Regardless of what happens to the ACA under the new administration, healthcare providers and administrators generally agree it's important to preserve the gains the industry has achieved as it works to transform into a value-based system. Population health management is central to these efforts.
The definition of population health is broad and contains many elements. It is the notion that healthcare providers must take a more proactive role in patients' health outside of the hospital walls. Instead of "sick care" — only engaging with patients when they arrive at the hospital with an illness or injury — population health places strong emphasis on prevention. It also accounts for the social determinants of health, such as an individual's socioeconomic status, housing, employment, access to transportation, mental well-being and relationships.
Most hospitals have planned or implemented at least some sort of population health management initiative, and the momentum driving such efforts continues to build as federal and private reimbursement continues to shift from volume-based to value-based models. But all population health efforts will fall short if providers and administrators fail to make the following changes.
1. Redefine "health." When we sat down to devise our population health strategy, we realized we first needed to agree on a set of goals and objectives. To do that, we had to redefine what "health" means to us. Health encompasses far more than just medical care. The greatest determinants of health are lifestyle, behavior, social and economic circumstances and genetics, in addition to access to high-quality medical care.
After redefining "health" and identifying its main tenets, providers must subsequently rethink the necessary steps to achieve ideal health outcomes for patients. This is an integral first step when it comes to designing a population health strategy.
Getting the right leaders on board is another important element of our strategy. That is why we've created a new executive role to ensure we are properly investing in and addressing these various determinants of health. Ram Raju, MD, former CEO of NYC Health + Hospitals, is now senior vice president and community health investment officer at Northwell Health. Dr. Raju is very sensitive to the need to address the social determinants of health and keep a constant pulse on the individual needs of the communities we serve across New York.
2. Improve access to care. Although the ACA led to unprecedented gains in the rate of healthcare coverage in the U.S., having health insurance is not the same as having access to care. In some regions, people must travel long distances before reaching a hospital or physician's office. Many of these places have poor public transportation, and people may not have access to a car. So although they might have a health plan, they have no way to get healthcare. Furthermore, they have little or no choice when it comes to selecting a provider.
As health systems seek to improve the health of the populations they serve and expand their market reach, they must be strategic about where they place facilities and offices, especially ambulatory centers. It will be impossible to keep people healthy if it's impossible for them to attain medical services.
Access to diverse physicians is also critical, but often overlooked. In some communities, providers and patients can't even communicate because of language barriers. Providers must keep up with the changing local demographics so they can effectively communicate and work with the patient population in their language and culture. They must expand their communication skills and be prepared to help patients who may not possess a high level of health literacy.
3. Keep your doors open. Unlike other industries that primarily operate five days a week, hospitals must be open 24/7. However, most hospitals don't operate to their full extent seven days a week. For example, most surgeries take place Monday through Friday, and the operating room schedule is always packed. It may be really difficult to get an operation on the board during the week, but most ORs are empty on Saturdays and Sundays.
The same thing happens in the physician's office. The appointment schedule might be completely full Monday through Friday, but many offices are typically closed after 5 p.m. and on weekends. Well, what do you do tell patients who work all day during the week and can only see the doctor on the evenings and weekends? That’s the case for many patients and family members, yet healthcare is slow to accommodate them.
Healthcare providers — if we truly want to improve the health of out populations — must be open and accessible to people when it is convenient for them to seek care. This change will require a cultural shift and an open mind, but it is necessary to make population health management efforts work. Everyone looks forward to weekends. That's family time and important for replenishing energy. One potential solution is establishing a rotating schedule where providers take turns working weekends and taking time off during the week. For the sake of our patients, this is a change we need to embrace.