-for-service business
• Embarking on this type of fundamental transformation is too risky

You can always find an excuse for not doing something. Ask my wife. But it seems to me that at minimum, senior leaders owe it to their organization to at least figure out how to address population health management with Medicare Shared Savings or better yet, with their own employees.

I don't ask this question of all the people I interview because I'm necessarily going to write about their preparations (or lack thereof) for population health. But I don't do it to kill time, either. I ask because I'm always curious about the degree to which big, hyped changes to healthcare's business model are translating into action. Here's what I'm trying to understand:

• What size organizations are buying in? (Mainly the larger ones, as you might expect, but several small organizations are finding a way.)
• Is size or lack of a coordinated care continuum a detriment, and are you taking steps to change so that your organization acquires such prerequisites through partnership or purchase?
• How much of what we hear about business model disruption is hype and what is of substance?

Relying on my informal surveying alone, I would guess that adoption of population health strategies was widespread; well more than two-thirds of the senior leaders I interview are excited about how they are embracing population health and changing healthcare for the better, eliminating waste, coordinating the care that was previously siloed, and adding the pieces necessary, through partnership or acquisition, to provide healthcare instead of sick care. Many happily say that this more aligned model is why they decided to make a career of healthcare in the first place.

Curtis Kretzinger, chief operating officer of Mosaic Life Care, until recently known as Heartland Health, in St. Joseph, MO, is making population health the strategic focus of the organization, and he says it's invigorating for him personally and for Mosaic's clinicians to find innovative ways to align with the patient's best health interests. He has high hopes for Mosaic's version of population health strategy.

"The problem with healthcare is it's focusing on the wrong end of the equation," he says. "What happens if I can keep you from being sick? Most are sick not because of illness, but because of their life. Wouldn't that be cool? Would you pay for that? Of course you would. We know how to do that."

Of course there's one major problem with such anecdotal surveying: selection bias. As writers, we tend to gravitate toward those organizations that are being bold—those who are innovating. No one wants to read about the status quo. Our readers already know how to deal with the situation as it is; they want to know how to adapt to what's coming. Which is why I'm glad I can rely on one of the dozen or so major surveys our research division produces each year to balance what I'm hearing from sources. Because population health, while hot, is not taking hold quite as quickly as I would have thought.

The standout statistic in our October research and analysis report is one where my informal questioning would have led me to the wrong conclusion: that for most healthcare organizations, population health is their future and they're working as quickly as they can to move from one business model to the other. The key insight into reality is in the responses to this question: How is your organization poised to improve the overall health of a population?

While 49% say they are "fully committed and under way," and 31% have experimental pilot programs under way, 20% have not reached the experimental stage—that is, with pilot programs and the like.

Many of us have lived through the failed promise of managed care, the mixed blessings of healthcare IT implementations, the Patient Protection and Affordable Care Act, the implementation of healthcare insurance exchanges, and the endless tinkering with payment methodologies by the Centers for Medicare and Medicaid Services. Hype is a spectator sport in healthcare.

But the fact is, many healthcare providers are still paid based on fee-for-service contracting, which is a disincentive for the radical changes that have to occur with a strategic pivot to a population health-based strategy.

Here's what I can say with some confidence: Whether today's population health strategies aimed at providing right care at the right time in the right setting will ultimately be successful is undetermined, but I applaud the efforts and the early results of those who are innovating efficiency into a bloated and often pernicious healthcare sector. By the time it is clear enough to distinguish hype from reality, it will probably be too late to change course.