Tag Archives: Population Health

As Healthcare Changes, So Must its CEOs, CFOs, COOs…

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To keep up with big changes in how healthcare is administered, financed, and organized, top leaders are finding a need for new talents and organizational structures.

To keep up with big changes in how healthcare is administered, financed, and organized, top leaders are finding a need for new talents and organizational structures.

Healthcare reform as a term has become so ubiquitous that it is almost indefinable. At first, and broadly, it meant removing the waste in an excessively expensive healthcare system that too often added to the problems of the people whose health it aimed to improve. Then it became legislative and regulatory, in the form of the Patient Protection and Affordable Care Act and its incentives aimed at improving the continuum of care and expanding the pool of those covered by health insurance.

Now, for many in the industry, healthcare reform has matured into a business imperative: the process of ingraining tactics, strategies, and reimbursement changes so that health systems improve quality and efficiency with the parallel goal of weaning us all off a system in which incentives have been so misaligned that neither quality nor efficiency was rewarded.

That leaders finally are able to translate healthcare reform into action is welcome, but to many health systems trying to survive and thrive in a rapidly changing business environment, the old maxim that all healthcare is local is being proved true. Making sense of healthcare reform is up to individual organizations and their unique local circumstances. Fortunately, there are some broad themes and organizational principles that are helpful for all that are trying to make this transition. What works in one place won’t necessarily work in another, but the innovation level is off the charts as healthcare organization leaders reshape what being a leading healthcare organization means as well as what it requires.

The right place for the right care

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http://www.us.jll.com/united-states/en-us/Research/US-Healthcare-Perspective-2017-JLL.pdf?661ac41b-8177-4716-8c89-a88e24e95f17

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How can we improve the health of our communities, while also reducing costs and maintaining high-quality care? And how will we pay for it? These are the most vexing questions facing healthcare executives today.

An expanded patient base will be necessary for survival. Location is an increasingly critical factor in determining future success, with many asking: “Where do we need to be and what kind of service do we need to deliver?”

Uncertainty is unavoidable in the healthcare industry. But regardless of what direction healthcare reform may take, certain facts will not change. Healthcare costs must decrease to provide more care to more people, and keeping patients out of expensive hospital settings can drive down the cost of care and simultaneously improve population health. The right real estate strategy can help hospitals ensure that they have the right places for the right care.

 

Why an “Empty Desire” for Big Data is Inhibiting Value-Based Care

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Value-based care and big data in healthcare

For the most part, the healthcare industry has embraced the idea that access to big data is a critical part of doing business in the modern care environment.  But there’s a major difference between having big data and leveraging it effectively for cutting costs and improving quality.

The chasm is growing between organizations that simply have access to data and those who know how to use it well, argues Shahid Shah, Entrepreneur-in-Residence at the AHIP Innovation Lab, and the resulting imbalance of information is making it difficult for payers and providers to truly make the leap into value-based care.

If provider organizations and their payer partners wish to bridge those gaps and prepare for a financial environment that prioritizes better outcomes, they will need to completely overhaul their approach to developing quality metrics, designing their health IT environments, and quantifying their data-driven relationships.

The process must start with taking a closer look at what payers really want or need when they talk about sharing information.

“Payers have an empty desire for data,” Shah told HealthITAnalytics.com at the HL7 FHIR Value-Based Care Summit in Chicago.

“It’s empty because it’s not in contracts yet. They haven’t reached the level of sophistication where they can accept data from providers and do something meaningful with it. If providers actually started giving them data, they wouldn’t know what to do with it, because they don’t have the systems in place.”

While there are still some technical challenges that make data aggregation and analytics a problematic proposition, the bigger issues are cultural, organizational, and legal.

“The infrastructure isn’t the main obstacle,” explained Shah, who is also Co-Founder and CEO of Netspective Communications.  “Developers will always try to solve whatever problems you throw at them, even if it takes a while.  There is nothing that a developer won’t eventually be able to do.”

“Data blocking and the inability to share data really happen because we haven’t created the demand ecosystem for interoperability. The fundamental flaw of our so-called desire for interoperability is that we haven’t reduced it to a transaction that can be measured and monitored in legal terms.”

The current generation of value-based care contracts simply don’t contain the necessary language to establish clear parameters for effective data sharing, he stated.

“They just don’t deal with data,” he said.  “There aren’t clauses that say things like, ‘I want you to send me this amount of data on this number of your patients over this period of time using this particular standard so that I can calculate these ten measures using such-and-such as the denominator, et cetera.’”

“Instead, payers ask for raw data so that they can compute the measures on their own, but that can lead to conflicts with providers and confusion over payments.  We need a better way to share data – and better data to share – if we’re going to make value-based care work.”

9 healthcare systems join forces with IHI to reduce healthcare inequities

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http://www.fiercehealthcare.com/healthcare/9-healthcare-systems-join-forces-ihi-to-reduce-healthcare-inequities?mkt_tok=eyJpIjoiTUdJMU1UYzBZMlptTlRFNSIsInQiOiIxU3dwUGNwOEpwMmQyQk9NNklmU3NOaTVuY3FcL0t6UjNVeHhNMFdPRmplQktSNWRcL2NhdW50a2d3cmJrelBlWUxobkIyemU3TGpVejE4akRvT3RpekFOZW84bXpnaHFpcXl2ME1USCtCSVVKZ2Jhdldlc0tmRUFWbUY4Z1lLbzRLIn0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Patient-centered care

Henry Ford Health System, Kaiser Permanente Health Plan and Hospitals and Rush University Medical Center are among nine healthcare systems working on a new initiative to reduce inequities in health and healthcare access, treatment and outcomes.

The Institute for Healthcare Improvement (IHI) launched its two-year “Pursuing Equity” initiative on Monday. Its goal is to break new ground by explicitly addressing institutional racism and by identifying ways healthcare organizations can reduce clinical disparities of care as well as improve equity in employee wellness and social determinants of health.

The other systems participating in the project include HealthPartners in Bloomington, Minnesota; Main Line Health in Newton Square, Pennsylvania; Methodist Le Bonheur Healthcare, Memphis, Tennessee; Northwest Colorado Health, Steamboat Springs, Colorado; and Southern Jamaica Plain Health Center, Brigham & Women’s Hospital, Jamaica Plain, Massachusetts.

Each system will build on the work they’ve already done within their institutions, including launching programs to reduce clinical disparities, track equity in process and outcomes data, and improve knowledge and capability.

“We see a future where every healthcare system in the country pursues equity as part of daily work and core skills, ensuring that individuals and communities can attain their full health potential—and we believe Pursuing Equity is an important step in creating a blueprint for other organizations to follow,” said Derek Feeley, IHI president and CEO, in an announcement (PDF). “Pursuing Equity is part of the next phase of IHI’s ongoing commitment to address the unjust, costly, and persistent inequities in health and healthcare across the nation. We are energized and ready to continue this critical work.”

The initiative will be funded by theRx Foundation, Bristol-Myers Squibb Foundation, and the participating health systems.

How Should We Measure The Distribution Of Health In A Population?

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http://healthaffairs.org/blog/2017/03/17/how-should-we-measure-the-distribution-of-health-in-a-population/

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Measuring population health and its distribution can unite groups across sectors around a set of clear, defined goals. However, no one metric can capture the intricate and complex nature of population health. Instead, we need a matrix of indicators to gain a full picture of health and how it is changing. (see Figure 1). For example, rather than measuring only end-of-the-line health outcomes such as mortality, we need to measure a range of metrics across the health pathway, including the determinants of health, risk factors, prevention and treatment.

In addition, to understand the distribution of health in a population and address inequalities, we need to measure health across different subpopulations.

Yet there is little evidence on which sub-population groups should be considered. Commonly used segmentations are based on socioeconomic status, geography, gender and ethnicity. However, population health can also be explored across different disease or age groups. In addition, risk factors play an important part in determining population health, and could provide a basis to segment the population. There also exist specific societal or clinical groups that carry particular relevance to policymakers, such as employees, prisoners, homeless people, disabled people or people with drug dependencies.

While all these population groups are important to population health, it is not practically possible, or desirable, to measure and present health outcomes across all possible dimensions. Therefore, we conducted an expert Delphi study, which uses several rounds of questionnaires, where the results from earlier rounds feed into the next in order to reach a consensus among participants. Our goal was to prioritize population segmentation approaches, and guide both the collection and presentation of population health data.

Implications For Policymakers

There exists a clear consensus among health care experts around the need for population segmentation in order to measure population health and health equity. However, there is no single way to do this. All ten population segmentation approaches were considered important by the panel. These results highlight the value of considering the wide range of different population groups that may influence health outcomes.

The results of this study can help researchers and policymakers prioritize the way they analyze and present population health data. In addition, these results should guide the collection of data. For example, the panel considered socioeconomic status and risk factors to be very important, but administrative datasets collect information on these issues in different ways and according to different definitions. Standardizing the collection of segmentation variables would allow population-wide analysis of the distribution of health.

Policymakers should also consider using a data-driven approach to identify population segments, rather than a priori defined population groups. Big data and data mining techniques can help quantify the distribution of outcomes in a population and identify the factors driving these differences.

It is important to note that measuring the distribution of health is only one of the many steps we can and should take to create healthier populations. We must continue to explore how population health will benefit from emerging innovations in technology, service model design and big data and analytics.

 

Caring for High-Need, High-Cost Patients — An Urgent Priority

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http://www.nejm.org/doi/full/10.1056/NEJMp1608511?utm_source=TrendMD&utm_medium=cpc&utm_campaign=NEJM_TrendMD

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Improving the performance of America’s health system will require improving care for the patients who use it most: people with multiple chronic conditions that are often complicated by patients’ limited ability to care for themselves independently and by their complex social needs. Focusing on this population makes sense for humanitarian, demographic, and financial reasons.

From a humanitarian standpoint, high-need, high-cost (HNHC) patients deserve heightened attention both because they have major health care problems and because they are more likely than other patients to be affected by preventable health care quality and safety problems, given their frequent contact with the system. Demographically, the aging of our population ensures that HNHC patients, many of whom are older adults, will account for an increasing proportion of users of our health care system. And financially, the care of HNHC patients is costly. One frequently cited statistic is that they compose the 5% of our population that accounts for 50% of the country’s annual health care spending.

At least three steps are essential to meeting the needs of these patients: developing a deep understanding of this diverse population; identifying evidence-based programs that offer them higher-quality, integrated care at lower cost; and accelerating the adoption of these programs on a national level. Although we are making progress in each of these areas, much work remains.

 

Aetna, UnitedHealth show increasing appetite for value-based care contracts

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Aetna has long held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020.

The biggest health insurers are moving quickly towards to value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.

“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.

“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.

As Healthcare Changes, So Must its CEOs, CFOs, COOs…

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To keep up with big changes in how healthcare is administered, financed, and organized, top leaders are finding a need for new talents and organizational structures.

Geisinger Health System CEO launches population health initiative

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Geisinger Health System CEO launches population health initiative

From left: Steve Krein (moderator) Esther Dyson, Dr. David Feinberg, Dr. Richard Zane

Geisinger Health System CEO Dr. David Feinberg used the StartUp Health Festival to launch its population health initiative, Springboard Health during the J.P. Morgan Healthcare Conference in San Francisco this week.

Starting with Springboard Healthy Scranton, the program will work with Scranton, Pennsylvania residents on helping them to manage diabetes, obesity and behavioral health needs. It will also help individuals gain access to healthy food by leveraging food banks.

The program launch was part of a wider panel discussion on building innovation hubs with the panelists reaching a similar conclusion — that hospitals and health systems need to work with their communities to transform themselves or risk being disrupted in ways they can’t control.

In an interview with MedCity News, when asked what Feinberg has learned from hospital public health initiatives, for better or worse, Feinberg said he wanted to avoid the kind of piecemeal initiatives that Geisinger, admittedly, has done as well.

“A lot of times health systems do a community needs assessment because it’s a requirement and when it comes back, obesity is an issue, transportation is an issue, access to care is an issue, mental health is an issue. But then, no one does anything with that data but put it on the shelf until you do the report the next year. Then they’ll have a health fair, do some health screenings and we are guilty of all that too. So it is sort of piecemeal, not consistent and never really brings everybody into the community together and says, ‘We will do this together’.”

Feinberg noted that Springboard Healthy Scranton would include elements such as a fresh food pharmacy — an initiative that “prescribes” a food program for diabetic, food-insecure patients. The initiative will also pull together data, genomics, and double down on community involvement in an interesting combination of population health and personalized medicine.

Geisinger will do DNA sequencing for Scranton area program participants so they can receive information about serious genetic conditions they may be at risk for yet unaware of. The idea is to do early testing and get a diagnosis earlier to improve the long-term outlook for those individuals.

“It is about how we can engage with our community and benefit from our community,” Feinberg said.