Evolving stages of population health and ACOs: A comparison of 4 health systems

Population health and value-based care delivery is a journey — and every hospital and health system is at a different stage depending on market, payer mix and provider readiness.

"[Population health] has had a slow trajectory over time and now really truly has ramped up. I have never seen as much change so fast," said Vicki Harter, vice president of care transformation for Caradigm, a population health software company, on a panel at the Becker's Hospital Review 7th Annual Meeting in Chicago. "Things are going to continue to evolve as CMS continues with Medicare and Medicaid innovation projects," she added.

On a panel moderated by Brian Silverstein, MD, managing partner of HC Wisdom, Ms. Harter and four other panelists who represented hospitals and health systems discussed their unique progress on the journey to population health and accountable care.

Here are the takeaways from each hospital and health system leaders' experience with population health.

Dennis Shelby, CEO of Wilson Medical Center (Neodesha, Kan.)
Wilson Medical Center, a 15-bed nonprofit critical access hospital, was rejected as an accountable care organization and instead joined CMS' Transforming Clinical Practice Initiative, which is designed to support providers in developing comprehensive quality improvement strategies that align with CMS innovation models under the Affordable Care Act.

"I wasn't sure how [the ACA] would play out for rural healthcare," Mr. Shelby said. After getting rejected from the ACO world, WMC joined a project led by Quorum Health Resources to learn more about the ACO environment. Through this experience he said he realized WMC wasn't ready, but it is now. His main takeaway from the experience was finding the value in care coordination for chronic conditions in the primary care setting. WMC has two provider-based rural health clinics and a certified health coach paid for by Medicare. The service is profitable and serves people when and where they need to be treated, according to Mr. Shelby.

"It's actually one of the first things the government has done that makes sense to me," he added with a laugh.

George Mayzell, MD, CMO and chief transformation officer of Adventist Midwest Health (Hinsdale, Ill.)
Part of the national Adventist Health System network, Adventist Midwest is a nonprofit, faith-based group of hospitals and outpatient-based facilities in Chicago's west suburbs. According to Dr. Mayzell, to take on full risk and provide true population health services, a system must carefully lay the groundwork and build infrastructure first.

This groundwork includes developing data and analytical tools and building clinically integrated networks. Based on her work with Cardigm, Ms. Harter agreed with Dr. Mayzell in that providers across the nation are still struggling with how to handle the data analytics piece of population health. On the clinical side, Dr. Mayzell said building a CIN and aligning physicians to the hospital is critical because ACOs call for a different network of care than what physicians may be familiar with.

"You want to remind physicians how important it is, in any ACO or network you have, to think about the family — and the family is not just your group anymore, it's whatever that network is," Dr. Mayzell explained.

The final step of the process to creating the basis for true population health is linking the payment model to this care model. "If you try to design a great care model you are going to have to make sure payment is aligned with what you are doing," Dr. Mayzell said, noting that it will feel like a major change at most organizations.

Gyasi Chisley, CEO of Methodist Healthcare North and senior vice president of Methodist Le Bonheur Healthcare (Memphis, Tenn.)
Methodist is a faith-based integrated healthcare delivery system with four adult hospitals in the Memphis metro area that is participating in a handful of alternative payment models with population health aims, such as the Bundled Payment for Care Improvement initiative, gainsharing activities and commercial partnerships. It is focusing efforts on evolving its physicians in a physician-led professionally managed organization, advancing payer partnerships and vertically integrating itself through collaborations in the community, according to Mr. Chisley.

One example of Methodist's population health efforts is a partnership with Cigna that focuses on the "frequent flyers," or what Mr. Chisley calls the "loyal customers" in the 38109 zip code. This area's residents had high healthcare utilization costs and little access to primary care, according to Mr. Chisley. Its focus on that cohort has already produced reductions in admissions and readmissions, he said, and the system plans to expand this concept to three other zip codes in the next year.

Care transition and coordination are at the core of population health, Dr. Chisley said, "and we just don't do that well in our industry."

Roy Proujansky, MD, CEO of Nemours' Delaware Valley Operations and executive vice president of health operations for Nemours (Jacksonville, Fla.)
Nemours is a nonprofit children's health system with hospitals and clinics in Florida and the Delaware Valley. In Delaware, just under half of the pediatric population is in Medicaid. Nemours operates the state's only children's hospital as well as 11 primary care clinics, according to Dr. Proujansky. The state is fairly advanced in terms of population health — every adult hospital in the state has an ACO or is participating in one. Nemours is in the early stages of developing a pediatric ACO, he said.

Nemours has been involved in population health activities for over a decade and allots $7.5 million to $8 million annually to its division of health and prevention services, according to Dr. Proujansky. These efforts have centered on obesity, asthma and integration of behavioral health services. The system has achieved improvements in these arenas through community partnerships, adult education and expanded telehealth capabilities.

"We would not have been able to accomplish anything we did in obesity and asthma without partners in the community and in the state," Dr. Proujansky said, "And policy change was critical for us with telehealth parity."


More articles on accountable care:

Cigna, Rush launch collaborative care program
McKesson, BCBS of Arizona partner on value-based care
Nonprofit health system's commercial ACO denied tax exemption

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