The goal of population health is the systematic and transparent delivery of services to improve the health status of a given population at a prospective price, ultimately delivering better outcomes at lower cost.
Population health management reflects a new care delivery model that emphasizes wellness and prevention, and requires new payment models that support that goal. Rather than making money on high-cost procedures and episodes, healthcare delivery organizations will focus on preventing them from occurring. This doesn't mean rationing care... it means ensuring that each patient gets the right treatment at the right time in the right setting.
By managing health problems at the least expensive point of care, healthcare delivery organizations will be able to lower total costs and redefine "healthcare" to include more than just "sick care." Building the capabilities, infrastructure, and culture required to successfully transition to population health management is a significant challenge that demands investment of time and capital, but the reward will be a marketable approach to maximizing the health of a population that improves the bottom line and paves the way for future delivery and payment models.
Capabilities
The ultimate goal of population health management is improve the health of a population by engaging patients as consumers in making better choices about their own health, by supporting wellness, and by providing the right care at the earliest practical time at the most cost-effective point in the care continuum. This is a significant departure from current operations at many health systems, and will require developing new clinical, analytic, and coordination capabilities.
At the clinical level, providers will need to develop and implement care protocols based on best practices, clinical guidelines, and peer-reviewed literature. Care protocols should be tailored to a specific patient population for both acute care episodes and chronic disease management, and should consider the continuum of care to ensure that patients are engaged and managed appropriately at all points in their treatment.
New analytic capabilities will be required to support implementation of new clinical practices and goals, and to facilitate alignment of incentives across the organization. Relevant outcome metrics will need to be captured, tracked, and reported in an actionable manner so that clinicians and administrators can understand where progress is occurring and where gaps remain. Similarly, a new approach to financial analytics should tie new cost accounting capabilities to relevant clinical units, putting information about the cost ramifications of different clinical behaviors into the hands of those who will be held accountable.
Coordination of patient care across the continuum is currently rudimentary. Such coordination is inhibited by multiple IT systems that don't interface, and even more so by a clinical culture that places little value on continuity across points of care. New processes, role responsibilities and accountabilities will need to be put in place to address this deficit, even after the technical challenges are dealt with.
Infrastructure
In the current healthcare model, the hospital is king. Population health management requires systems to rethink their care delivery model in a way that moves patients away from acute care settings by emphasizing prevention and engaging patients in active disease management and prevention. For many systems, empty acute care beds will be repurposed for long-term care, rehab, observation units, and other points along care in the continuum.
New goals may require roles, reporting relationships, and accountabilities to be redefined. Some functions may be expanded, while others may need to be repurposed. This process will require a critical assessment of organizational strengths and gaps, and developing a plan to best deploy resources.
Systems will also need to rethink their relationships with external providers. While the current healthcare environment is experiencing record rates of consolidation, many organizations are finding that strategic partnerships with outside provider organizations, done effectively, can provide patient coordination across the continuum without the capital expenditure to buy the entire range of services needed.
Culture
Population health management is not just a change in operations... it's a major change in the culture of healthcare delivery. Executive management and the board of directors will play a critical role in creating a culture of leadership and innovation. Once leadership is committed to pursuing population health and value-based care models, they must drive culture change throughout the organization that can support and sustain this goal. Such change involves setting performance goals that are aligned with new objectives, engaging clinical staff as they work to meet new cost and quality goals, and ensuring that the commitment to delivering value is reinforced through reward, recognition, accountability mechanisms, and cultural norms throughout the organization.
Physicians should be empowered as leaders to drive innovation in a way that emphasizes utilizing best practices to provide patients the best care. Goals, objectives, and progress should be clearly communicated throughout the organization in order to engage and inform all relevant staff members.
Leading the Charge to Population Health
The landscape for healthcare is changing rapidly. Demands for better outcomes and lower costs will only grow, and the differences between health and healthcare have taken center stage. As provider organizations begin to tackle the challenge of managing population health, they'll need to develop a systematic approach to quality improvement and how it's measured across the continuum of care. The practical demands of managing population health are huge – and require underlying cultural and operational shifts. The sooner healthcare leaders get started, the more likely they will be to have a successful "takeoff".
Adapted from "Getting to Population Health Management," Abrams, Numerof and Buseman, 2015.
Michael N. Abrams, MA is Managing Partner, Rita E. Numerof, PhD is President, and Christen M. Buseman, PhD, MPH, is a Research Analyst at Numerof & Associates, Inc. (Numerof). Numerof is a strategy development and implementation firm with more than 25 years' experience helping major pharmaceutical, device, diagnostic, payer and delivery organizations define, create and deliver value across healthcare. Experts in business model transformation, Numerof specializes in understanding and managing variation in cost and quality, deploying bundled pricing and other new payment models, launching population health initiatives, reconfiguring care models and pathways, and integrating retail medicine, acute care and post-acute care. For more information, visit our website.