The healthcare industry’s transition to value-based care requires a mind-shift—it’s moving from delivering sick care to delivering continuous health, and rewards those who prove they’re helping patients live healthier lives. It requires healthcare organizations to invest in population health management (PHM) programs and allocate their resources in a very different way. Rather than measuring success solely in terms of a financial bottom line, it’s increasingly determined by value, outcomes and patient experience. While there is light at the end of the tunnel, health systems need to make sure there is a clear destination in mind.
Healthcare has historically been slow to adapt to change, but the waiting game for defining what PHM means to your organization is over. As reimbursement increasingly shifts toward this value-based model, the question among hospital c-suites is no longer when or should we start, but how do we start.
While kick-starting a PHM program can seem complex and disruptive, it does not have to be a complete overhaul of your current operations. In fact, health systems need to be comfortable operating under both fee-for-service and value-based care during this transition period. By applying these tips to help make the process as seamless as possible, organizations can find what PHM tactics work for them, ultimately creating more meaningful partnerships with patients, and reaping the benefits of reduced costs and improved outcomes.
Jump in, and make it manageable.
When thinking about your PHM program, it’s important not to bite off more than you can chew; break your population into manageable pieces or risk categories to keep it from overwhelming you. If you want to start with a more controlled, low-risk population, your own employees can make for a great testing ground for PHM tactics. They serve as a defined population with a set healthcare package, which allows you to try innovative approaches before tackling more complex patient populations.
Beyond your own employees, continue to tackle one niche patient population and quality metric at a time—whether it’s reducing the number of patients who use the ED for non-emergent issues, or creating a centralized role to conduct patient outreach to diabetics. Once you achieve success in one area, you can expand to others.
Make a business case to the c-suite.
By nature, PHM competes with a health system’s biggest source of revenue—the hospital—by encouraging providers to better manage the patient outside its four walls. Fee-for-service has trained the C-suite to value admissions, ED visits and full hospital beds, all of which create a stream of consistent revenue. PHM advocates now have the challenge of adjusting that mindset to prioritize appropriate care settings for each patient and ultimately reduce admissions by keeping them healthy at home. To avoid friction in conversations with the C-suite, quality leaders need to approach strategies from a financial perspective and make it appealing to those weary of disrupting a fee-for-service world.
It can be difficult for quality leaders to develop a business case for value-based initiatives, as many of them involve an upfront investment and a long-lead ROI. The key is to highlight how improving outcomes on even a small scale will lead to incentives from payers in your market. Take the example of pitching the idea of a population health coordinator. Instead of relying on the overworked front desk to reach out to patients who haven’t had certain routine exams done in a while, this new role would serve as a centralized coordinator to engage with patients and schedule appointments. While there’s an initial cost associated with staffing this role, more often than not, they pay for themselves in the form of incentive dollars from health plans and increased visits in the clinics. This can then be reinvested into more coordinators, care managers or other PHM tactics, and create a domino effect of long-term cost savings and sustained value.
Leverage technology that will help advance your PHM programs.
To manage a population across the care continuum and to take on a risk-bearing payment model; patient data has to flow, be understandable, and be actionable. However, today’s healthcare environment lacks the interoperability necessary to exchange patient information in a way that positively impacts the care cycle. Many health systems operate under multiple electronic health records (EHR), making the necessary visibility into a patient’s interactions with the healthcare system and their overall well-being nearly impossible.
To have success in PHM, we need to get practical about interoperability and adopt platforms that pull patient data from disparate sources. For example, Philips’ PHM solution provides a connected ecosystem to help organizations collaboratively manage health. The solution aggregates patient data into longitudinal records and patient profiles, and stratifies populations by acuity and risk, so providers can identify specific patient cohorts. This helps activate customized care planning to close care gaps and enroll patients in appropriate programs. With the use of third-party solutions such as this, health systems can easily track against value-based measures and identify opportunities to improve quality and drive revenue.
Be willing to fail.
There is a learning curve to navigating value-based care. Everyone will try different initiatives that don’t take off, aren’t the right fit, or don’t yield the expected outcome. You will fail, but be sure to do so early, and don’t dwell on things that aren’t working. A pilot is not something you try out for a year; that’s a program! Identify weaknesses, rectify them, and move on.
Population health doesn’t come in a box neatly wrapped up with a bow. It’s messy, and that’s why more than 73 percent of health system executives view the transition to risk-based care models as a top priority, but many see it as a difficult one to tackle. The reality is healthcare organizations that move more quickly to build PHM programs will benefit from the ‘snowball effect,’ in which their ability to successfully manage lives now helps set them up for bigger and better value-based contracts in the future.
It will undoubtedly mean different things to different organizations, and that’s okay. We don’t need one grand solution that fits all, as long as the right mind-set is there to improve care for the patient. So, what are you waiting for? If healthcare organizations want to thrive in this new age, they must take the first steps now in transforming how they think about, manage and deliver care for today’s consumer-savvy patients.
Cindy Gaines is the chief nursing officer, population health management, at Philips