As an emergency room physician, I'm completely in favor of new payer-provider partnerships that try to control costs while improving care quality and patient satisfaction. The road to the ER is often paved by failures in care coordination and lapses in care.
Information technology that was intended to result in better care (electronic medical records, healthcare information exchanges) have often been more of a burden to providers than a solution, and population health tools have been hard to implement in a world where a small fraction of patients in a practice are on a cost and quality contract.
Well-designed population health tools, implemented thoroughly, can create impact in ways that benefit the patient, make workflow easier for the provider and keep costs low for health systems and payers. After 10 years of trying to get it right, what has become abundantly clear is that the provider must be engaged in the process. The physician, at the end of the day, has the relationship that matters most to the patients after their own family, and population health management is care. Having this care done as part of an integrated, coordinated care process involving the provider is by far the most effective way to lower costs of care, improve quality and improve the physician work-life balance.
As payers recognize this important influence, they must partner with practices if there is any hope to achieve the triple aim. Through programs like patient-centered medical homes, payers are attempting to move physicians toward value-based care in an integrated care model. A PCMH requires population health management in order to support incentives and treat patients uniquely based on their specific risk factors. Accountable care organizations are making this work, validating the benefits of value-based care. So how do we spread this benefit to all practices with the support of payers in an efficient manner?
Based on our success at Rise Health, we believe there are five key principles that must be considered in any population health strategy.
1. Preserve the patient-physician relationship. Real population health management isn't about data and analytics; it's about caring for people. It's why most physicians became doctors in the first place. So if you're going to use population health data, it should be organized around the patient-physician relationship. In designing for population health management, any new solutions or features need to answer this question: How does the program support that relationship?
2. Bridge the credibility gap between payer and provider. Payers and providers manage and analyze data differently. Payers tend to think provider data is inaccessible and not standardized. Providers think payer data is unworkable and comes in the wrong format. Historically, they're both right. Population health management needs to be designed so that data and reporting help payers and providers work together to get the patient moving in the right care direction.
3. Data and analytics should be useful and actionable. Big data, small data or something in between is only useful if it's truly actionable. That requires looking at information in a new way. Once we know who is at risk, we have to have realistic, high-impact feedback at the time when patients are focused and willing to hear it. Timing is everything when it comes to population health.
4. Technology plus transformation improves the health of the practice. Without hope of a financial incentive, physicians will view population health management the same way they view the introduction of a new electronic health record — more work, less productivity and negative financial consequences. Practice transformation that works, combined with the right population health management tools, can double per physician revenue in a fee-for-service or value-based care model.
5. Customer service is the key. Retailers have known this for years; healthcare is still figuring it out. Successful population health management must touch patients through an engagement strategy that delivers on the success of strong customer service management principles.
A well-designed, thoroughly integrated population health management strategy brings together customer service, clinical decision support and the right data to build something revolutionary in healthcare: better outcomes.
Mark Crockett is CEO of Rise Health, a population management company dedicated to transforming healthcare. He practices emergency medicine at Advocate Good Samaritan in Downer's Grove, IL and is a member of the American College of Emergency Physicians.
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