Increasingly, the healthcare industry is seeing the growth of population health-based care models, strategies and payment arrangements, some of which have been very successful.
Joseph F. Damore, vice president of population health management at Premier, and Curt Kretzinger, COO of St. Joseph, Mo.-based Mosaic Life Care, shared what's working in population health management and why at the American College of Healthcare Executives' 2015 Congress on Healthcare Leadership in Chicago March 16.
Highlighted below are three areas hospitals and health systems need to work on to create effective population health management strategies, as outlined by Mr. Damore.
1. Transforming payment models. Population health transformation models must go hand in glove with the transformation of new payment models. If organizations don't do that, they will likely help the insurance companies make a "boatload of money" according to Mr. Damore since the implemented strategies will drive down per capita costs. For organizations still on getting paid fee-for-service, doing so will land them in deep financial trouble.
2. Case management. It's critical for organizations to integrate case management into their primary care and care continuum. To begin, hospitals should measure the population's health using claims data identify the groups of individuals using up the most costs.
"The reality is, you can manage that group with a combination of physicians and laypeople who know how to care for people in nonclinical ways and make a big difference," said Mr. Damore.
3. Post-acute care. The role of discharge planners is to get people out of the hospital and shorten the length of stay as much as possible. In doing so, they don't always consider what the most cost-effective or fitting options are for patients, meaning many people end up in skilled nursing care facilities who don't need to be there.
"If you convert those discharge planners into care managers and have a program in place that better analyzes where to send patients, it dramatically lowers cost," said Mr. Damore.
Mosaic Life Care is a prime example of an organization that wholeheartedly embraced the concept of population health by changing their payment model, improving care management integration and prioritizing post-acute care.
"As much as we want to take care of your healthcare problems, that's really not what healthcare is about," said Mr. Kretzinger. "Healthcare is about your dreams, hopes and aspirations, and when they don't work well, you get sick. We believe that if we can help you improve your relationships, spirituality and creativity, you're going to get less ill."