Determining the direction of a population health strategy must include physician alignment, leadership ability, and space to communicate with core care team members. But a "leadership deficit" is hampering progress, says the chief health officer of one state's hospital association.
Population health may be a goal that unites an organization's clinicians, administrators, and leadership, but communication gaps exists between front line members of the care team and management that threatens to derail major progress on improving healthcare outcomes, cost, and quality.
An online poll conducted by Harris of 955 medical professionals from hospitals with 200+ beds and physician offices with at least 25 physicians showed that better communication among care partners improves care coordination, which has grown increasingly important.
According to the HealthLeaders Media's own research, published in the intelligence report, Population Health: Are You as Ready as You Think You Are?, respondents chose aligning care goals and incentives along the care continuum as the top strategy they planned on using to support population health at their site of care.
The same poll that shows improved communication leads to better care coordination, however, also revealed that healthcare administrators had much more confidence in an EHR's ability to support care coordination than the clinical staff.
Roughly 51% of hospitalists, PCPs, and specialists agreed that an EHR was sufficient to coordinate care along the continuum. Administration placed more emphasis on the EHR. For example, 78% of office managers and 65% of hospital administrators surveyed said the EHR was good enough to ensure collaboration.
Jennifer DeBruler, MD, medical director of Advocate Medical Group's Contact Center, a 40,000-square-foot facility that serves as the centralized point of contact for AMG patients to schedule appointments and get healthcare guidance, says the gap in administrative and clinical perspectives could point to a deficiency in the EHR, but it could also be due to slow adoption of technology use in healthcare.
"When you're the person using the EHR, it's different," she says. "I've used multiple EHRs, and there are glitches in every one. I think using technology is new, and adopting change is difficult for patients [and] doctors. A health system has to make great efforts to connect. At Advocate, we can easily click a button and see the record of a patient."
AMG is the physician-led medical group that is part of Advocate Health Care, the large, nonprofit, faith-based integrated health system with 12 acute care hospitals based in Downers Grove. Connecting the more than 250 sites of care within Advocate is a primary part of the system's population health strategy.
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Jay Bhatt, DO, MPH, MPA, FACP, |
DeBruler, who is also on AMG's 17-member Physician Governing Council, says Advocate does a good job of making sure the system's view of population health is communicated down to the frontlines of care, which, according to the Harris poll, is not happening often enough.
Despite high numbers of administrators knowing an organization's population health strategy—94% of hospitals administrators, 91% of case managers, and 95% office managers reported being familiar with it—the awareness significantly dropped among physicians, nurses, specialists, and hospitalists.
"I believe that an important component of investing in health transformation is physician alignment," says Jay Bhatt, DO, MPH, MPA, FACP, chief health officer of the Illinois Hospital Association.
Bhatt is the first to hold such a position within the IHA, and helping physicians and hospitals understand how to implement population health is central to his role. Bhatt was hired by IHA last month from the Chicago Department of Public Health. He remains an internist at the Erie Family Health Center in Chicago, as well as physician at the Northwestern University Feinberg School of Medicine, and a lecturer at the University of Michigan.
He says the gap in population health strategy in many organizations is the lack of physician leadership opportunities.
"In order to transform care, the leadership has to work and be mindful of bringing the clinical team along," he says. "Physician training has not captured leadership and management as core principals. You learn that ad hoc. They (physicians) are being asked to assume a higher level of responsibility but there's a leadership deficit."
Some health systems have developed proprietary physician leadership academies, the IHA has developed a three-month physician leadership training program to fill the need for employed and independent physicians.
"There is already existing infrastructure in which you can redesign the educational content and training gets delivered," says Bhatt.
In his clinical experience, for example, Bhatt has a morning huddle before seeing patients with his nurse and medical assistant to find out details about patients that helps him plan a visit effectively.
"I had a patient the other day decide he wanted to be a college student and go into social work," says Bhatt. "This individual had been suffering from depression, and it allowed me to have a conversation about what support and challenges were needed in terms of transition, which can exacerbate depression symptoms. It allows us to think about the person holistically."
In addition to the morning huddles, Bhatt says the care team meets twice a week to review what worked, what didn't, and "recalibrate" for the next week.
"These processes have to be embedded into the work flow," he says. "The larger team huddle allows us to see patterns in the way we work that hinders or helps the patient. This could be done in hospitals in existing venues. It speaks to creating a space for communication so you close the loop across all care teams."
At AMG, the system's population health strategy is pushed down to the frontlines in multiple ways. DeBruler says doctors are required to check their Advocate email, care managers visit AMG offices twice a week to review patient panels, and there is an upcoming quarterly meeting at Advocate that will focus on population health.
DeBruler also attends monthly meetings with fellow Physician Governance Board members who are tasked with carrying the leadership message to the offices, which is reinforced with data and tied to clinical metrics.
Coordinating care for patients is an intensive effort that doesn't likely have an immediate payoff, but investing in communication with your physicians who are carrying out this kind of long-term strategy does.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.