At the annual HealthLeaders Media CEO Exchange, leaders of hospital and healthcare systems speak candidly about both the difficulty and necessity of managing the health of populations.
Achieving the triple aim of healthcare is a messy road that will likely be paved with programs that haven't come close to improving cost, quality, or health outcomes. Population health, however, is one initiative that healthcare leaders believe is here to stay.
At the annual HealthLeaders Media CEO Exchange in Colorado Springs last week, leaders of hospital and healthcare systems spoke candidly about both the difficulty and necessity of managing the health of populations as a way to reign in healthcare costs while improving patients' health.
"Population health management is a fact," says Mark Herzog, FACHE, President and CEO of Holy Family Memorial, a health system that includes a medical center as well as a network of clinics and physicians in Manitowoc, WI.
Herzog, who has led HFM since 2001, is on a mission to improve the health of the 80,000 residents who live in the organization's service area. He calls it "right care," as in the right care at the right time and in the right place, but the most important thing, to Herzog, is that HFM does what is right for the community.
The singular focus aided in reworking HFM's mission statement to a single sentence that provides a clearer path to what it hopes to achieve: "Holy Family Memorial is a network of health professionals who, rooted in the healing ministry of Jesus Christ, provide services to help individuals and our communities achieve healthier lives."
Through Lean Six Sigma leadership principles, HFM is now a flatter organization, administratively, which Herzog believes helps its ability to adapt to changing healthcare industry pressures while staying true to its mission. For example, in 2001, there were 10 senior leadership positions, now there are five.
HFM's strategy to improve the health of its community members has primarily been focused on reducing utilization of inpatient services and instead providing access to the appropriate care in its outpatient clinics.
Emphasizing outpatient care is a popular strategy. While inpatient hospital charges command higher reimbursement rates, organizations also run a higher risk of negative incidents, such as hospital-acquired infections, for which they hospitals can be penalized if patients have to readmitted within 30 days.
The organization has made significant strides in its effort to increase outpatient services. Since 2001, hospitalizations are down by 40% while clinic visits have increased by 38%.
HFM also began looking at its population from a different point of view. Instead of asking how to help the sick get better— which it does, of course— Herzog emphasizes keeping the community out of the hospital by getting them and keeping them healthy.
An independent analysis of the health of Manitowoc's residents shows it has improved. In 2010, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute released the state's county health rankings.
Based on behavioral, social, economic, and environmental factors, Manitowoc County ranked 50th out of 72 counties on the study's summary of health factors. In 2014, Manitowoc County had climbed 21 spots and now ranks 29th.
Physician Engagement
Another key component to making population health work for an organization is putting physicians in more leadership roles and holding them accountable for the delivery of care to patients.
Two organizations, Baylor Scott & White Healthcare, a nonprofit, 46-hospital integrated healthcare system based in Dallas that is one of the largest systems in the country, and Methodist Le Bonheur Healthcare, a seven-hospital, nonprofit health system based in Memphis, Tennessee, are bringing physicians to the forefront of their population health efforts, but in different capacities.
Baylor Scott & White has developed a network of employed and independent physicians to populate what it calls its Baylor Scott & White Quality Alliance (BSWQA). The effort was started at Baylor prior to its merger with Scott & White, but the idea was embraced and it continues to grow in size and scope.
The idea, says Joel Allison, FACHE, CEO of Baylor Scott & White Healthcare, was to truly have a clinically integrated network that engages physicians to help improve quality, cost, and outcomes. The structure of the BSWQA includes 3,700 physicians at 31 hospitals in north central Texas. To be part of the alliance, physicians must pay $1,500 to join and agree to use the BSWQA electronic medical record system and meet its quality standards.
"This is that bridge from volume to value." says Allison.
Allison says quality has always been part of Baylor's and Scott & White's identities. The population health proposition relies on quality to capture revenue. The future of reimbursement is in value-based care, and Allison says the BSWQA is helping build its foundation.
The quality alliance was tested on Baylor's employees first, but the model of care has since been picked up by a teacher's union in Texas because of its success at reducing cost and readmission rates.
There have been physicians who haven't met the quality criteria, and have been let go from the organization. But in its first 23 months, covering 34,000 lives, there was a 4.3% reduction in hospital admissions; an 18% drop in 30-day readmissions, resulting in a 7% savings totaling $13.9 million.
Baylor Scott & White's effort to hold physicians to a higher level of care for its patients is being echoed in other systems throughout the country, including at Methodist LeBonheur in Memphis, though that narrow, or preferred network approach is in its infancy compared to the organization's physician leadership initiative.
Physician Leadership Academy
This month, Methodist LeBonheur will graduate its first cohort of about two dozen doctors from its Physician Leadership Academy, a year-long program that emphasizes creating a consistent culture across its system.
To get into Methodist Le Bonheur's Physician Leadership Academy, doctors must be nominated by on one of the seven hospital CEOs and go through an interview process.
Once accepted, the classes are rigorous, and for the most part, are at a physical location, once a month for four hours. Some of the classes are online in the summer months to allow flexibility for physicians, but teaching in traditional classroom setting was intentional.
Since the system has seven hospitals, it's not uncommon for physicians who share common leadership goals to never set eyes on one another. It builds bonds and reinforces common goals physicians can take back to the hospitals or clinics where they practice.
"Traditionally, physicians focus on their specialty," says Michael Ugwueke, FACHE, President and COO of Methodist LeBonheur. "We wanted to change that culture and have physicians bring solutions that apply to all our hospitals."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.