Dr. Black is “fundamentally, a primary care physician, an internist, at heart,” in her own words. For about 20 years, she practiced medicine in the Boston area. There, she became deeply familiar with the region’s managed care environment, and went on to work for Harvard Pilgrim Health Care as a medical director. “We were focused on effective care delivery 25 years ago,” she says. “This same focus has matured and spread in the industry ever since.” 
Dr. Black is now the chief medical officer of Chicago-based Valence Health, a value-based healthcare solutions company. In this role, she pairs her clinical background and time spent working in delivery systems — both practices and hospitals — with a payer perspective. Dr. Black shared her perspective as a physician and medical executive on population health, value-based care delivery and the two phrases she most wants eliminated from the industry’s vocabulary.
Question: The idea of population health has really gained traction in the past few years. Can you tell me more about your experience with it and when you first became familiar with it?
Dr. Carol Black: My first experience dates back to the early 1980s in my practice environment. I was at that time practicing in the staff model of the Harvard Community Health Plan — an organization committed to quality, but [that was] also the payer, much like the [Oakland, Calif.-based] Kaiser Permanente model. I had to think about how to effectively and efficiently deliver care. My thinking regarding population health stems from those roots, from caring for a population as a whole. [It’s about] identifying opportunities, optimizing health and doing it in an effective and cost-efficient manner.
To me, the pace of transition [from volume- to value-based care] has been phenomenal. Just at a personal level, it’s been amazing to watch the transition over the past few years. It’s an exciting change point in healthcare and, overall, I believe we’re seeing incredible industry traction in embracing the principles of moving to value-based care and population health. In some spots, the traction has been a little slower, but overall it’s been faster than I expected.
Q: How do you think a CEO’s take on population health might differ from that of a CMO?
CB: I think it’s a question of relative balance. If you think about it historically, and even today, what clinical folks and the CMO are thinking about is care delivery. Am I taking care of my patients in the best way? Am I delivering the care they need? As a physician or as a CMO, am I taking care of the population as well as I could? Are we doing things in the most evidence-based manner possible?
For the CEO it’s a necessity to focus on organizational performance. Thus [their focus] may be a bit more on cost, finance and organizational efficiency. But as we move into the value-based arena, more and more I think we’re seeing a blending. This varies among individual organizations, but there’s much more alignment where both sides see a balance, focusing more and more on all of these components — cost, quality and access — which is absolutely essential to get to the value.
Q: What are some observations you’ve collected from your work with hospitals? What is it about population health that they are doing right, and what do you find to be the most challenging tasks/initiatives, if any?
CB: I think hospitals today — and I’ve seen more and more of this over the last decade — are focusing enormously on quality and patient safety, but in a systematic, performance improvement way. They are much more focused on metrics, much more focused on process improvements and finding gaps in opportunities to avoid mishaps. It’s been a phenomenal transition. Hospitals have always been focused on quality, but it’s taken on a much more systematic approach.
Also, there is much more focus on internal efficiencies. There are a couple of phrases I would like to see erased from the world of medicine. One is, “Fell through a crack. …This or that test or result fell through a crack.” Or, “lost to follow up.” I think across healthcare and hospitals, there is a lot of emphasis on erasing those phrases from our vocabulary, which is what it’s all about.
For example, in the last few years there’s been more hospital focus on the care continuum — gluing together pieces of care before the patient came to the facility and also including the follow-up [in the episode of care]. There is emphasis on preventing readmissions, both ensuring appropriate follow-up as well as focusing on what we do while the patient is [present].
The challenge I’m hearing is navigating across the transition from approaches that are more volume-based to those that are more value-based. How do you navigate that transition in an operationally and fiscally responsible manner when all of your contracts don’t change tomorrow? How do you embrace the directional change and successfully navigate the transition? I think it really requires flexibility, as well as a thoughtful strategic plan that gets to the end goals but is also organizationally responsible.
More Articles on Population Health:
Paying for Population Health: Why Rewarding Value is Key
5 Myths Surrounding the Business of Population Health Management
What Organizations do Hospitals Partner With for Population Health?
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
