A large health system has jump-started its efforts to link its financing and delivery system by adopting a population health management strategy for its own employees. Population health management is one of the triple aims of healthcare reform, along with high quality and low cost.
All payers will continue to pressure top line revenue growth for hospitals, but when CMS launched value-based purchasing and the readmissions reduction program in August 2012 (see iProtean blog October 3, 2012), it took a large step towards linking quality and payment. The rationale behind the 30-day readmission penalty focuses on providing adequate post-discharge care management to avoid a patient’s readmission to the hospital. Avoiding readmissions can be considered a component of population health management because “it focuses on a defined group of people (patients with certain diagnoses who have been treated in acute care facilities), a set time period (30 days post-discharge) and at least one clearly defined goal (keeping them healthy enough to stay out of the hospital). Both providers and patients assume responsibility for maintaining the population’s health.” (Sanford, “Population Health Management: A ‘Start Small’ Strategy,” hfm, January 2013.)
The large health system designed a pilot program for its population health management strategy, using its employees and families as the base for the new system. The model includes a health plan, wellness programs and incentives to encourage healthy behaviors. It uses the medical home model to coordinate individuals’ care. IT will be implemented system wide to ensure that each person’s records can be shared among various caregivers. Early intervention for specific conditions—lower back pain, diabetes, high blood pressure, high cholesterol and obesity—will be the initial focus.
“We expect to gain valuable experience managing the health of chronic care populations, which can be applied to risk-based contracts with private and government payers in the future,” said Kathleen Sanford, senior vice president of nursing at Catholic Health Initiatives, Denver and author of the January 2013 hfm article. The system expects to reduce employee healthcare costs by 10 to 14 percent.
Population health management necessarily requires a large population base, and this large health system has sufficient numbers of employees/families to conduct the pilot and gain the needed experience. If a hospital/system doesn’t have the employee numbers to pilot a population health management program, it can and should adopt delivery strategies that focus on clinical integration and the upcoming payment changes. The value-based purchasing program and readmission penalty program set organizations on this path by focusing on managing the care of patients with a select panel of diagnoses.
iProtean recently published an advanced course, Value-Based Purchasing & Accountable Care Organizations, and will publish several additional courses that address population health management. iProtean subscribers, look for Transforming Your Organization into an Integrated Delivery System and Financing Considerations for Integrated Delivery Systems—featuring Marian Jennings, Lisa Goldstein, Dan Grauman and Nate Kaufman—in January and February. Future courses that expand on population health management, Affiliation and Consolidation Strategies parts 1 and 2, will appear in your library of courses in March/April.
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