Attendees at the HealthLeaders Media 2015 Population Health Exchange detailed two population health management programs that are tackling obesity and improving chronic disease management.
At an invitation-only gathering, healthcare leaders at the forefront of population health shared information on engaging patients, managing their chronic diseases, and leveraging data to improve health outcomes among communities and patient populations.
More than two dozen healthcare executives from a broad spectrum of disciplines shared their thoughts challenges, solutions, and innovations at HealthLeaders Media's 2015 Population Health Exchange at The Park Hyatt Aviara in Carlsbad, CA June 17–19.
Community Engagement is Key
Jean Krause, chief quality and safety officer at Gundersen Health System in La Crosse, WI, shared strategies for improving obesity rates.
Wisconsin's obesity rates are following national trends, up from 10% to 14% in 1990 to between 25% and 29% in 2010, said Krause. During a 2012 La Crosse community-wide assessment, Gundersen identified obesity and food availability as community health issues that the organization could influence.
The health system's main campus and surrounding neighborhood reside in a food desert, which is defined by the USDA as urban neighborhoods and rural towns where fresh, healthy, affordable foods are not easily accessible. "[Residents] end up buying less healthy items at gas stations," she said. "In order to improve the health of the population, we have to get outside of our own walls."
Population Health Exchange: Partnerships Key to New Models of Care
So Gundersen began working with the community to support interventions such as exercise groups and the "Chefs in the Schools" program. "We're teaching the kids how to grow vegetables and make good meal choices," she said. "Then they're going home and teaching their parents."
There are now healthy food selections in highly visible areas in gas stations, 500-calorie meals on restaurant menus, and 15 schools with gardens. During the Minute-in-Motion event recently, 5,000 community members clocked 7 million minutes of exercise.
"This work takes time, talent, and engagement," Krause said. "It doesn't take a lot of money in some cases." She stressed that success to any population health-based intervention depends on community engagement and ownership.
Now Gunderson is starting to see a bend in the obesity curve. "It's the community that's got the hand in it. We happen to be there to support them."
Better Engagement; Better Disease Management
The medical home model is a well-known approach to population health, but gastroenterologist Lawrence Kosinski, MD, president of Elgin Gastroenterology Endoscopy Center in Elgin, Illinois, is taking the concept one step further with a specialty intensive medical home in its specialty.
Lawrence Kosinski, MD |
"We're the first intensive medical home that Blue Cross Blue Shield Illinois has formed a partnership for in Illinois. We're very proud of what we've accomplished with this," said Kosinski.
Chronic diseases overall are responsible for two-thirds of the cost of healthcare today, he said. And "In the gastroenterology space, inflammatory bowel disease is one of the major cost drivers. It's a very high-risk, high-cost patient population. Most of them are young and a lot of them have a single morbidity—Crohn's disease."
These patients cost about $11,000 per patient per year, and half of the cost is attributable to inpatient work. "Treatment of complications—fistulas, abscesses, bowel obstructions—these are serious things that happen to these people," Kosinski said.
"Gastroenterologists, who are the experts in the disease process, received 3.5 cents of the dollars that Blue Cross spends," he said. "It immediately became obvious to us that there was a care management issue here. The wrong people were taking care of a very high-risk group of patients and not doing a very good job at it."
As a result, morbidity and mortality were occurring along with excess cost, he explained. Based on this data, Kosinski wondered if there was there an opportunity to improve care at the provider level and if that could be the basis of a shared savings program with their payer Blue Cross Blue Shield of Illinois.
When he looked at data on hospitalization rates, he noticed that less than one third of the patients admitted to the hospital for a complication had a CPT code for a physician visit in the 30 days prior to the admission.
"They were sick enough to go in and have a bowel obstruction, an abscess, a fistula, [or] an infection, but miraculously they weren't sick enough to be seen by a doctor in the 30 days before," Kosinski said. "Patient engagement problem. Major."
After going live in December 2014 with the shared savings program, Kosinski knew there had to be two goals—engage the physicians and engage the patients.
To support the physicians, an elaborate set of clinical decision support tools were created and embedded in the EHR. Patient engagement was achieved by using the patient portal to send a monthly questionnaire from the Crohn's Activity Index. Patients' responses to five questions generate a "Sonar score" which assigns a number to symptom intensity.
"We're able to plot patient symptoms over time," Kosinski said. "We're able to encourage our physicians to practice according to guidelines that were set in the clinical decision support tool."
The portal eventually became too cumbersome, so the group developed its own Sonar application that works on smartphone technology. They send out the same questionnaires and if a patient has an abnormal Sonar score, a nurse care manager receives a text so she may follow up with the patient and create a plan to provide appropriate medical care.
The program is in its early phases, but it is generating significant data already. Leadership is able to monitor physicians based on performance such as preventing a hospital admission. Doctors will be paid based on their performance rather than volume.
As for what the future may hold for this model of population health, Kosinski said "Specialists need to convert from fee-for-service proceduralists to masters of chronic disease management."
And he believes a team-based care philosophy and approach must be adopted. "I always use this funny line, 'MD stands for My Decision.'" Kosinski joked. "That is no longer adequate. You have to work within a team."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.