In our October Intelligence Report, 90% of healthcare leaders indicated a commitment to improve the overall health of a defined population. What steps is your organization taking toward population health management, and what have been some of the challenges and successes you've encountered?
Elisabeth Stambaugh, MD, FACOG
Senior Medical Director
Cornerstone Health Care
High Point, NC
On commitments and conflicts: All of our contracts include some gainshare portions. We are hoping to move even further than that. We established a couple of specialty clinics, one of which is a congestive heart failure clinic that has significantly reduced hospitalizations and especially rehospitalizations. It has put us a little bit at loggerheads with the hospital because their inpatient population has gone down so much with our success. I also sit on the hospital board so I can appreciate both sides.
On building a value-based clinic: We identified patients within our ACO and they were enrolled in this multidisciplinary clinic with psychologists, nutritionists, pharmacists, physicians, and advanced practice professionals who got the patients to come in very regularly. We have nurse navigators who reach out to patients instead of waiting for them to reach out to us.
On problems with payers: Probably the biggest obstacle in all of our population health initiatives is getting the flexibility with the payers. For instance, getting patients into the heart function clinic frequently means they often have more copays. Whereas in the future when we get to full risk, we will be able to say 'you don't have copays. If you go to the emergency room you will have a huge copay so come see us first for no copay.' The other part of dealing with the payers that has been so frustrating is that in order to truly analyze the data, the payers have to be willing to give it to us. Some of that we can get from our own records but some of it we need from payers and that has been like pulling teeth.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.