Where are we on the road to population health?

The terms "population health" and "population health management" have become ubiquitous among healthcare professionals as reimbursement models and medical providers transform from fee-for-service systems to value-based care. Despite their prevalence, the industry has yet to decide on a single definition of "population health."

A panel of healthcare executives dug into this topic at Becker's 5th Annual CEO + CFO Roundtable Nov. 8 in Chicago. Molly Gamble, editor-in-chief of Becker's Hospital Review, moderated a panel discussion on key trends, issues and responses to population health.

Ms. Gamble first asked the panelists to give their definitions of population health.

Deb Gage, president and CEO of Medecision, a population health management and software as a service company, elicited laughter from the audience with her description of population health, which she likened to the topic of teenage sex. "Everyone's talking about it, no one really knows how to do it — everyone thinks everyone else is doing it so we all say we're doing it."

Rick Sheff, MD, principal and CMO of The Greeley Company, offered a theoretical definition and an operational definition during the panel discussion. "The first is achieving the triple aim, which includes improving the health of the population, enhancing the experience of care and reducing the per capita cost of care. Achieving provider sustainability bumps it up to the quadruple aim, because without this the first three legs won't get met. The operational definition of population health is being responsible for the total cost of care for a population without losing our shirts."

In practical terms, population health can be summarized as the merger of acute care and public health, according to Timothy Putnam, CEO of Margaret Mary Health in Batesville, Ind. Previously, discussion on the health of a population used to center around "clean water and vaccines," said Mr. Putnam. Now, there is greater focus on acting proactively to better manage populations of patients with chronic conditions and reduce hospital utilization.

The key to achieving these goals is expanding efforts beyond the walls of the hospital and establishing closely coordinated systems with other community service providers, according to Valinda Rutledge, vice president of public payor health strategy in the Care Coordination Institute at Greenville (S.C.) Health System and former CMS official.

Greenville Health System has partnered with various community agencies and organizations to create "patient-centered medical neighborhoods," a step beyond the patient-centered medical home, which is a delivery model whereby care is coordinated through the primary care physician to ensure patients receive the necessary care when and where they need it. The PCMNs include the deployment of mobile health clinics that travel through the community and enhanced partnerships with social workers. For example, paramedics who respond to 9-1-1 calls are accompanied by a social worker, and they assess the patient as a team to determine if they can administer care at the scene or if the patient requires a trip to the emergency room.

"The paramedics assess each patient instead of automatically bringing them to the ER," said Ms. Rutledge. "Maybe the patient is having an asthma attack because they ran out of their inhaler medication. While the patient is being stabilized, a paramedic will refill the prescription and bring it back to them. That's bringing primary care into the neighborhood."

In addition to rethinking how to respond to emergency calls, Mr. Putnam noted the importance of getting communities to change their view of healthcare providers. "We realized we were looking at the health of one patient at a time, not the health of the entire population," he said. "We were seen as a place to go when you were sick or injured." In particular, Mr. Putnam said Margaret Mary Health wasn't doing enough wellness visits. "When we called people and said you need to come in for a wellness visit and their answer was, 'You're a hospital and I'm not sick so there's no reason to come in,' that changed our entire mindset." This change required engaging the physicians to see the broader picture — not just the patient in front of them.  

Currently, population health management efforts largely focus on managing the risk of high healthcare utilizers, or "frequent flyers," according to John Myers, MD, CEO of North Texas Integrated Delivery at Envision Healthcare and CEO of Questcare Medical Services. "As we improve that population, we can then focus on the wellness aspect. But for now the sicker population is growing and dominating the ER — admissions are going up. That's being seen across hospitals."

The successful implementation of population health management efforts that emphasize wellness and extend beyond reducing the rate of ER visits among the sickest patients will require coordination among formerly discrete organizations and agencies to transform communities' cultures into ones that value health, as well as reimbursement models that reward healthcare professionals for engaging in such work.

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