Financial incentives, technological advances and pioneering care models have provided fertile soil for the green shoots of population health to grow. But for these programs to flourish, they will need more sophisticated analytics, patient stratification, community involvement and care management.
This week, PwC’s Health Research Institute (HRI) released “Population health: Scaling up,” where they interviewed executives in leading healthcare, research and academic institutions on how organizations can better scale their efforts. The report finds that 70% of clinicians surveyed by PwC’s Health Research Institute (HRI) reported that they do not participate in risk-based, incentive-based or shared savings reimbursement models. Yet the US Centers for Medicare and Medicaid Services has made adoption of these payment models a major goal, aiming to have 50% of Medicare payments in value-based models by 2018.
Private payers also are striking risk-based deals with health systems and pharmaceutical companies. Healthcare organizations with evidence that their population health programs are working well on a large scale are more likely to be rewarded in these deals. Scaled-up population health management calls for skills and resources that no single organization can provide on its own. Partnerships and targeted acquisitions from inside and outside the traditional health system are its lifeblood.
Through the strategic insights of those surveyed, the report concludes that the three keys to scaling population health are:
1. Strengthening risk stratification
Address “whole health” needs that are medical, social and environmental. Additionally, providers and insurers may find benefit in pooling resources to identify target populations through the use of EHRs and claims databases.
– Example –Benevera Health, Partners HealthCare
Last fall, Benevera Health emerged as a joint venture between four New England-based healthcare organizations – Dartmouth Hitchcock Medical Center, Elliot Health System, Frisbie Memorial Hospital and Harvard Pilgrim Health Care – to share patient data and improve outcomes for Harvard Pilgrim’s 80,000 members in New Hampshire.
Through this strategy, Benevera addressed gaps in knowledge, allowing the network to choose appropriate interventions for distinct patient populations. Harvard Pilgrim’s 2016 insurance premiums were 4% lower than they would have been without the partnership.
2. Developing a full-service care delivery network with strong care management:
Building an ecosystem of care that extends into the community (and the home) through the development of strong service level agreements with partners to fill service gaps and extend reach to patients.
Example – Ascension Health’s hospitals
More than 80% of consumers surveyed by HRI said that they are open to non-traditional ways of receiving care, such as virtual visits, care in the home and at-home diagnostics.31 “Healthcare is just like retail. Bar none, it’s what the patient needs,” said Dave Baker, chief enterprise architect at Ascension Information Services, who has spent most of his career developing technology strategies for retailers and financial services firms. Baker is developing a strategy to expand population health platforms across Ascension’s operations in 24 states and the District of Columbia.
3. Engaging patients through community resources and running a data-driven operation:
Population health programs should prioritize data efforts and provide information to clinicians and their partners in manageable bites.
– Examples – MD Anderson Cancer Center, The Center for Health Equity and Community Engaged Research at The Icahn School of Medicine at Mount Sinai in New York City
MD Anderson Cancer Center is working with IBM’s supercomputer, Watson, to suggest cancer treatment options based on scientific evidence through EHR. ClinGen, a genomics project, is convening hundreds of labs and institutions to share genomic and phenotypic data from diverse patient groups, and then analyze outcomes and make them available in EHRs.
The Center for Health Equity and Community Engaged Research at the Icahn School of Medicine at Mount Sinai collects data on 90,000 patients in federally qualified health centers across New York. The center then translates research findings into improving clinical care in these centers.
To avoid unintended consequences of employing these tactics too quickly, PwC experts suggest organizations start smaller to find early wins, understand how population health supports their mission and existing business model, and to evaluate often and adjust promptly, as necessary.
The full report is available for download here.