4 components of a successful population health initiative

Population health management is a crucial competency for healthcare providers to improve care quality and lower costs. However, many hospitals nationwide still struggle to implement successful population health initiatives and deliver high-value care, according to Carl Couch, MD, CMO of nThrive, an Alpharetta, Ga.-based revenue cycle management company.

The average family of four has an annual household income of $58,000 and spends $24,000 — or 43 percent of their income — on healthcare each year, according to Dr. Couch. "This is unsustainable," he said. "I don't believe we can attain value, which can be defined as quality in relation to cost, without paying attention to population health."

This article was sponsored by nThrive.

Dr. Couch joined fellow nThrive colleagues Moshe Starkman, a senior value-based reimbursement consultant, and Scott Jones, a senior consultant, to discuss the current state of population health and identify the main aspects of a successful population health initiative during a Nov. 15 executive roundtable at the Becker's Hospital Review 6th Annual CEO + CFO Roundtable in Chicago. More than two dozen hospital C-suite executives were also in attendance at the event.

Here are the four main components of a strong population health initiative leaders discussed during the roundtable.

1. Emphasis on primary care. Primary care physicians must not only provide focused care to at-risk patient populations under a population health model, but also empower them to take a larger responsibility in their own healthcare.

"It used to be that someone with high cholesterol and diabetes would go to McDonald's after their doctor's appointment, and they didn't understand why that was bad," said Mr. Starkman. "That's not acceptable anymore in a population health model. Now, the doctor didn't do his job correctly if the patient goes to McDonald's."

Physicians must educate patients on their illness or chronic disease and ensure they understand how to maintain healthy behaviors outside of the hospital. Fortunately, technology is helping facilitate this process, according to Mr. Starkman. He believes cell phones are now part of a patient's medical team due to the increasing prevalence of fitness tracking apps, digital health apps and telemedicine.

"Patients are becoming their own primary care provider," Mr. Starkman said. "While they may not learn about their care from a medical stance, they're becoming more self aware about their own behavior and that's the first step."

2. Careful data driven environment. Good data is an integral part of a population health initiative, according to Dr. Couch. "If you don't measure something, it's very hard to manage it," he said. Measuring performance and outcomes also helps hospitals gauge progress, identify effective initiatives and pinpoint further areas of improvement.

While healthcare providers are now capturing data through EHRs, many don't know what to do with it, according to Mr. Starkman. In fact, a majority of healthcare leaders at the roundtable said they did not fully trust their data, and a few even said they knew it was wrong — a trend Mr. Starkman regularly sees when consulting hospitals nationwide.

Dr. Couch recommended hospitals use claims data, which is the only true source of cost, to assess their own performance and patients' health outcomes. This data must also be aggregated in a meaningful way.

To highlight the benefits of combining disparate data systems into one database, Mr. Jones shared his recent experience working with Livonia, Mich.-based Trinity Health, a 93-hospital nonprofit health system that had 58 different data systems functioning across 22 states. Mr. Jones and his colleagues mapped out each of the 58 data systems — for both billing and EHRs — to reconcile the information into one seamless data center accessible to Trinity providers nationwide.

"For the first time, a physician in Albany, N.Y., and one in Fresno, Calif., could look at the same metric and be held to the same performance expectations that were tracked and managed," said Mr. Jones.

This level of data transparency also helped build physician's trust in the data's integrity, since they knew exactly where the information was coming from. To maintain this trust, hospital leaders must continually review the data and prove it is reconcilable and accurate, according to Mr. Jones.

3. Physician leadership. Physicians are responsible for at least three-fourths of U.S. healthcare costs, since most care requires physician orders, according to Dr. Couch. Therefore, bringing physicians on board with a population health initiative is key to a hospital's success.

"A lot has to do with actually engaging physicians differently and making sure they are confident they are a stakeholder in the business," said the chief learning officer of a four-hospital integrated healthcare delivery system in the Midwest. "They need to feel like we are managing their needs in the hospital or organization."

The COO of a 10-hospital system in the Midwest echoed this statement, saying his health system created a physician cabinet about five years ago to advise leaders on how to run their clinically integrated delivery network. Leadership gained helpful insights from the physician cabinet, which became very engaged in the CIN and also helped the health system establish an ACO.

Data represents another valuable tool to engage physicians in population health initiatives and reduce healthcare utilization. However, getting physician stakeholders to accept the data can be an initial challenge for hospital leaders. Dr. Couch said physicians typically have a three-stage reaction to data. First, they say the data is wrong. Then they say their patients are different or sicker, so the data doesn't apply to them. Finally, they accept the information and ask what they can do differently, according to Dr. Couch.

"We need to work through these stages so they understand the data," he said. "From a population health standpoint, we need organization level data, practice level data and individual data. Physicians are competitive and hate to be outliers ... showing them how they perform in relation to their peers is what drives behavior change."

4. Off–the-radar disease management. The attention patients receive outside the four walls of a hospital influences what happens in the hospital, according to Dr. Couch. "Pre- and post-care is an extremely important part of taking care of patients," he said.

Once hospitals establish an effective data analysis process and earn physician support, they must work to identify and solve care gaps in their local healthcare market. While ensuring patients follow the right diet or take their medications seems like an impossible task, the plethora of data — and the increasing interoperability of data systems — make it a more realistic goal.

With a redefined look at primary care, strong physician support, reliable data to spur behavior changes and heightened focus on addressing care gaps, hospitals can significantly improve the health of their local communities.

"I've heard people's frustration about population health being like trying to boil the ocean," said Dr. Couch. "None of us will fix healthcare in our lifetimes. But we can all make an incredible difference in the lake we live in."

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