Population Health Initiative - What Should It Look Like At Its Core (Part 1)

A Multi Part Deep Dive Into Population Health

 Population Health initiative is a fluid, dynamic process that is currently not in its entirety in place in many institutions. The risk and rewards acquired by capturing the marketplace early is clear, time is of the essence and the collection of the right technology, people and processes are key. Improving population health requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations and reducing the per capita costs. Analytics captured through a 360° view utilizing interoperability are the key to enabling and achieving the Triple Aim as defined by CMS.

Valued Based Care, at the core of population health, is the collection of structured and unstructured data. Unstructured data is often overlooked as it presents challenges, but there are opportunities within the environment today that will allow for it to be collected and reentered into a structured format. This would meet the goal that we are trying to accomplish, which is capturing the entire data throughout the continuum of care without limitations of interoperability. Outcomes cannot be limited by lack of data, care plans have to be comprehensive and rich in data.

Technology must be considered early and thoughtfully through process rich algorithms as it is the only way to capture and stratify for desired results, it can make or break the initiative. In the first risk ventures, we saw Medicare Advantage companies without technology as it relates to population health management software, had the ability to control medical costs/ratios. They accomplished this by centralizing infrastructure; a couple of noted parties were Leon Medical Centers and Pasteur Medical Centers. Bringing in both infrastructures and a population health software would make it easy to promote your population health initiative to payers and risk-based participants for population health management. Mimicking the infrastructure components agreed to and by having the right strategic technology partner in place, expanding geographic footprint would make it more attractive to large payers.

Coordination of care, medication, referrals and authorizations for the entire continuum of care with one care plan, will serve in and of itself for best practice models and comparative analysis. The population health initiative should be wrapped into a Clinically Integrated Network (CIN or IDN). The ongoing costs needed to continue to operate could be offset from the revenue lines, particularly Transitional and Chronic Care Management (TCM & CCM).

The initiative should look inward and outward for opportunities. Specifically, outwards, there should be an upside by physicians joining the CIN. For example, physicians could become Medical Home (PCMH) accredited, not limited by lack of data to participate in risk opportunities, provide them a mechanism for their reporting on metrics and other payments for performance strategies. Also, protect them from any penalties like not meeting reporting requirements from the government (MACRA). CIN/IDN should include management assistance in modifying workflows or creating workflows that will enrich their practices, patient satisfaction with the overall goal for “Best Care Practice” models. This type of outreach will also encourage other practices to join your team as you make it easier for them to manage MACRA and risk within their managed care contracts, meet outbound opportunities for patient satisfaction as well as reporting. From the institutional side (Healthcare Systems), the legacy process that has been in place should be modified and run in parallel, embracing the PCP as the Gate Keeper going forward.

Population health will dominate all future revenue lines… do not under estimate the community of services and resources which will be needed to succeed.

Future Articles related to Population Health Initiative.

Potential Revenue lines for Population Health Part 2:

Necessary components in considering a Strategic Technology Partner Part 3:

By Mario Espino