The healthcare industry has been increasingly focused on leveraging technology for population health initiatives — but what first steps can executives take to create a successful program?
During an athenahealth-sponsored executive roundtable at Becker's Hospital Review 5th Annual CEO + CFO Roundtable, healthcare industry experts weighed in on the opportunities and challenges their organizations faced when introducing population health initiatives.
Here are five actions for your population health checklist:
1. Adjust physician compensation. Many executives said appropriate compensation is the foundation of an engaged physician workforce. And as executives have begun implementing additional interventions into the patient experience, a growing concern is how physicians will be compensated for this follow-up care.
The chief regional strategy and growth officer of a Midwest-based behavioral health service network with more than 150 locations noted that hospitals in markets with multiple healthcare facilities may find it particularly challenging to levy additional mandates on employees, in fear of these physicians switching employers.
"It's highly competitive for employed, in-network physicians, and while ultimately there are other factors — organizational, oversight, physician burnout — the initial entry is the financial incentive piece," he said. "Without that, there's not even a gateway to have those deeper conversations."
The president and founder of an anesthesia management company that runs programs at more than 180 facilities explained how, in spite of the uncertain healthcare landscape, physician desire for fair compensation is one aspect of employee retention that will not change.
"I don't think anyone in this country really knows what's going to happen with MACRA, or MIPS, or any of that," he said. "But money and lifestyle, together, are going to be huge driving forces. You cannot ever forget that."
2. Ensure technology usability. Before encouraging physicians to capture population health data, it is critical for hospital leadership to consider the physician user experience with technology.
"When our docs turn on their computers and stare at their workloads, improving that environment, I think, is paramount," said the medical vice president of hospital and surgical services of an 18-location medical center in the Midwest. "Nothing else works, unless we show understanding that we have to help them along with the EMR."
Many physicians have reported frustration with EMRs. In the Medscape EHR Report 2016, the majority of physicians reported that EHRs slowed down their workflow; earlier this year, a study in Mayo Clinic Proceedings even linked EHRs with physician burnout.
However, successful healthcare executives can leverage new technology to help physicians streamline their workload, according to Paul Merrild, senior vice president and general manager of athenahealth's enterprise division.
"Are providers actually using the things we know will save them the most time?" he asked. "If providers and other users of the system simply aren't taking advantage of it, you oftentimes don't know."
Mr. Merrild said that, using athenahealth's system, executives can track when providers are working on the system, for how long and how many keystrokes, to gauge their efficiency during tasks like clinical documentation.
3. Ramp up physician engagement. Once healthcare facilities have implemented efficient technology for clinicians, executives stressed the importance of physician leadership.
Many executives said more physicians on their medical staffs are interested in contributing to leadership decisions and influencing the organization's future.
"We have a physician leadership academy in place, and it's gone a long way to making the physicians more comfortable with what we're doing and with where we're trying to go," said the senior vice president and chief financial officer of a 581-bed medical center in the South.
Mr. Merrild partially attributes this desire to play a role in an organization's future to recent acquisitions in the healthcare industry. He suggested that, as physicians find themselves folded into different health systems, they are increasingly looking to understand their organization's mission and goals.
"Especially with all of the consolidation that has happened, there's a bit of an identity crisis," Mr. Merrild said. "'I was part of organization A, now I'm part of organization B.'"
4. Nurture strategic partnerships. After establishing the infrastructure for a population health strategy on an individual organizational level, reaching out to other healthcare facilities to craft effective partnerships marks another necessary, but challenging, step.
The senior vice president and chief strategy officer of a 585-bed acute care referral center in the Midwest spoke to how aligning strategy and incentives has proved particularly challenging. Although the referral center is in an urban/suburban market, the majority of its affiliated organizations are critical access hospitals in rural regions.
"Their expectations and thoughts on population health are very different from what we're facing, so aligning the incentives and the objectives is where we're really struggling," she said. "It becomes a real challenge, because our financial incentives and reimbursements are shifting, and theirs aren't. We have to figure out a way to align those."
5. Optimize data exchange. Executives also noted the challenges posed by lack of industry-wide interoperability, since different technology platforms may not be able to exchange data with one another.
When asked about availability, only 28 percent of providers said they always or often had reasonable access to EMR information from a different vendor, according to a recent KLAS report; only 6 percent of these healthcare providers reported high level of interoperability.
"The barriers to creating partnerships are immense from an information-sharing perspective," said the chief financial officer of an East Coast-based healthcare provider comprised of three hospitals. "The people in our own organization are just totally tied to the legacy system, and think everyone has to come into Epic to be our partner, rather than being more flexible with how we partner."
For Mr. Merrild, choosing healthcare software that encourages data sharing plays a pivotal role.
"From a technology perspective, we just embrace a philosophy of 'open,'" Mr. Merrild said of athenahealth. "We believe that trading with partners, and a liquid data stream going from provider A to provider B to provider C, is critical when you think about the long-term future of healthcare."