The Road to Population Health: Key Considerations
Population-based care delivery models aim to achieve best possible quality at minimum necessary cost. These models include accountable care organizations and patient-centered medical homes. Population-based models are not to be confused with episode-based care models, such as bundled payments, and fee-for-service initiatives, such as bonus payments for quality improvements.
Dr. Shah said there are three building blocks for population-based models:
• Division and organization of population base. Care must be delivered to meet specific patient needs as indicated by patient segmentation into cohorts, e.g., very high risk, high risk, moderate risk, low risk and very low risk.
• A multidisciplinary care system. This includes the establishment of clinical protocols and evidence-based care procedures, care coordination, case conferences and clinical performance reviews.
• Supporting enablers. This includes intangible strengths and functions such as aligned incentives, joint decision-making, information transparency, clinical leadership and patient engagement.
Dr. Shah calls these three components the "whats" of population-based models. "For each one of these three building blocks, the keys to the success lie under the hood. It's the how that differentiates successful models," said Dr. Shah. For example, risk stratification may seem like a relatively straightforward exercise, but it involves several decisions around its implementation and design that may make or break its success. How a hospital or payor approaches risk stratification will influence how stakeholders perceive it, react to it and ultimately whether or not stakeholders alter their behavior.
The presenters noted four broad approaches to population-based models: those led by payors, hospitals, physicians, and communities. In a poll conducted during the webinar, 21 percent of attendees said payor-led models are driving or are most likely to drive impact in their markets — more than hospitals (18 percent) and physicians (3 percent). [Note: The fourth option was a combination of two or more of those three, which polled at 58 percent.] Dr. Shah said market factors may favor a specific model – for example, markets in which payors have a meaningful share of a provider's overall patient base increase the likelihood of influencing provider behavior change and therefore favor payor-led models.
Mr. Stanford explained that providers should be cognizant of three different horizons as they plan, implement and grow their population-based models. Right now, the healthcare industry is in the thick of regulatory turbulence, which will endure through 2014. From then through 2016, the industry will enter a period of what Mr. Stanford calls "market turbulence," in which insurance exchanges will open, employers and individuals will make decisions about coverage and regulators will refine rules. Then, after 2016, the industry will enter into a "new normal," in which outmoded providers disappear, market participants stabilize and market pricing and enrolling levels settle. The goal for hospitals is to move into that "new normal" via a sturdy population-based model.
For healthcare providers to survive beyond 2016 or in the new normal, they need to modify and strengthen five traditional capabilities, according to Mr. Stanford. These capabilities call for a significant transition from one "old" function to the new, as listed here.
1. Move beyond physician recruitment to clinical integration.
2. Transition from acute-care excellence to managing the care continuum.
3. Excel from payor contracting to risk management.
4. Move from cross subsidization to focused lines of business management.
5. Switch from business-to-business marketing to business-to-consumer marketing, in which you identify, understand, reach, engage and influence consumers.
Finally, in a closing poll, the presenters asked where attendees found themselves in terms of their development of population health management. The majority of attendees are still in the planning or designing phase for the model. Numbers came in as follows:
• Thinking about it, but haven't yet garnered leadership support — 34 percent
• We have a leadership coalition and we're in the design phase — 47 percent
• We've designed the system and we're implementing it — 15 percent
• The population health system is mature and working, and we are focused on scale — 4 percent
View or download the Webinar by clicking here (wmv). We suggest you download the video to your computer before viewing to ensure better quality. If you have problems viewing the video, which is in Windows Media Video format, you can use a program like VLC media player, free for download by clicking here.
Download a copy of the presentation by clicking here (pdf).
More Articles on Population-Based Health:5 Steps Toward Accountable Care
Bridging the Gap: 5 Resources on the Transition to Value-Based Care
Managing Population Health: Where Should Hospitals Begin?
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