Whenever I engage in discussion with health care executives or clinicians about strategies and programs for population health management (PHM), we have to step back and invest the time to get everyone on the same page as to what this broad and widely interpreted term truly means. Not surprising, the notion of population health management is referred to as squishy, and informal surveys suggest clinicians may not know what PHM means to them.
This lack of clarity in definition and scope is a growing problem, because the migration to value-based care and payment models that we’ve been witnessing for several years is accelerating. Yes, there may be a pause by some healthcare systems and payers in moving forward on value-based initiatives until the Trump Administration’s health policies become clearer for the reasons articulated in a recent article posted here. However, we are reminded by executives of key non-government health organizations that payment reform is a bipartisan priority. Regardless of the future of the Affordable Care Act, the Medicare Access and CHIP Reauthorization Act (MACRA) alternative payment model is a driver for continuing down the path of population health management. For additional insights on MACRA, read our recent blog, “Top 10 Takeaways from the MACRA Final Rule.”
Making the transition to an environment where payments are outcomes-based requires significant investments in infrastructure and programs to manage the health of patient populations. All stakeholders in health care are affected, including health care systems, payers, and pharmaceutical companies. But, before informed decisions can be made about strategies and investments in this new world, collaborating organizations need to work together toward a common view of population health management that has clear and aligned goals and well-defined boundaries.
Here I will propose a starting point – a general framework that is straightforward and is scoped to be within the “wheelhouse” of a health care delivery organization that is collaborating with payers or pharmaceutical companies to implement population health programs. This framework can serve as the vehicle for developing well-defined, sharply focused programs to target specific patient populations and are managed toward measurable goals.
First, we need to carve out of the broad concept of total population health management those aspects that can be influenced by health care providers. In its most comprehensive form, total population health encompasses management of socioeconomic and environmental factors in addition to clinical and health behavior indicators affecting a defined population’s health status. While this is certainly the long game, Dr. Donald Berwick, President Emeritus of the Institute for Healthcare Improvement and healthcare visionary cautions that the U.S. healthcare system isn’t close to where it needs to be to address the multiple determinants of a population’s health. What can be influenced are the clinical indicators of health and health behaviors of certain patient populations – especially groups diagnosed with certain chronic conditions or at high risk of developing a chronic disease in the near future.
With that narrower band of determinants in place, a goal of population health management programs gaining broad acceptance – and based on the IHI’s Triple Aim – looks achievable: to (1) improve the health of a particular patient population, (2) improve the quality and safety of care delivered to this defined group, while (3) reducing costs. Evaluating progress towards this goal is based on outcome measures already broadly adopted by health care providers (e.g., % patients with blood pressure under control, rate of adverse drug events, emergency department visits). In a value-based world, a payer, pharmaceutical company, and healthcare system can find alignment between this goal and each of their respective strategic interests.
Last, we need a framework to design population health programs to achieve this goal for a specific patient population and set of outcomes i.e., performance indicators. This framework has four components: (1) target population, (2) risk factors, (3) interventions, and (4) key measures. Two examples of actual, clearly defined and scoped, and arguably successful population health programs illustrate this design framework: congestive health failure program at Essentia Health and vaccination program sponsored by Merck:
With this approach to population health management, stakeholders can come together and implement sharply focused programs, and driven by measurable near- and long-term result targets.
I will return to this blog soon to share a business case for pharmaceutical company collaboration with health care systems on population health programs.