The Popularization of Population Health: Enduring Traits & Current Challenges

Rose Maljanian is founder and CEO of HealthCAWS, a privately held corporation focused on improving health and making healthcare more affordable by aligning accountability models and supports for success. Throughout her career, Maljanian has served on the frontlines of health innovation as SVP for Product Innovation at Magellan Health Services, a senior member of the Innovation Center leadership team at Humana, and as the founding director of Hartford Hospital’s Institute for Outcomes Research and Evaluation. She is a founding and current Board member of the Population Health Alliance.
Note that this post was originally published by Oliver Wyman Health on May 17, 2016.

Population Health is the latest topic talked about in every innovation and investor setting, yet it has been in the making for decades. Frameworks have been made publically available for years by thought leadership groups such as the Population Health Alliance (PHA). The primary reason population health has moved up higher on the national radar is that the umbrella term “population health” includes “value-based care.” Other groups such as the American Medical Group Association (AMGA) and the Patient-Centered Primary Care Collaborative (PCPCC) have additionally contributed to the advancement of the underpinnings for the delivery of value-based care.

The enduring traits of population health management include: accountability for a defined population, intervening in partnership with the consumer and producing results in the form of measured outcomes tied to performance agreements. While great strides had been made by multiple stakeholders to advance population health in a fee-for-service environment, the current trend of aligning financial incentives for care delivery, versus consumer engagement and care coordination initiatives alone, substantially improves the likelihood that all stakeholders will work together toward value-based goals.

Common challenges in population health management have been highlighted over the years but authors in a recent article published in the International Journal of Integrated Care summed up the major challenges we are facing today quite succinctly: governance models, engagement of the population served, payment models, and evaluation of what by its nature is a complex multifaceted set of interventions.

Here are three ways to move the industry forward:

1) Lead with your strengths: Understand roles and focus on accountability and outcomes

a) Population health management entities: These organizations take responsibility for a defined population for a defined set of outcomes (quality and cost). Examples all share common themes of defined population, accountability, intervention, and outcomes:

  • Providers and hospital systems in various risk sharing models for quality and cost outcomes for defined populations owning, licensing, or partnering for necessary data and technology solutions
  • Payer initiatives (health plan and employer)that for a defined population take full risk and/or support providers to take risk, provide front end and back end data solutions, and coordinate care and other services and interventions (licensed or wholly owned) leading to outcomes for which they are accountable
  • Health services companies that for a defined population in total or for a phase of the care continuum (e.g. inpatient, outpatient, post acute) provide front end and back end data solutions and coordinate services and interventions (licensed or wholly owned) leading to outcomes for which they are accountable
  • Community or public health entities that are responsible for a defined population for which they monitor, intervene with, and produce outcomes for which they are accountable

b) Population health support solution companies: It really is OK for one organization not to do it all. Partners are needed to enable the implementation of population health with support tools and services. A company can provide a vital component of support to population health management entities. The four market segments above all need supports that integrate well with their core competencies. These tools and functions are vital to identifying and stratifying the population, setting triggers for outreach or quality improvement, engaging consumers, intervening and measuring and tracking outcomes to ensure the success of both consumers in achieving their goals and healthcare organizations in meeting their value-based contract requirements. Solutions that fall into this category may be:

  • Analytics companies, front end or back end, that provide predictive modeling, risk stratification, outcomes evaluation, and reporting
  • Electronic Health Record (EHR) or Health Information Exchange (HIE) solutions for data acquisition and management and transmission platforms and services
  • Consumer portals, health risk assessments, health and wellness trackers, biometric monitoring, telehealth, and CRMs
  • Care management software alone or with staffing but no risk bearing
  • Administrative services companies

2) Checklist for success: Build from past evidence and learnings

  • Look at evidence based research and case studies for components of the population health strategy that make up the total program
  • Use data assets and modeling to identify and intervene with high risk groups and work with providers and consumers to get quality gaps and high but avoidable utilization under control quickly
  • Don’t forget that health is dynamic and a static snapshot is out of date immediately, even more so if based on a report from a 1-3 month data lag
  • Don’t forget about the full continuum of care; moderate risk individuals can move to high risk and low to moderate if they are ignored
  • Leverage care extenders and technology to keep support strategies for all groups affordable
  • Take a community approach; the environment of live, work, and play represents the bulk of impactable hours

3) Consumer is king: Keep the focus on patient-centered solutions  

The future of population health tied to consumer experience: Consumers are expected to continue taking a more proactive, holistic approach to health; care is also increasingly occurring remotely, at home or in nontraditional settings; and advancements in technology are growing exponentially not only for what in other fields is 101 items like data capture, analysis, and sharing but with more focus on improved diagnostics, monitoring, and treatments that put consumers increasingly in the driver’s seat. Consider these keys to population health consumerism:

  • Population health ultimately involves the roll-up of individual consumer’s goals and their personal best outcomes. Shoe horning individual consumers into predefined goals will likely yield unrealistic care plans, avoidance behaviors, and unintended consequences
  • Understand the average consumer is overwhelmed by delivery systems, insurance procedures; thus most need guidance and support at each touchpoint
  • Provide convenience and efficient self-service and self-management options where possible like other industries but pair them with the necessary clinical expertise and support

The Great Debate

In November at the PHA Annual Forum, Al Lewis, CEO of Quizzify, and Ron Goetzel, Senior Scientist, Johns Hopkins Bloomberg School of Public Health engaged in “The Great Debate” on whether employee wellness programs demonstrate a return on investment. Download the recording here.

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