'Competitors by day, colleagues by night': How population health is sparking change in hospitals' strategy

For hospitals, healthcare solutions companies and EHR providers alike, population health requires different organizational behaviors and muscles. A panel of four industry experts discussed some of the major trends and issues that go hand-in-hand with expanding population health efforts at the Becker's Hospital Review 4th Annual CEO Roundtable + CFO/CIO Roundtable.

Waukegan, Ill.-based Vista Health System is part of the Community Care Partners Accountable Care Entity. ACEs were driven by an Illinois mandate in 2011 for half of the state's Medicaid program participants to be enrolled in care coordination by Jan. 1, 2015. The state's health department called for providers to submit applications to become ACEs, which function like ACOs but for Medicaid populations.

To earn ACE status, Vista partnered with one of its longstanding competitors, NorthShore Highland Park (Ill.) Hospital. "We're fierce competitors by day, but we're colleagues by night, said Vista President and CEO Barbara Martin, MSN. "We have to talk, we have to collaborate and we have to work together, specifically related to population health." In addition to Vista and NorthShore, the ACE also includes other entities that offer bilingual healthcare, social services and wellness resources. Those are Erie Family Health Center and the Lake County Health Department and Community Health Center.

Lawrence (Mass.) General Hospital's journey with population health began roughly three years ago, according to President and CEO Dianne Anderson. As a mid-size, nonprofit community disproportionate share hospital, Lawrence General was one of seven hospitals approved for participation in a three-year Medicaid waiver in 2012. The $628 million state and federal funds made available through the waiver came with some strings, including use of population health strategies to decrease readmissions and utilization of the emergency department.

"We got launched on the whole population health initiative through the waiver program," said Ms. Anderson. "The way it worked was, in order for us to receive millions of dollars in funds to fill the deficit from our Medicaid rates, we had to follow steps to meet the basic elements of the new approach."

In May 2014, Lawrence General joined the Beth Israel Deaconess Care Organization, which enhanced its relationship with Boston-based Beth Israel Deaconess Medical Center. The two had already collaborated for certain specialties and service lines, such as cardiovascular and intensive care. As a member of the accountable care organization, Lawrence General offers patients access to specialty care at BIDMC, and its associated physicians also accept a portion of the financial responsibility for outcomes.

Ms. Anderson also reorganized the hospital's senior management team to charge population health efforts. The community hospital now has a division of transformation, a chief transformation officer and a director of population health. The team developed a way to flag Medicare patients when they present for care, so care teams can pay closer attention to care options for them, such as home care and extra support resources to prevent readmissions.

New leadership models and use of data analytics to prevent hospitalization are becoming more popular strategies among organizations cementing their commitment to population health, according to Michael Simpson, president and CEO of Caradigm. The healthcare informatics company focuses on data analytics, care coordination and patient engagement.

"Population health is a team sport, and Lawrence General is a phenomenal example of that concept," said Mr. Simpson. "More hospitals are realizing that you can't just worry about what's happening within your walls, since hospitals' costs are bleeding outside the facility."

Mr. Simpson notes more hospitals are creating positions and service lines dedicated to social issues — like access to food and transportation — that affect health. He's also seen more hospitals, integrated care networks and other healthcare organizations make better use of the data they already have and turn it into actionable information for care teams. "They want to understand the data they have, figure out where they have revenue leakage and then transform the organization to fix those problems and improve population health."

Using data to track the quality of care both inside the hospital and in outpatient and post-acute settings to identify readmission risks is also of high importance, according to Mr. Simpson and Paul Merrild, vice president of athenahealth's Enterprise Solutions Group.

"Data is a necessary — but not sufficient — capability to be successful in this world. I think one of the key things that will ultimately make us all very successful is learning how to present the right data, in the right context, to the right person at the right time," said Mr. Merrild. Whether it's a Medicare Shared Savings Program ACO or shared-savings agreement with a commercial payer, every value-based contract contains quality measures of some sort. "Meeting those measures requires data and some degree of management, which is where hospital leadership, transformation teams or collaborative accountable care entities will come into play more and more."

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