In an era of consolidation and decreasing reimbursements, how can hospitals and health systems provide substantial population health programs for their patient populations?
Kevin Ban, MD, CMO of athenahealth, and Deborah Bulger, executive director of strategic account management programs for Change Healthcare, discussed the qualities of successful population health programs and their impact on various patient populations during an April 13 panel at Becker's Hospital Review 9th Annual Meeting, which took place in Chicago from April 11 through April 14.
According to Dr. Ban, when the healthcare industry refers to population health, "We're referring to a payment model — we're paying for outcomes, budget, quality metrics and figuring out how an organization will reap the benefits at a much later date." A contract like that, he noted, presents an incredibly risky situation for payers.
"The joke I hear a lot [in terms of population health] is, 'Systems are spending millions of dollars so they can lose millions of dollars.' The fee-for-service model works for most organizations — it takes a tremendous amount of courage for people entering into value-based contracts [to do so]," Dr. Ban said.
However, it is possible to get an organization's physician staff and administration on board in adopting certain population health initiatives. One of the key ways to do so, according to Ms. Bulger, is to present physicians and other stakeholders with tangible data explaining how certain population health initiatives will lead to better patient outcomes.
"The management of data is important to garner physicians' trust [and] create an environment that incentivizes physicians to ask questions about the [population health] model," she said, adding leadership and staff must also examine "how [an organization's] care management programs reduce readmissions and where those patients go after they leave the hospital and what kind of care they get, the types of interventions that are taken there. … It is a very different approach than what we took even 20 years ago."
While the goal of population health initiatives is to improve health outcomes for patients across the board, Dr. Ban said it is unlikely an organization's programs will affect every patient that comes through the hospital.
"You won't be able to move the needle on certain patient populations, so don't even bother. Trauma care is one of them; there are others," he said. "You have to be judicious because your resources are limited. [You have to] get used to the fact you're not going to be able to impact all of your populations, but it's a great goal to have."