Toward Population Health Management

In our October Intelligence Report, 90% of healthcare leaders indicated a commitment to improve the overall health of a defined population. What steps is your organization taking toward population health management, and what have been some of the challenges and successes you've encountered?

Elisabeth Stambaugh, MD, FACOG
Senior Medical Director
Cornerstone Health Care
High Point, NC

On commitments and conflicts: All of our contracts include some gainshare portions. We are hoping to move even further than that. We established a couple of specialty clinics, one of which is a congestive heart failure clinic that has significantly reduced hospitalizations and especially rehospitalizations. It has put us a little bit at loggerheads with the hospital because their inpatient population has gone down so much with our success. I also sit on the hospital board so I can appreciate both sides.

On building a value-based clinic: We identified patients within our ACO and they were enrolled in this multidisciplinary clinic with psychologists, nutritionists, pharmacists, physicians, and advanced practice professionals who got the patients to come in very regularly. We have nurse navigators who reach out to patients instead of waiting for them to reach out to us.

On problems with payers: Probably the biggest obstacle in all of our population health initiatives is getting the flexibility with the payers. For instance, getting patients into the heart function clinic frequently means they often have more copays. Whereas in the future when we get to full risk, we will be able to say 'you don't have copays. If you go to the emergency room you will have a huge copay so come see us first for no copay.' The other part of dealing with the payers that has been so frustrating is that in order to truly analyze the data, the payers have to be willing to give it to us. Some of that we can get from our own records but some of it we need from payers and that has been like pulling teeth.

Ben Humphrey, MD
Former CEO
The Medical Group of Ohio
Columbus, OH

We are a physician-owned organization but we are partnered in a physician-hospital organization called Ohio Health Group.

We have a variety of quality metrics that year after year have been improving. Through our processes we can provide actionable data to physicians at the point and time of care so that they can enhance their performance. We've had a very successful pay-for-quality program. Starting last year, we began a total cost-of-care gainsharing arrangement with payers with the goal in time that we will probably be on the risk side of that.

The challenges have been ongoing but we led the system to understand that we must become clinically integrated. We invited our hospital partner to join us in that endeavor. The biggest hurdle was engaging physicians but that is a hurdle we crossed several years ago. We then engaged what we called our physician support tool, which is a data warehouse where we can collect data from the payers, the practices, the hospitals, the laboratories in the area, and then feed actionable data out to the practice through a web-based physician support tool. Physicians are pretty competitive. If you give them data that says "you are not doing as well as you did last year" or "you're not as good as you think you are here at the bottom quartile of your specialty," it's amazing what they come up with.

Jim Nathan
President and CEO
Lee Memorial Health System
Fort Myers, FL

While we and our community are not fully ready for comprehensive population health management, we have been working hard with limited resources to build competencies and capacity to transform care delivery to increase value to our community, including patients, business, payers, and other health providers. We have a 300-plus employed physician group, Lee Physician Group, that is transforming into [using] more team-based care, care coordination, [and] data to manage performance at the point of care.

LPG is also pursuing patient-centered medical home status including accepting certain pay-for-performance arrangements. We are using our own employee health plan with 15,000 participants as an early test case for population health and chronic disease management while repurposing our nearly 20-year-old physician hospital organization to collaborate with independent, contracted, and employed physicians to establish a quality-focused model for clinical integration. We are developing knowledge of how to use data mining and information technology tools for data driven medical management. We are developing an extensive continuum-of-care model for nonacute care services through both owned and independent community health and human service providers.

Early successes include redesigning our nationally acclaimed care management services to better coordinate care across the continuum into multiple settings including the home, our care transitions program, and telehealth, plus early stages of house calls, a skilled nursing physician specialist program, and partnering with independent nursing homes to reduce unnecessary readmissions.

Donald R. Lurye, MD
CEO
Elmhurst (Ill.) Clinic, LLC

We are working hard both within Elmhurst Clinic and at a health system level to become experts at population health. Within our practice, we are expanding the use of RN care managers to assist physicians with the care of chronic illness and using data from our electronic health records to help them do so. This includes proactive patient outreach, prescheduling of labs, and connecting patients to various support services.

We are also reexamining our workflow and trying to move our culture from reactive, patient-initiated care to, at some level, thinking about all of our patients every day. Elmhurst Memorial Hospital's merger with Edward Hospital and the creation of the Edward-Elmhurst Healthcare system has allowed us to take part in a multipayer clinical integration effort. In the near future, we look forward to having all of Edward-Elmhurst Healthcare's physician practices and hospitals on a single EHR platform, all measuring quality and utilization in the same manner.

Physicians respond well to the concept of population health and the opportunity to improve both quality and service. Certainly moving to a single EHR will be a challenge, as will working through issues of physicians' continued desire for autonomy and their angst over increasing collaboration with colleagues currently viewed as competitors.