Population Health Management: Hospitals' Changing Employer Role

A look at how two health systems approach population health management for their employees.

Population health management is a relatively new approach to healthcare, and one that fundamentally changes the industry. Instead of only treating patients episodically, hospitals and health systems believe it is also critical to focus on keeping patients healthy and out of the hospital.

"We have to be more than an organization that treats patients. We have to be partners with individuals in the community both if they're feeling well or ill," says Lieutenant General Mark Hertling, senior vice president of global strategy, physician leadership and Healthy 100 initiatives at Florida Hospital in Orlando. Healthy 100 is a program developed by Florida Hospital to educate and motivate people to adopt healthy lifestyle changes.

While the healthcare system's role in the community is changing to that of a partner in health and in sickness, many systems have also renewed their commitment to partnering with employees and also keeping them well. Their role as employers is changing along with their role in their communities.

The reason Florida Hospital focuses a bulk of its population health management efforts on its employee population is two-fold. First, the system's mission is to extend the healing ministry of Christ. "The Florida Hospital way claims everyone needs healing in some respect," including employees, Lt. Gen. Hertling says.

Secondly, boosting employee health ties into the system's aim to be an example to the community in improving the health and well-being of everyone in its community and beyond. "In order to improve the community, we have to model that health [in our system]," he says.
 
Franciscan Missionaries of Our Lady Health System in Baton Rouge, La., has a similar mindset. "It's our team members who are working to care for patients every day, and they very much want to embody the spirit of health and well-being," says Stephanie Mills, MD, president and CEO of Franciscan Health and Wellness, a subsidiary of the system. "We have to start with our own workforce who is treating our patients every day."

This, Dr. Mills says, is a shift in thinking from even five years ago. "It's interesting to see the change as health systems understand this is something [they] need to invest in a little more than the past. We're definitely seeing the tides have changed a bit."

What's being done

Based on their missions and newfound focus on improving the health of all populations, FMOLHS and Florida Hospital have created programs to live by example for their communities by keeping their employees healthy. Each system has created unique programs to address health needs of their specific employee population.

Florida Hospital. The Healthy 100 program, which has a track for employees, is built on the eight principles of CREATION Health: Choice, Rest, Environment, Activity, Trust, Interpersonal relationships, Outlook and Nutrition. All programs in the Healthy 100 initiative are built on these principles.

For example, the system recently did a deep dive into its food options, under the Nutrition principle. "It's difficult in the healthcare environment to do the right thing [nutritionally] because there are a lot of challenges," Lt. Gen. Hertling says. Physicians eat on a tight schedule, for instance, or nurses skip lunch or snack to save time. And, there are the specific nutritional needs of patients, and the desire for “comfort food” from the patient’s families.  The system is looking into offering different, healthy options to address nutrition in each of these population's needs.

Another focus of the Healthy 100 is going after employees who are currently unmotivated to change their eating or habits to become healthier. "That's not where most health programs go after," he notes, as they prefer to target a smaller percentage of people who already may be motivated to make changes. So, for its employees, Florida Hospital established a buddy program for exercising. "That's proven to be the most successful way to be held accountable," and get previously unmotivated individuals to make healthier choices.

Franciscan Missionaries of Our Lady Health System. The five-hospital system established Franciscan Health and Wellness in 2010 as it began to look at healthcare reform and the challenges the system and other employers were facing in the community. The Healthy Lives program is based on four main components: clinical and health plan analytics, health risk assessments and screenings, tailored health coaching and wellness programming and care management.

Franciscan Health and Wellness has developed several special programs through Healthy Lives for employees to use. One successful program is the pregnancy wellness program, which resulted from an analysis showing an opportunity to reduce preterm births. Through the program, soon-to-be mothers enroll and meet with a health coach — often a nurse — every month during pregnancy and for six months after. "It's been a very powerful program…we've seen a dramatic reduction in our preterm births," Dr. Mills says, and pregnancy-related care compliance scores have also improved.

These are just a few examples of what the two systems have done to take the population health management approach to their own employee base.

Moving beyond employees

These employee-specific programs are an important stepping stone toward achieving the overarching goal of population health management: improving the health of everyone, perhaps even the entire nation. This is something Lt. Gen. Hertling isn't quick to forget. "It really has to do with the future of healthcare and how it's tied to the future of America," he says. "We're in terrible shape as a country. We're at an inflection point," and it's his and Florida Hospital's goal to change the direction of the nation. "First, we improve the health of our own workers. Then the community, then the nation."

Franciscan Health and Wellness is working with employers in the communities the Franciscan Missionaries of Our Lady Health System serves. Franciscan Health and Wellness has also already spread its population health management expertise outside of its local Louisiana community — the system is working with health systems in four other states to help them develop similar population health management expertise to improve the health of even more Americans.

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