One of the aims of health reform is improving population health. While hospitals have always been committed to the community, this new focus on population health management expands hospitals' responsibility beyond routine screenings and occasional educational sessions. Hospitals are being challenged to not only take care of patients within their four walls, but to also prevent patients from needing to come to (or come back to) the hospital — a goal which may seem counterintuitive, but will be financially incentivized as reimbursement models change. Erin O'Connor, practice leader at Cammack LaRhette Consulting, shares strategies hospitals can use to track their progress in meeting three key goals of population health management.
Population health management goals and strategies
1. Financial goals. Initially, hospitals should focus on at least mitigating cost increases if not keeping them flat or decreasing them, according to Ms. O'Connor. Hospitals can achieve this goal in the short term by focusing on appropriate utilization. For example, hospitals should encourage patients to use urgent care centers and other resources for minor injuries instead of emergency departments. Efforts for long-term financial strength should focus more on prevention and wellness, such as promoting medication adherence. "The short term is more around managing and coordinating care as efficiently as possible, and the long term is prevention of chronic conditions and keeping people healthy," Ms. O'Connor says.
2. Clinical goals. Population health clinical goals should include both process metrics and outcomes metrics, according to Ms. O'Connor. Process metrics could include the delivery of cancer screenings and regular blood pressure readings for people with hypertension. Outcomes metrics could include the percent of diabetes patients who maintain their sugar readings at an appropriate level.
Hospitals should assess the health of the community to determine what the greatest needs are. Diabetes and hypertension are two chronic conditions that may be highly prevalent, for example, and hospitals may focus efforts and set clinical goals specific to those areas. "Chronic conditions that can be well managed with appropriate low-cost therapies are areas that population health management programs should focus on," Ms. O'Connor says.
One low-cost intervention to improve clinical measures is medication reconciliation programs, according to Ms. O'Connor. Medication nonadherence is one of the major causes of readmissions, so ensuring patients understand how to take their medication properly, especially when being discharged from the hospital, can yield significant clinical and financial benefits.
3. Engagement goals. Patients' engagement in their healthcare is another overarching goal of population health management. Patient engagement is crucial for population health management, because prevention and wellness depend on patients making healthy choices when not in a hospital or other healthcare facility. The challenge is "how to create that relationship with our patients and provide them with resources and information and opportunities to do a better job managing their own health in between visits to the provider's office," Ms. O'Connor says.
Understanding the population
Ms. O'Connor suggests hospitals engage patients in their care by meeting people where they are — evaluating the current healthcare choices of the community and taking a focused approach to changing behavior. Hospitals should look at demographic information to determine if more language services are needed for healthcare resources in the community, for example. Hospitals can also leverage technology, such as telemedicine, for patients to more easily connect with healthcare providers.
This approach of assessing and addressing the community's needs demands hospitals look at the entire patient instead of the disease, according to Mr. O'Connor. "The whole idea is to put the patient at the center and organize care around the patient, not the disease."
Additionally, Ms. O'Connor says hospitals can practice population health management and patient engagement through an employee health plan. Hospitals that sponsor their own health insurance can provide incentives or reduce health insurance costs for employees who make certain healthy choices, such as going to the gym or taking a health assessment, or for employees who reach positive health outcomes like blood pressure within range, according to Ms. O'Connor.
Targeting specific goals
Population health management is a relatively abstract, amorphous term. By setting specific financial, clinical and patient engagement goals, hospitals can more easily prioritize efforts ands improve the health of the community. Targeting areas such as cost containment; process and outcome quality metrics; and patients' use of community healthcare resources can guide hospitals in developing core strategies of managing population health.
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